Source: Annual Congress 2001 - Immune deficiencies and the lung in childhood
Disease area: Paediatric lung diseases, Respiratory infections

Abstract

Infection with nontuberculous mycobacteria (NTM) occurs occasionally in immunocompetent adults in combination with predisposing forms of respiratory diseases and is more frequent in immunodeficient subjects. Recently IL12-or IFNg-receptor deficiency has been described as a predisposition to NTM infection.
Two previously healthy boys (4 yrs and 3 yrs) were admitted because of conversion of tuberculin skin test, fever and cough. Values were within normal limits for: immunoglobulins and IgG subclasses in serum. Multipuncture skin test, tetanus and pneumococci-specific IgGAb, granulocyte and lymphocyte function were normal. HIV-serology was negative.
Due to tuberculin conversion, abnormal chest radiographs and characteristic bronchoscopic findings, the presumptive diagnosis was tuberculosis and antituberculotic treatment was started. Two weeks later culture of sputum and bronchial secretion revealed a strain of Mycobacterium avium. We changed therapy to clarithromycin, ethambutol, rifampin and prothionamide with complete remission. Evaluation for IFNg or IL-12 (IFNGR1, IFNGR2, IL12B, IL12RB1) receptor deficiency revealed no mutations.
We conclude that NTM should always be considered for differential diagnosis of pulmonary tuberculosis. To our knowledge this is the first description of otherwise healthy children who acquired pulmonary Mycobacterium avium infection without a IFNg or IL-12 receptor deficiency.

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Citations should be made in the following way:
K. Rüter, K. Magdorf, J. L. Casanova, K. Paul, U. Wahn (Berlin, Germany; Paris, France). Pulmonary infection with Mycobacterium avium in immunocompetent children without IFN-γ (interferon-gamma) or IL-12-receptor deficiency. Eur Respir J 2001; 16: Suppl. 31, 3435

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