Characterization of Mycobacteria in HIV/AIDS Patients of Nepal

Abstract

Besides Mycobacterium tuberculosis, a number of other Mycobacterium species are also occasional
human pathogens. Tuberculosis due to Mycobacterium avium complex (MAC) and Mycobacterium
kansasii is particularly prevalent in AIDS patients as compared to the normal population. A crosssectional
study was carried out during January 2004 to August 2005 in 100 HIV-infected persons
visiting Tribhuvan University, Teaching Hospital, and about a dozen of HIV/AIDS care centers
of Kathmandu with the objectives to characterize the different mycobacterial species in HIV/AIDS
patients. Three sputum specimens from each person were used to investigate tuberculosis by Ziehl-
Neelsen staining, culture and identifi cation tests. Among the 100 HIV-infected cases, 66 (66%) were
males and 34 (34%) were females. Sixty percent of the cases were in the age group of 21-30 years.
Mycobacteria were detected in 23 (23%) HIV cases of which 15 (65.2%) were in the age group of 21-30
years ; 17(74%) were males and 6 (26 %) were females. Among 23 co-infected cases, 22 were culture
positive for mycobacteria. Among these, the predominant one was Mycobacterium avium complex
(MAC), 9 (41%), followed by M. tuberculosis, 6 (27%), M .kansasii, 4 (18%), M. fortuitum, 2 (10%) and
M. chelonae 1 (4%). Signifi cant relationship was established between smoking/alcoholism and the
subsequent development of tuberculosis (χ2=7.24, p<0.05 for smoking habit and χ2=4.39, p<0.05
for alcoholisn). Fourteen (61%) co-infected cases presented with weight loss and cough whereas
diarrhea was presented only by those patients with atypical mycobacterial co-infection, which was
as high as 5 (56%) in patients with MAC co-infection. This study demonstrated the predominance
of atypical mycobacteria, mainly MAC, in HIV/AIDS cases and most of them were from sputum
smear-negative cases.
Key words: Human Immunodefi ciency Virus, mycobacteria, tuberculosis