Disseminated Mycobacterium marinum in HIV unmasked by Immune Reconstitution Inflammatory Syndrome

Author:

Manion, Maura

Dulanto Chiang, Augusto

Pei, Luxin

Wong, Chun-Shu

Khil, Pavel

Hammoud, Dima A

Anderson, Megan

Laidlaw, Elizabeth

Kuriakose,Safia

Lisco, Andrea

Zelazny, Adrian M

Dekker, John P

Sereti, Irini
Author Address

National Institute of Allergy and Infectious Diseases, Bethesda, MD USA., Equal contribution., National Human Genome Research Institute, NIH, Bethesda, MD USA., Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, MD USA., Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Frederick, MD, USA., Department of Laboratory Medicine, Clinical Center, NIH, Bethesda, MD, USA.,

Abstract:

Distinguishing disseminated Mycobacterium marinum from multifocal cutaneous disease in HIV/AIDS patients can present a diagnostic challenge, especially in the context of immune reconstitution inflammatory syndrome (IRIS). In this work, we demonstrate the utility of flow cytometry and whole genome sequencing (WGS) to diagnose disseminated M. marinum unmasked by IRIS following initiation of antiretroviral therapy. Flow cytometry demonstrated robust cytokine production by CD4 T-cells in response to stimulation with M. marinum lysate. WGS of isolates from distinct lesions was consistent with clonal dissemination, supporting that preexisting disseminated M. marinum disease was uncovered by inflammatory manifestations, consistent with unmasking mycobacterial IRIS. Published by Oxford University Press for the Infectious Diseases Society of America 2020. This work is written by (a) US Government employee(s) and is in the public domain in the US.

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