Mycobacterium colombiense Pneumonia in HIV-Infected Patients: Three Case Reports and a Literature Review

Abstract

Background

Mycobacterium colombiense pneumonia in HIV-infected patients is relatively unusual but is associated with a high mortality rate, as well as high rates of misdiagnosis and delayed diagnosis. Clinical metagenome next-generation sequencing (mNGS) may have potential for its accurate and timely diagnosis.

Case Presentation

We retrospectively reviewed the medical records of three HIV-infected patients who presented with M. colombiense pneumonia in Zhejiang Province between January 2019 and December 2020. No specific clinical presentations or radiological manifestations were found in any of the patients. The detection of M. colombiense is 28–55 days earlier using mNGS on bronchoalveolar lavage fluid (BALF) compared to traditional culture methods. A combined treatment of rifabutin, clarithromycin, or azithromycin, and ethambutol did not provide timely relief of symptoms in these three patients. In the early stage of treatment, moxifloxacin and linezolid were used for several weeks. The average course of treatment for all three patients was close to 17 months.

Conclusion

We recommend early BALF mNGS for fast and accurate diagnosis of M. colombiense pneumonia in HIV-infected patients with low CD4 counts and long duration of symptoms. Further, moxifloxacin and linezolid may be beneficial in the early stage of treatment.

Keywords:

• metagenomic next-generation sequencing
• nontuberculous mycobacteria
• Mycobacterium colombiense
• pneumonitis
• HIV
• AIDS

Abbreviations

mNGS, metagenomic next-generation sequencing; NTM, Nontuberculous mycobacteria; M. colombiense, Mycobacterium colombiense; MAC, M. avium complex; BALF, bronchoalveolar lavage fluid; PBC, protected brush catheter; PCR, polymerase chain reaction; CT, computed tomography; ART, antiretroviral therapy; DTG, Dolutegravir; TDF, Tenofovir; 3TC, Lamivudine; EFV, efavirenz; FTC/TDF, emtricitabine/tenofovir; Mfx, moxifloxacin; AZI, azithromycin; Amk, Amikacin; Rfb, rifabutin; EMB, ethambutol; Clr, clarithromycin; LNZ, linezolid.

Data Sharing Statement

Patient data that were used in this study are provided in the tables.

Ethics Approval

The treatment of three patients was conducted in accordance with the Declaration of Helsinki. This report received the approval of the Ethics Committee of the First Affiliated Hospital of Zhejiang University School of Medicine (IIT20230802A).

Consent for Publication

Written informed consent has been obtained from three patients for the case details and images to be published. The case report does not contain any pictures that could identify the patient.

Acknowledgments

We especially acknowledge all frontline healthcare workers engaged in direct diagnosis, treatment, and care of patients.

Disclosure

None of the authors have any conflicts of interest to declare.

Additional information

Funding

This work was supported by the National Major Scientific and Technological Special Project for “Significant New Drugs Development” during the Thirteenth Five-Year Plan Period (grant number 2017ZX09303004-001). The funding organization had no involvement in the study or in the decision to submit the article for publication.