Nontuberculous Mycobacterial Meningitis - Clinical Infectious ...

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cm 1996;23 (December) Nontuberculous Mycobacterial Meningitis 1269 Table 1. (Continued) Downloaded from http://cid.oxfordjournals.org/ by guest on April 9, 2013 Antibiotic susceptibilities Classification CSF findings Treatment Outcome (result) ofNTMM NA NA Cured NA Probable "Increased cells and protein, low NA Died NA Definitive glucose" Cloudy; WBCs, 3,000/rnm3 Pen, SSZ Rapid improvement, NA Probable CSF normal WBCs, 83/rnm3 (100% lymphocytes); AmB, 5-FC*; INH + Rif Improved; spastic INH (R), PAS (R), Rif (R), Probable protein, 38 mg/dL; glucose, added gait after AmB Etb (R), Stm (R), Cyse 32 mg/dL therapy (S), Etbi (S) NA NA Died after 3 d NA Probable NA NA Cured NA Doubtful NA NA Died NA Probable NA NA Died NA Probable WBCs, 4711rnm3 (13% PMNs, 84% Pen, Clm, INH, Rif Developed mild NA Probable lymphocytes); protein, 234 mg/dL; hydrocephalus glucose, 41 mg/dL NA NA Died NA Doubtful WBCs, 13/rnm3 and 15/mm3; protein NA Died NA Definitive levels increased NA NA Died NA Probable Lymphocytes, 71%; protein, 41 mg/dL NA In-hospital mortality, NA Definitive :±: 18 mg/dLt ; glucose, 54 mg/dL :±: 67% 23 mg/dO WBCs, 4/rnm3; protein, 115 mg/dL; INH, Rif, Etb; Clm, Ofx, Died NA Definitive glucose, 36 mg/dL; adenosine Amik added deaminase, 1.5 UIL Normal INH, Rif, Eth Died NA Doubtful NA NA Cured NA Probable NA NA Cured NA Probable NA NA Died 3 mo later NA Probable NA NA Cured NA Probable NA NA Cured NA Probable NA NA NA NA Doubtful Xantbochromic, hypertensive INH, PAS, Stm, Prd; Miscarried; died 5 w INH (R), PAS (R) Probable Cyse added later WBCs, 1Irnm3; protein, 55 mg/dL; Oxa, Om, INH Died NA Definitive glucose, 82 mg/dL WBCs, 53/rnm3 (100% lymphocytes); INH, Stm, Etb, INHII Improved after NA Definitive protein, 500 mg/dL; glucose, 27 removal of shunt mg/dL Normal NA Cured NA Probable Cloudy; WBCs, 3,025/mm3 (77% PZA, Eth, Etbi, Km; Improved after INH (R), PAS (R), Stm Definitive PMNs); protein, 237 mg/dL; drainage of cauda drainage; residual (R), Cyse (R), Km (S), glucose, 51 mg/dL equina abscess; final motor weakness Oxa (S) tberapy with Km + Oxa
1270 Flor et al. CID 1996; 23 (December) Table 1. (Continued) Case no. [reference] Underlying Clinical findings related to NTM and other organisms isolated Age (y)/sex condition NTMM (site, no. of isolations) Autopsy findings 43 [30] 19/F None Meningitis after diskectomy M. jortuitum (CSF, 2) NA 44 [31] 101M Chronic otitis media 45 [32] 46 [33] NA 161M None (back trauma) Subdural empyema, brain M. fortuitum (CSF and NA abscess, meningitis abscess) None Fever, headache M. fortuitum (CSF, 1) NA 47 [8] NA AIDS Hemiplegia, malaise, fever, hypoadrenalism 48 [18] 131M None Meningitis, papilledema, hemiplegia 49 [34] 34/F Pregnancy 50 [35] 2/F None 51 [36] 9 molM None 52 [37] 131M Lymphoma Meningitis, lumbar abscess M. fortuitum (CSF, lumbar NA abscess) Meningitis, peritonitis; miliary on CXR Meningitis, malaise Meningitis Meningitis M. kansasii (CSF) NA M. kansasii (CSF) Granulomas and caseum in lungs, hilar nodes, meninges; M. kansasii recovered from meningeal membranes M. kansasii (CSF) NA M. kansasii (CSF, 1); M. tuberculosis (CSF, 3); AFB (CSF, 4) AFB (CSF); M. kansasii (CSF) M. kansasii (CSF) Miliary lesions in spleen, adrenal glands, and brain; creamy meninges; M. kansasii recovered from meningeal membranes; M. tuberculosis recovered from lymph nodes and CSF NA NOTE. AFB = acid-fast bacilli; AmB = amphotericin B; Amik = amikacin; Clm = clarithromycin; CMV = cytomegalovirus; Cpm = capreomycin; CXR = chest radiograph; Cyse = cycloserine; Dox = doxycycline; Ern = erythromycin; Eth = ethambutol; Ethi = ethionamide; Gm = gentamicin; 5-FC = flucytosine; INH = isoniazid; Km = kanamycin; MAC = Mycobacterium aviul11 complex; NA = not available; NTM = nontuberculous mycobacteria; NTMM = nontuberculous mycobacterial meningitis; Oxa = oxacillin; Ofx = ofloxacin; PAS = para-aminosalicylic acid; PCP = Pneumocytis carinii pneumonia; Pen = penicillin; PMN = polymorphonuclear cells; PR = present report; Prd = prednisone; PZA = pyrazinamide; R = resistant; Rif = rifampin; S = susceptible; Stm = streptomycin; SSZ = sulfizoxazole; Tm = tobramycin; TMP-SMZ = trimethoprim-sulfamethoxazole. [IS] reported an incidence of CNS involvement with MAC that ranged from 3% to 10%. It is difficult to draw conclusions concerning MAC meningitis in immunocompetent patients because only two cases have been well documented (cases 2 [18] and S [20], table 1). Both patients were children with disease diagnosed by clinicians as "typical tuberculous meningitis" that resulted in death, and the treatments were not reported. The other cases that have been reported were probable or doubtful; three resolved with no therapy or inappropriate therapy (cases 1 [17], 6 [20], and 3 [18]), and in two of these cases, concomitant infections including tuberculosis (case 9 [23]) and cryptococcosis (case 4 [19]) were present. A case of CNS Downloaded from http://cid.oxfordjournals.org/ by guest on April 9, 2013 involvement with MAC in an immunocompetent patient has been reported [41]. Meningitis due to organisms of Runyon group II has been associated with certain geographical areas such as Japan. Yamamoto et al. [17] described five probable cases (five of nine reported cases) that occurred in Japan before 1967. These authors did not report specific therapies or follow-up; however, the patients had a disseminated form ofthe disease, with miliary or fibrocaseous pulmonary infiltrates and meningitis and all but one of them recovered (mortality, 20%). Mycobacterium gordonae was recovered in the two cases classified as definitive meningitis. An underlying condition was present in both of the patients-a child with hydroceph- NA
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