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Mycobacterium szulgai in a Patient with Advanced Acquired Immunodeficiency Syndrome: An Unusual Pathogen with Unusual Multidrug Resistance
Author(s) -
KangBirken S. Lena,
Prichard John G.
Publication year - 2006
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.26.11.1646
Subject(s) - ethambutol , pyrazinamide , medicine , rifampicin , tuberculosis , isoniazid , amikacin , clarithromycin , ciprofloxacin , mycobacterium tuberculosis , sputum , immunology , microbiology and biotechnology , antibiotics , biology , pathology , helicobacter pylori
A 37‐year‐old Hispanic man with advanced acquired immunodeficiency syndrome developed extensive pulmonary disease with persistent cough, fever, night sweats, worsening dyspnea, and weight loss. Sputum samples showed scant growth of acid‐fast bacilli. He failed to respond to the standard tuberculosis regimen of isoniazid, rifampin, ethambutol, and pyrazinamide. Subsequently, Mycobacterium szulgai was identified, and susceptibility tests showed it to be resistant to all four of those agents. Therapy was changed to clarithromycin, doxycycline, ciprofloxacin, and amikacin. Within 2 weeks, the patient's condition improved significantly, and 6 months after treatment, extensive pulmonary infiltrates had nearly resolved. Fewer than 1% of all human isolates of mycobacteria consist of M. szulgai , which is relatively susceptible to standard antimycobacterial agents. To our knowledge, this is the first reported case of M. szulgai with resistance to all primary antituberculosis drugs.