Mycobacterium avium complex infection in HIV/AIDS patients

HIV/AIDS Division, Infectious Diseases FJ Muñiz Hospital, Buenos Aires, Argentina.
Expert Review of Anti-infective Therapy (Impact Factor: 3.46). 07/2008; 6(3):351-63. DOI: 10.1586/14787210.6.3.351
Source: PubMed


Disseminated Mycobacterium avium complex (MAC) infection is a severe complication of advanced HIV/AIDS disease. Disseminated infection due to MAC appeared later in the natural history of HIV disease and was an independent predictor of mortality in patients before the extended use of highly active antiretroviral therapy (HAART). The use of combination schemes, including three or four antimicrobial agents followed by secondary prophylaxis and HAARTs, improved the survival and reduced mortality rates. However, subjects who ignore their serological status for HIV, or who are not receiving or do not tolerate HAART, are at high risk of developing disseminated MAC disease. In addition, patients who show a good immunological and virological response to HAART can develop episodes of immune reconstitution inflammatory syndrome associated with MAC, including supurative lymphadenitis and subcutaneous or soft-tissue abscesses. In this article, we describe the epidemiological, clinical, immunological, therapeutic and preventive aspects of MAC infection in HIV-seropositive patients in the pre- and post-HAART era.

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Available from: Marcelo E Corti, Sep 19, 2014
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    • "Tuberculosis (TB) remains a major public health challenge globally , estimations indicating that roughly one third of the world's population has been infected with M. tuberculosis, with 1.5 million associated deaths occurring annually [61]. The genus Mycobacterium includes highly pathogenic species such as the etiological agent of TB, M. tuberculosis, and Mycobacterium leprae (responsible for leprosy), but also opportunistic pathogens such as Mycobacterium avium, which can affect immunocompromised individuals [62]. Similarly to other pathogenic bacteria, Mycobacterium species can modulate expression of miR-155 upon infection [63] [64] [65] [66] [67]. "
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    ABSTRACT: MicroRNAs are small non-coding RNAs with a central role in the post-transcriptional control of gene expression, that have been implicated in a wide-range of biological processes. Regulation of miRNA expression is increasingly recognized as a crucial part of the host response to infection by bacterial pathogens, as well as a novel molecular strategy exploited by bacteria to manipulate host cell pathways. Here, we review the current knowledge of bacterial pathogens that modulate host microRNA expression, focusing on mammalian host cells, and the implications of microRNAs (miRNA) regulation on the outcome of infection. The emerging role of commensal bacteria, as part of the gut microbiota, on host miRNA expression in the presence or absence of bacterial pathogens is also discussed.
    FEBS Letters 08/2014; 588(22). DOI:10.1016/j.febslet.2014.08.002 · 3.17 Impact Factor
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    • "This advancement has now attracted the interest of researcher to dissect the role of miRNAs in most deadly infectious human diseases like Tuberculosis. The genus Mycobacterium includes highly pathogenic species Mycobacterium tuberculosis (causing tuberculosis) and Mycobacterium leprae (causing leprosy) but also opportunists such as M. avium, which can also cause disseminated infections in immuno-compromised persons such as AIDS patients [11]. Despite advances in modern medicine and diagnostics, TB remains a major challenge to global public health in the 21st century. "
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    ABSTRACT: MicroRNAs (miRNAs) are evolutionarily conserved, naturally abundant, small, regulatory non-coding RNAs that inhibit gene expression at the post-transcriptional level in a sequence-specific manner. Due to involvement in a broad range of biological processes and diseases, miRNAs are now commanding considerable attention. Although much of the focus has been on the role of miRNAs in different types of cancer, recent evidence also points to a critical role of miRNAs in infectious disease, including those of bacterial origin. Now, miRNAs research is exploring rapidly as a new thrust area of biomedical research with relevance to deadly bacterial diseases like Tuberculosis (caused by Mycobacterium tuberculosis). The purpose of this review is to highlight the current developments in area of miRNAs regulation in Mycobacterial diseases; and how this might influence the diagnosis, understanding of disease biology, control and management in the future.
    Journal of Biomedical Science 02/2013; 20(1):14. DOI:10.1186/1423-0127-20-14 · 2.76 Impact Factor
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    • "The organism is generally ubiquitous in soil and in the environment, but it is readily cleared in most human hosts.1 Generally, prophylaxis consists of a once-weekly macrolide in patients with a CD4 cell count less than 75.2,3 Like Mycobacterium tuberculosis infection, MAI infection often necessitates the use of a multidrug regimen, especially in heavily resistant cases.4 "
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    ABSTRACT: (MAI) complex is a common opportunistic infection that generally occurs in patients with a CD4 cell count less than 75. Current recommendations for prophylaxis include using a macrolide once a week, while treatment usually requires a multidrug regimen. Disseminated MAI infections often occur in patients who are not compliant with prophylaxis or their highly active antiretroviral therapy (HAART). Many manifestations of MAI infection are well documented in human immunodeficiency virus (HIV) patients, including pulmonary and cutaneous manifestations, but other unusual manifestations such as pericarditis, pleurisy, peritonitis, brain abscess, otitis media, and mastoiditis are sporadically reported in the infectious diseases literature. This case report is of a 22-year-old female who contracted HIV at a young age and who was subsequently noncompliant with HAART, MAI prophylaxis, and prior treatment for disseminated MAI infection. Unsurprisingly, the patient developed recurrent disseminated MAI infection. The patient's presentation was atypical, as she developed severe otomastoiditis and posterior reversible encephalopathy syndrome. The posterior reversible encephalopathy syndrome was thought to be due to the disseminated MAI infection or to immune reconstitution inflammatory syndrome. The infection was confirmed to be secondary to MAI by culture of the mastoid bone. Microbiological analysis of the MAI strain cultured showed resistance to several first-line antibiotics used for prophylaxis against and treatment of MAI. This was likely due to the patient's chronic noncompliance. Otomastoiditis secondary to MAI is extremely rare in adults and has been reported in only four case reports and one case series previously. Improved clinician education in the diagnosis, treatment, and, most important, prevention of MAI and other opportunistic infections is needed. Greater HIV screening, appropriate HAART medication administration, and availability of infectious disease specialists is needed in at-risk populations to help prevent such serious infections. Patient education and greater access to care should serve to prevent medication nonadherence and to enhance affordability of HAART and prophylactic antibiotics.
    HIV/AIDS - Research and Palliative Care 02/2013; 5:61-6. DOI:10.2147/HIV.S36545
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