by Konrad T Juszkiewicz, MD, MPH Donald Burgess,

by Konrad T Juszkiewicz, MD, MPH Donald Burgess, Ph. D DRK Biomedical Research and Development LLC Almaty, November,

Localizedtypemaybe asymptomatic Lowgraderemittentfever, nightsweats, malaise, anorexia, weightloss Sputumatfirstmucoidandlaterpurulent Haemoptysisinhalfofthepatients Pleureticpain

History, physicalexamination, radiological findings “consolidation & cavitation” Identificationoftheacid-fastbacilliinsmears andcultureofsputum“ 10 weeks” PCRamplificationof. M. tuberculosis. DN

Dependson: Theextentofthediseaseandthepatientimmune status Secondaryamyloidosismayoccurinpersistentcases

1. 1. Pulmonary fibrosis Thelunglesionsmayhealwithfibrosis atanystage , particularlywith treatment This ranges fromminorapicalscarringtoextensiveandseverewidespread fibrosisproducinglocalizedtowidespreadhoney-combappearanceofthe lungtissue. Itisparticularlyseeninrelapsingandprogressiveuntreated disease Thisiscomplicatedby respiratoryfailure&corpulmonale 2. 2. Pleural fibrosis Fibrosiscommonlyobliteratethepleuralspace 3. 3. Bronchiectasis Damagetothebronchialwallsandscarringcancausedistalpulmonary collapse, secondaryinfectionandbronchiectasis

Mycobacterialinfectionofalltypesareincreasedin immunocompromisedindividualsandisinmostcases dueto reactivation of latent infection Featuresaresimilartoinfectioninimmunocompetent individualsbutdiseaseusually progresses more rapidly dueto decreasedhostresponse

Theseinfectionsarecausedbyagroupof non-tuberculous mycobacteriaofwhichthemostimportanttypesare M. avium- intracellulare and M. kanasii Theorganismsarewidelydistributedin soil, water & domestic animals Infectionis acquired directly from the environment andnot bycasetocasecontact Infectionbytheseorganismsisseenin immunocompromised patientsparticularly. AIDS Itcanbeseenalsoinimmunocompetentindividualswith chronicpulmonarydisease

Thelymphnodesinthismesentery, bestseenattheleft, are enlargedandhavecutsurfacesthatappearyellow-tan. Thesenodes arefilledwithsheetsof. Mycobacteriumavium-complex(MAC) organisms, andtheimmuneresponseissopoorinthis. AIDSpatient thatthereis no focal granuloma formation

Microscopically, Mycobacteriumavium-intracellulareinfectionis markedby numerous acid fast organisms growing within macrophages. Lotsofbrightredrodsareseen, particularlyin macrophages, inthisacidfaststainoflymphnode

Deburgess@drkbiomed. org Kjuszkiewicz@drkbiomed. org Cell. : +