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Mycobacterium kansasii in Bilbao and Bizkaia

Abstract number: 903_r2295

Leal M.V.

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Background:

The aim of this study is to know clinical significance of isolates and the epidemiology of the infection.

Patients and methods:

We reviewed 334 clinical records of patients with M. kansasii isolated from 1994 to 2002 in Bilbao area and from 2000 to 2002 in Bizkaia county. First, we used ATS diagnostics criteria for nontuberculous mycobacterial disease to the cases and then were further classified into according to modified criteria into probable, possible, probable-definitive, and colonisation. PCR-RFLP and AFLP analysis were also applied to clinical isolates.

Results:

A total of 199 patients met ATS criteria (59.6%), probable disease 21 (6.3%), probable-definitive 37 (11.1%), possible 19 (5.7%) and colonisation 58 (17.4%). We considered ATS and probable disease as M. kansasii disease: 220 patients. These were 184 (83.6%) HIV- and 36 (16.4%) HIV+ with male predominance (5/1). 126 patients lived in Bilbao where the peripheral districts showed higher incidence 6.94‰. In Bizkaia county there were an incidence of 5.07‰ in the period studied. The predisposing factors were 25.9% COPD, 11.4% hepathopaty, 8.6% gastrectomy and 6.8% neoplasia. There was a higher frequency of COPD in HIV – (P < 0.05) and greater proportion of hepathopathy between HIV+. The respiratory symptoms were 70.9% cough, 24.1% dyspnoea, 18.2% haemoptysis and 20.5% chest pain. Fever, anorexia, weight reduction, cough and expectoration were more frequent in HIV+ patients (P < 0.05). X-rays showed infiltrates (106) or cavity lesions (106) and both (28). The predominant presentation was unilateral and in the right upper lobe. HIV- and + did not differ significantly in X rays. Cavity lesions were associated with haemoptysis (P < 0.05). Isoniazid, rifampicin and ethambutol was initiated or previous theraphy was changed when M. kansasii was recovered in 201 patients (34 HIV+ and 167 HIV-). Subtype I was the only subtype isolated and seven clones were obtained, one of them with 42 strains of HIV- and other one with 10 of HIV+. Conclusions: ATS criteria, with their requirement for multiple positive specimens may be excessively strict for clinical purposes. Only subtype I was found although is heterogeneous.

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Session Details

Date: 01/08/2007
Time: 00:00-00:00
Session name: XXIst ISTH Congress
Subject:
Location: Oxford, UK
Presentation type:
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