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Volume 10, Number 5—May 2004


Mycobacterium africanum Cases, California

Edward Desmond*Comments to Author , Ameena T. Ahmed*, William S. Probert*, Janet Ely*, Yvonne Jang*, Cynthia A. Sanders*, Shou-Yean Lin*, and Jennifer Flood*
Author affiliations: *California Department of Health Services, Berkeley, California

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Table 1

Clinical characteristics of patients with Mycobacterium africanum disease

Patient Demographic characteristics Signs and symptoms Clinical characteristics Treatmenta Outcome
25-y-old black South African man with recent travel to West Africa
3 months’ productive cough, weight loss, and low-grade fever
Large left upper lobe infiltrate on chest radiograph
INH, rifampin, PZA, and ethambutol by directly observed therapy for 6 months
Resolution of symptoms and improvement of chest radiograph
34-y-old black West African woman recently arrived in U.S. with metastatic carcinoma, treated with chemotherapy one year prior to presentation.
2 months’ cough, fever, night sweats, fatigue
Right lower lobe cavitation, streaky infiltrates bilaterally on chest radiograph, normocytic anemia
INH, rifampin, PZA, and ethambutol by DOT
Sputum culture negative after 2 weeks of therapy. Only modest improvement in chest radiograph. Returned to West Africa after 4 months DOT
26-y-old black South African, immigrated to U.S. 2 y before diagnosis
Cavitary lesion on chest radiograph
INH, rifampin, PZA, and ethambutol by DOT for 6 months
Sputum culture and smear negative, chest radiograph improved
26-y-old Vietnamese man, immigrated to U.S. 6 y before diagnosis. No history of travel to Africa or African contacts with tuberculosis
2 weeks’ productive cough, positive PPD
Capreomycin, ofloxacin, PAS, clofazamine, and cycloserine for 2 y by DOT
Sputum smear and culture converted to negative, symptoms resolved. Free of disease 2 y after therapy completed
E 27-y-old U.S.-born black man with no known risk factors for tuberculosis infection. No history of travel to Africa or African contacts with tuberculosis 2 months’ anorexia and weight loss; 1 month of cough and night sweats; 1 week of fever and abdominal pain Normal chest radiograph results. Pancreatic cyst and fullness of left psoas muscle on CT scan INH, rifampin, PZA, and ethambutol for 10 months by DOT Symptoms resolved. Free of disease 1 y after therapy completed

aINH, izoniazid; PZA, pyrazinamide; DOT, directly observed therapy; CT, computerized tomography, PPD, purified protein derivative; PAS, para-aminosalicylic acid.

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