Mycobacterium avium-intracellulare otomastoiditis in a young AIDS patient case report and review of the literature

J Alexander Viehman,1,2 Daniel Khalil,3 Christine Barhoma,4 Ramy Magdy Hanna1 1Department of Medicine, Olive View-UCLA Medical Center, Los Angeles, 2David Geffen School of Medicine at UCLA, Los Angeles, 3Department of Biology, University of California, Riverside, 4Creighton University School of Phar...

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Autores principales:	Viehman JA, Khalil D, Barhoma C, Hanna RM
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2013
Materias:	Immunologic diseases. Allergy RC581-607
Acceso en línea:	https://doaj.org/article/d5a759012b96453f8bf815924ae312d3
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spelling	oai:doaj.org-article:d5a759012b96453f8bf815924ae312d32021-12-02T06:23:21ZMycobacterium avium-intracellulare otomastoiditis in a young AIDS patient case report and review of the literature1179-1373https://doaj.org/article/d5a759012b96453f8bf815924ae312d32013-02-01T00:00:00Zhttp://www.dovepress.com/mycobacterium-avium-intracellulare-otomastoiditis-in-a-young-aids-pati-a12282https://doaj.org/toc/1179-1373J Alexander Viehman,1,2 Daniel Khalil,3 Christine Barhoma,4 Ramy Magdy Hanna1 1Department of Medicine, Olive View-UCLA Medical Center, Los Angeles, 2David Geffen School of Medicine at UCLA, Los Angeles, 3Department of Biology, University of California, Riverside, 4Creighton University School of Pharmacy and Health Professions, CA, USA Abstract: Mycobacterium avium-intracellulare (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&#39;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&#39;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. Keywords: opportunistic infection, posterior reversible encephalopathy syndrome, acquired immune deficiency syndrome, macrolide, multidrug regimen, noncomplianceViehman JAKhalil DBarhoma CHanna RMDove Medical PressarticleImmunologic diseases. AllergyRC581-607ENHIV/AIDS: Research and Palliative Care, Vol 2013, Iss default, Pp 61-66 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Immunologic diseases. Allergy RC581-607
spellingShingle	Immunologic diseases. Allergy RC581-607 Viehman JA Khalil D Barhoma C Hanna RM Mycobacterium avium-intracellulare otomastoiditis in a young AIDS patient case report and review of the literature
description	J Alexander Viehman,1,2 Daniel Khalil,3 Christine Barhoma,4 Ramy Magdy Hanna1 1Department of Medicine, Olive View-UCLA Medical Center, Los Angeles, 2David Geffen School of Medicine at UCLA, Los Angeles, 3Department of Biology, University of California, Riverside, 4Creighton University School of Pharmacy and Health Professions, CA, USA Abstract: Mycobacterium avium-intracellulare (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&#39;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&#39;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. Keywords: opportunistic infection, posterior reversible encephalopathy syndrome, acquired immune deficiency syndrome, macrolide, multidrug regimen, noncompliance
format	article
author	Viehman JA Khalil D Barhoma C Hanna RM
author_facet	Viehman JA Khalil D Barhoma C Hanna RM
author_sort	Viehman JA
title	Mycobacterium avium-intracellulare otomastoiditis in a young AIDS patient case report and review of the literature
title_short	Mycobacterium avium-intracellulare otomastoiditis in a young AIDS patient case report and review of the literature
title_full	Mycobacterium avium-intracellulare otomastoiditis in a young AIDS patient case report and review of the literature
title_fullStr	Mycobacterium avium-intracellulare otomastoiditis in a young AIDS patient case report and review of the literature
title_full_unstemmed	Mycobacterium avium-intracellulare otomastoiditis in a young AIDS patient case report and review of the literature
title_sort	mycobacterium avium-intracellulare otomastoiditis in a young aids patient case report and review of the literature
publisher	Dove Medical Press
publishDate	2013
url	https://doaj.org/article/d5a759012b96453f8bf815924ae312d3
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Mycobacterium avium-intracellulare otomastoiditis in a young AIDS patient case report and review of the literature

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