[Nontuberculous mycobacterial pulmonary disease - The new ATS/ERS/ESCMID/IDSA Guideline]. / Lungenerkrankung durch nicht-tuberkulöse Mykobakterien ­ Die neue ATS/ERS/ESCMID/IDSA-Leitlinie.

The new ATS/ERS/ESCMID/IDSA guideline answers 22 PICO questions on the treatment of lung diseases caused by Mycobacterium avium complex (MAC), M. kansasii, M. xenopi and M. abscessus. NON-TUBERCULOUS MYCOBACTERIA (NTM) LUNG DISEASE: Especially in patients with microscopic detection of acid-fast bacteria in sputum or with cavernous disease manifestation, the start of treatment should not be delayed. Treatment should be based on species-specific resistance testing (according to the CLSI guidelines). In selected patients, adjuvant surgical resection after consultation with an expert is recommended. MAC LUNG DISEASE: Therapy is based on a regimen with at least three drugs including a macrolide (rather azithromycin than clarithromycin) and ethambutol. For patients with cavitation, with pronounced nodular bronchiectatic disease or with macrolide resistance, daily oral therapy should be expanded by parenteral amikacin or streptomycin. Liposomally encapsulated amikacin for inhalation is recommended in patients with treatment failure. Patients with nodular-bronchiectatic disease manifestation should receive oral macrolide-based therapy, which - depending on the extent - can be given 3 times a week. The recommended duration is 12 months after conversion of the sputum culture. M. KANSASII LUNG DISEASE: The triple combination of rifampicin, ethambutol and macrolide (or isoniazid) is recommended for at least 12 months. In patients with rifampicin resistance or intolerance, moxifloxacin is recommended as a replacement. M. XENOPI LUNG DISEASE: The combination of rifampicin, ethambutol and macrolide (and/or moxifloxacin) is recommended for at least 12 months after conversion of the sputum culture. For patients with cavernous disease manifestation, it is recommended to add at least parenteral amikacin and to consult experts. M. ABSCESSUS LUNG DISEASE: At least 3, in the beginning rather 4 drugs are recommended for therapy. The choice of substance should be based on a in vitro resistance test. Macrolides are the basis, but should not be counted in patients with strains with inducible macrolide resistance. Due to the lack of data, no explicit recommendations are made regarding the duration of therapy; a consultation of experts is recommended.

Factors which influence treatment initiation for pulmonary non-tuberculous mycobacterium infection in HIV negative patients; a multicentre observational study.

BACKGROUND: Clinical, radiological and microbiological criteria inform diagnosis of pulmonary Non-Tuberculous Mycobacteria (NTM) disease and treatment decisions. This multicentre, review aims to characterise NTM disease meeting ATS/IDSA criteria and define factors associated with initiation of treatment. METHODS: Sputum samples growing NTM from 5 London hospitals between 2010 and 2014 were identified. Data for HIV-negative individuals meeting ATS/IDSA guidelines for pulmonary NTM disease were extracted. Associations between clinical variables and treatment decision were investigated using Chi-squared, Fishers-exact or Mann Whitney tests. Factors associated with treatment in univariate analysis (p < 0.150) were included in a multivariate logistic regression model. RESULTS: NTM were identified from 817 individuals' sputum samples. 108 met ATS/IDSA criteria. 42/108 (39%) were initiated on treatment. Median age was 68 (56-78) in the cohort. On multivariate analysis, factors significantly associated with treatment of pulmonary NTM infection were: Cavitation on HRCT (OR: 6.49; 95% CI: 2.36-17.81), presenting with night sweats (OR 4.18; 95% CI: 1.08-16.13), and presenting with weight loss (OR 3.02; 95% CI: 1.15-7.93). Of those treated, 18(43%) have completed treatment, 9(21%) remain on treatment, 10(24%) stopped due to side effects, 5(12%) died during treatment. Mortality was 31% (n = 13) in treated versus 21% (n = 14) in the non-treated cohort. Subgroup analysis of individual NTM species did not observe any differences in treatment initiation or outcomes between groups. DISCUSSION: Decision to treat pulmonary NTM infection requires clinical judgement when interpreting clinical guidelines. Factors independently associated with decision to treat in this HIV-negative cohort include cavitation on HRCT and presenting with night sweats or weight loss.

Time-kill kinetics of slowly growing mycobacteria common in pulmonary disease.

OBJECTIVES: This study aimed to provide basic pharmacodynamic information for key antibiotics used to treat Mycobacterium avium and Mycobacterium xenopi pulmonary disease. METHODS: M. avium subspecies hominissuis IWGMT49 and M. xenopi ATCC 19250 type strains were used; the MICs of clarithromycin, amikacin and moxifloxacin were determined by broth microdilution. Time-kill assays were performed, exposing bacteria to 2-fold concentrations from 0.062× to 32× the MIC at 37°C for 240 h for M. avium or 42 days for M. xenopi. The sigmoid maximum effect (Emax) model was fitted to the time-kill curve data. RESULTS: Maximum killing of M. avium by amikacin was obtained between 24 and 120 h (0.0180 h(-1)) and was faster and higher than with clarithromycin (0.0109 h(-1)); however, regrowth and amikacin-resistant mutants were observed. Killing rates for M. xenopi were higher, 0.1533 h(-1) for clarithromycin and 0.1385 h(-1) for moxifloxacin, yet required 42 days. There were no significant differences between the Hill's slopes determined for all of the antibiotics tested against M. avium or M. xenopi (P = 0.9663 and P = 0.0844, respectively). CONCLUSIONS: The killing effect of amikacin and clarithromycin on M. avium subspecies hominissuis was low, although amikacin activity was higher than that of clarithromycin, supporting its role in a combined therapy. Clarithromycin and moxifloxacin may have similar activity within treatment regimens for M. xenopi disease. Future studies of in vitro and in vivo pharmacokinetic/pharmacodynamic interactions are needed to improve the current regimens to treat these two important slowly growing mycobacteria in pulmonary disease.

Improving existing tools for Mycobacterium xenopi treatment: assessment of drug combinations and characterization of mouse models of infection and chemotherapy.

BACKGROUND: Mycobacterium xenopi is a common agent of non-tuberculous mycobacterial lung diseases in Europe. However, an optimal treatment regimen for M. xenopi infection has not yet been established. Appropriate in vitro and in vivo model systems are needed for characterization of the activity of potential drugs and drug combinations against M. xenopi. METHODS: We utilized three experimental platforms to analyse the anti-M. xenopi activity of single and combination drug regimens. First, we determined the bacteriostatic and bactericidal activities of drugs alone and in combination in vitro. Second, we used serum from treated mice to evaluate drug activities ex vivo. Third, we analysed M. xenopi growth in four strains of mice (BALB/c, C57BL/6, beige and athymic nude) and developed a mouse model of chemotherapy for this infection. RESULTS: Two-drug combinations of ethambutol with rifampicin, rifapentine or moxifloxacin, and of clarithromycin with moxifloxacin were bactericidal in vitro, and the combination of ethambutol and rifampicin with either clarithromycin or moxifloxacin showed significant bactericidal activity ex vivo. Nude mice were the most susceptible strain to M. xenopi infection, and in this model amikacin-containing regimens were the most effective against M. xenopi. No difference in activity was found between regimens containing clarithromycin and moxifloxacin in vivo. CONCLUSION: The ethambutol/rifampicin combination with clarithromycin or moxifloxacin had significant bactericidal activity against M. xenopi. The nude mouse, being highly susceptible to M. xenopi, can be utilized for in vivo chemotherapy studies for this infection.

Profiling Mycobacterium xenopi with restriction fragment length polymorphism of insertion element IS1395.

OBJECTIVES: The aim of the present study was to assess the usefulness of insertion element IS1395 for differentiation of Mycobacterium xenopi, an increasingly common opportunistic human pathogen. METHODS: Fifty-two isolates obtained from 51 patients in Poland in 1996, 1997, and 1999, were analyzed by IS1395 restriction fragment length polymorphism (RFLP), and their susceptibilities to 11 anti-tuberculosis drugs were also determined. RESULTS: IS1395-associated banding patterns of the isolates were not highly polymorphic; the RFLP patterns displayed several bands in common. Nevertheless, 44 of the 52 isolates were clearly distinguishable from each other. Only eight strains (15.4%) occurred in four clusters of two identical clones, one of which comprised two isolates obtained from one patient with a 12-month interval. The remaining six patients with clustered strains showed no apparent epidemiologic links with the other patients from the same cluster, and they were most likely infected by the same environmental source. No noticeable difference in RFLP pattern or IS1395 copy number between drug-sensitive and drug-resistant strains was shown. A high proportion (84.6%) of strains resistant to at least one drug was found, and 7.7% were resistant to more than three drugs. CONCLUSIONS: The stability and utility of IS1395 for further detailed epidemiological investigations of M. xenopi was confirmed and extended.

Nontuberculous mycobacteria: susceptibility pattern and prevalence rate in Shanghai from 2005 to 2008.

BACKGROUND: An increasing incidence of disease caused by nontuberculous mycobacteria (NTM) is being reported. The purpose of this study was to determine the isolation rates of NTM from various clinical specimens, and their antimicrobial susceptibility patterns, over a 4-year period in Shanghai. METHODS: All NTM isolated between 2005 and 2008 at Shanghai Pulmonary Hospital, a key laboratory of mycobacteria tuberculosis in Shanghai, China, were identified with conventional biochemical tests and 16S rRNA gene sequencing. Antimicrobial susceptibility for all NTM was determined using the BACTEC MGIT 960 system. RESULTS: A total of 21,221 specimens were cultured, of which 4868 (22.94%) grew acid fast bacilli (AFB), and 248 (5.09%) of the AFB were NTM. The prevalence rate of NTM was determined as 4.26%, 4.70%, 4.96% and 6.38% among mycobacteria culture positive samples in years 2005, 2006, 2007 and 2008 respectively. These data indicated that the prevalence rate has continuously increased. Sixteen different species of NTM were identified, the most commonly encountered NTM in Shanghai were M. chelonae (26.7%), followed by M. fortuitum (15.4%), M. kansasii (14.2%), M. avium-intracellulare complex (13.1%) and M. terrae (6.9%). The rare species identified were M. marinum, M. gastri, M. triviale, M. ulcerans, M. smegmatis, M. phlci, M. gordonae, M. szulgai, M. simiae, M. scrofulaceum and M. xenopi. The five most commonly identified NTM species showed high drug resistance to general anti-tuberculosis drugs, particularly, M. chelonae and M. fortuitum appear to be multi-drug resistance. CONCLUSIONS: The prevalence of NTM in Shanghai showed a tendency to increase over the course of the study. The five most commonly isolated NTM species showed high drug resistance to first line anti-tuberculosis drugs.

Pulmonary Mycobacterium xenopi infection in non-HIV-infected patients: a systematic review.

SETTING: The incidence of Mycobacterium xenopi infections is increasing worldwide. The characteristics and optimal management of patients with pulmonary M. xenopi infections have not been well established. METHODS: Systematic review of English- and French-language studies reporting at least two cases of microbiologically confirmed M. xenopi lung infection. Studies were independently reviewed by two reviewers. We described the risk factors and clinical presentation of advanced infection, and examined the impact on clinical success and mortality of including individual antimycobacterial drugs in the treatment regimen. RESULTS: A total of 48 studies reporting on 1255 subjects were included. The majority were retrospective case series. There was marked heterogeneity among the studies. Patients were generally middle-aged men with a history of obstructive lung disease or prior tuberculosis, presenting with an upper lobe cavitary infection. There was no clear association between administration of particular drugs and clinical success or mortality. CONCLUSION: We could not demonstrate any advantage of specific drugs in the treatment of pulmonary M.xenopi infection. Observations from the pooled data are likely subject to significant confounding and selection biases. The inability to make firm conclusions on the optimal management of this increasingly common infection strongly underscores the need for further research.

Spondylitis due to Mycobacterium xenopi in a human immunodeficiency virus type 1-infected patient: case report and review of the literature.

Nontuberculous mycobacterial infections are well known to occur in patients with human immunodeficiency virus infection. However, spondylitis due to mycobacteria other than Mycobacterium tuberculosis is uncommon. We report a case of biopsy- and culture-proven Mycobacterium xenopi spondylitis in an AIDS patient and discuss approaches to diagnosis and therapy. This case serves to highlight the potential pathogenic role of this usually environmental commensal organism in severely immunosuppressed AIDS patients and uncertainties in their management, given the scarce data on appropriate therapy for this organism.

A decade surveillance study of Mycobacterium xenopi disease and antimicrobial susceptibility levels in a reference teaching hospital of northern Italy: HIV-associated versus non-HIV-associated infection.

OBJECTIVE AND METHOD: The aim of our survey is to investigate the epidemiology and in vitro antimicrobial susceptibility levels of 35 consecutive Mycobacterium xenopi strains responsible for confirmed disease at a University Hospital from 1993 to 2002 and to identify eventual differences in the in vitro sensitivity profile between the 17 strains isolated from patients with HIV disease and the 18 isolates cultured from non-HIV-infected individuals. RESULTS: The involvement of lower airways accounted for 88.6% of cases; but atypical pulmonary findings, including cavitation and a prominent inflammatory reaction, recently emerged in HIV-infected patients successfully treated with HAART, which raises the possible role of immune reconstitution syndrome in the clinical pathomorphism of this opportunistic disease. When compared with non-HIV-infected patients, patients with HIV disease had a lower mean age and a tendency to suffer from late relapses. The greatest overall in vitro sensitivity rate was registered for capreomycin and protionamide (100% of strains) followed by kanamicin (96.6%), whereas susceptibility rates for the first-line compounds such as ethambutol, isoniazid, and rifampicin were slightly lower (85.7% to 91.4%). No temporal variation in the susceptibility index was seen over the study decade. Non-HIV-infected patients experienced a higher frequency of M. xenopi isolates that proved to be resistant to at least one tested compound compared with HIV-associated episodes, despite the heavy and prolonged exposure of HIV-infected patients to broad spectrum antimicrobials, which included agents effective on atypical mycobacteria. Only one HIV-positive patient developed rifampicin resistance in his third disease recurrence. CONCLUSION: A rapid diagnosis, a reliable differentiation between colonization and disease, and an optimal therapeutic choice for atypical mycobacterial disease (including M. xenopi one) are still serious challenges for clinicians and bacteriologists who treat immunocompromised patients, such as those with HIV disease. In the immunocompromised host, diagnostic difficulties posed by late identification and eventually concurrent opportunistic disorders add their negative effects to therapeutic problems due to the unpredictable in vitro susceptibility profile of atypical mycobacteria, such as M. xenopi.

Pulmonary Mycobacterium xenopi infection in AIDS patients treated with HAART in Hungary.

Reported here are three cases of pulmonary Mycobacterium xenopi infection that occurred in AIDS patients in Hungary shortly after starting highly active antiretroviral therapy. In this country, Mycobacterium xenopi is the most common nontuberculous mycobacterial species causing pulmonary mycobacterial infections. Cases of pulmonary Mycobacterium xenopi disease have been described in patients infected with the human immunodeficiency virus infection and in patients with other immunodeficiencies; however, only limited information is currently available concerning the connection between nontuberculous Mycobacterium infection and AIDS in Hungary. This report thus adds useful information regarding the diagnosis, clinical course, and treatment regimens of Mycobacterium xenopi infections in AIDS patients.

Role of Mycobacterium xenopi disease in patients with HIV infection at the time of highly active antiretroviral therapy (HAART). Comparison with the pre-Haart period.

BACKGROUND AND SETTING: A reliable and timely clinical, radiological, and bacteriological diagnosis, and an optimal treatment of non-tubercular mycobacteriosis (including Mycobacterium xenopi disease), remain an unanswered challenge for clinicians facing immunocompromised patients, including those with HIV infection. OBJECTIVE: The aim of our survey is to report the frequency, and the epidemiological, immunological, microbiological, clinical, and therapeutic features of all confirmed HIV-associated M. xenopi disease observed from 1993-2002, with special attention paid to eventual differences that emerged after the introduction of potent antiretroviral therapy (highly active antiretroviral therapy, HAART), on the basis of an international literature update. DESIGN AND RESULTS: Our series of 17 consecutive confirmed M. xenopi infections retrieved in 14 out of 3000 patients followed for HIV disease complications raises a broad series of clinical, diagnostic, therapeutic, and prophylactic concerns. The great majority of M. xenopi disease involved the lower respiratory tract, but atypical features including cavitation and prominent exudative features became apparent in patients successfully treated with HAART, pointing out the possible role of the so-called immune reconstitution syndrome in these episodes. CONCLUSIONS: Diagnostic problems represented by late or missed identification due to slow culture and frequently concomitant opportunistic disorders, join therapeutic difficulties due to the unpredictable in vitro antimicrobial susceptibility profile of these organisms, selection of treatment and chemoprophylaxis according with clinical-radiological and microbiological suspicion, and concomitantly administered medications.

In vitro sensitivity of Mycobacterium xenopi to five antibiotics.

We tested 20 strains of Mycobacterium xenopi (M. xenopi) in order to evaluate their in vitro sensitivity to amikacine, clarithromycine, ethambutol, ofloxacine and rifampicin, by establishing minimal inhibitory concentration (MIC) on agar medium. MICs of amikacine, clarithromycine and ofloxacine are low, so that these antibiotics can be used in the treatment of M. xenopi infections. MICs of ethambutol are higher than seric concentrations. Though, its therapeutic use is due to its in vivo ability to enhance penetration of other antibiotics in mycobacteria. Strain sensitivity to rifampicin seems heterogeneous but the small number of tested strains does not entitle the exclusion of rifampicin from the treatment of M. xenopi infections.

Evaluation of the bactericidal efficiency of a 2% alkaline glutaraldehyde solution on Mycobacterium xenopi.

Mycobacterium xenopi (M. xenopi) has been implicated in hospital-acquired infections associated with colonization of hospital water systems. M. xenopi is considered to be as resistant as other atypical mycobacteria, which are known to be resistant to many disinfecting treatments. However, the efficacy of disinfectants on this organism has not yet been studied. Therefore we decided to evaluate its susceptibility to 2% alkaline glutaraldehyde solution, which is commonly used in hospitals. Tests were conducted using five strains of M. xenopi: three isolated from human samples, an environmental strain and a collection strain. We used a membrane filtration assay and counted surviving bacteria before and after several exposure times (5, 15, 30 and 60 min) with the disinfecting solution. The log10 reduction factor of organisms achieved within 60 min contact ranged from 2.5 to 7.5. This showed M. xenopi to be more resistant to disinfectants than M. tuberculosis or M. smegmatis and suggested that environmental strains may be more resistant to alkaline glutaraldehyde than those isolated from human samples.

[Negative effect of the components of the lysis-centrifugation system in the growth of mycobacteria in MGIT and Septi-Chek AFB liquid media]. / Efecto negativo de los componentes del sistema lisis-centrifugación en el crecimiento de micobacterias en los medios líquidos MGIT y Septi-Chek AFB.

BACKGROUND: The lysis-centrifugation system (Isolator system) is a technique with excellent results in the recovery of mycobacteria from blood specimens. This system consists mainly of saponin (SAP), polypropylenglycol (PPG), and sodium polianthol sulfonate (SPS). The objective of this work was to determine the effect of SAP, PPG, and SPS on the growth of Mycobacterium avium, M. kansasii, M. tuberculosis, and M. xenopi in fluid culture media MGIT and Septi-Chek AFB. METHODS: Two concentrations each of SAP, PPG, and SPS were prepared, and were added in 0.1 ml amounts (alone, in pairs and in combination) to fluid media MGIT and Septi-Chek AFB. Fluid culture media were then in individually inoculated with two different concentrations (10(3) and 10(5) CFU/ml) of each of the four mycobacterial strains used in this study. Culture media were incubated at 37 degrees C and were checked for growth daily. RESULTS: SAP, PPG, and SPS did not inhibit growth of mycobacteria but growth of these strains was indeed retarded (a lengthier time was required for detection of bacterial growth compared with the positive control). Final concentrations of SAP, PPG, and SPS which retarded mycobacterial growth varied, depending upon species, mycobacterial inoculum size, and fluid culture media used. CONCLUSIONS: Components included in the lysy-centrifugation system (SAP, PPG, and SPS), either alone or in combination retarded growth of M. avium, M. kansasii, M. tuberculosis, and M. xenopi in 10(3) and 10(5) CFU/ml concentrations in fluid culture media MGIT and Septi-Chek AFB. These results suggest that strategies should be adopted to decrease the concentrations of these three components, present in the sediment of the processed blood by the Isolator System, which eventually are going to be added to fluid media MGIT and Septi-Check AFB.

[Changes in the kidneys in patients with successive findings of Mycobacterium xenopi and Mycobacterium fortuitum in the urine--report of 16 cases]]. / Promene u bubrezima kod bolesnika sa visekratnim izlucivanjem urinom Mycobacterium xenopi i Mycobacterium fortuitum--prikaz 16 slucajeva.

INTRODUCTION: Environmental or MOTT (mycobacteria other than tubercle bacilli) mycobacteria are found in both living environment and most of the food we consume. These mycobacteria can induce a disease in humans, although they rarely do. There are a few reports of urogenital infections caused by these bacteria. This is a report of 16 patients with successive findings of Mycobacterium xenopi and Mycobacterium fortuitum in the urine. MATERIAL AND METHODS: In patients suspected for a specific disease of the urogenital tract 7-10 morning urine samples were sent for a bacteriological analysis before initiating any therapy. The samples were treated by 2% NaOH, neutralized by 1% HCl and cultivated on four UIT media with penicillin and acid additives. The cultivated media were incubated at 37C and followed for a potential growth for up to three months. Growth-exhibiting cultures were submitted to a further cultural and biochemical investigation, applying antituberculotic sensitivity tests and a biological probe when needed. The study included 6,468 patients. Finding of mycobacteria was registered in 180 (2.78%) patients. Of them, 164 had Mycobacterium tuberculosis while 16 patients had successive urine culture findings of MOTT bacilli: Mycobacterium xenopi--14 patients or Mycobacterium fortuitum--2 patients. RESULTS: Of 180 patients with positive bacteriologic urine finding, 164 (91.11%) had Mycobacterium tuberculosis and 16 (8.89%) had MOTT bacilli. Of the latter 16 patients, Mycobacterium xenopi was found in 14. They were all females aged 14-64 yrs. MOTT bacilli were secreted in certain time intervals, ranging from a month to nine years. The bacteria were registered successively, at the frequency rate of 6-53 times. Even 5 of 14 patients worked at the Institute for Lung Diseases as either a nurse, laboratory technician, cleaning lady or an officer at the bacteriologic material admission unit. The evidence of patho-anatomic renal changes was obtained from 11 of 14 patients, including a deformed pelvic system of the kidney, a dilated pelvis of the kidney, papillary ulceration, cystic formations, calcification, hydronephrosis and the presence of concrements. Cystic lesions were the most common ones, registered in 7/14 patients. Regarding functional disorders, haematuria, leukocytes in the sediment, proteinuria and renal colics were most frequently registered. Two patients with successive findings of Mycobacterium fortuitum were presented with neither significant patho-anatomic nor functional renal disorders. DISCUSSION: The following conclusions have emerged from the comparative analysis of the findings: the most common source of Mycobacterium tuberculosis is an infected person. The disease is transmitted by a droplet infection. Smear positive patients infect 50-63% of their family members. The renal disease induced by these bacteria is hematogenous in origin and is always associated with a former extrarenal infection. The infection is bilateral, but always manifested in one of the kidneys only. The symptoms of the infection appear in diverse combinations. The most common is a combination of dysuria and albuminuria, while 20% of patients are asymptomatic. The most effective diagnostic procedures are bacteriologic urine test for mycobacteria and intravenous pyelography. A combined antituberculotic 6-9-month treatment is usually effective. Regarding environmental mycobacteria (MOTT), their host is still obscure. The external environment contains them in abundance, but they are not transmitted from one person to another. The MOTT bacteria's habitat can be earth, water, waste waters, garbage, plant material, sphagnum of the swamp vegetation. They colonize the water-pipe systems in towns and are found in the biofilm which coats the water pipes. Water chlorination does not affect their development. They are also found in country yards, animal farms, raw milk and butter, fruit and vegetables. They are also registered in the house dust, in art

[Osteoarticular Mycobacterium xenopi infection]. / Infection ostéo-articulaire à Mycobacterium xenopi.

BACKGROUND: Mycobacterium xenopi is a potential pathogen for man and can cause bone and joint infections, particularly spondylodiscitis. Most cases of infection occur in fragilized patients and are found more and more often in AIDS patients. CASE REPORT: A 41-year-old HIV+ woman developed cervical spondylodiscitis due to Mycobacterium xenopi infection. The strain was isolated from a discovertebral biopsy and was resistant to several antibiotics. Outcome was unfavorable. DISCUSSION: Most of the cases reported to date have involved spondylodiscitis of the thoracic or lumbar spine. To our knowledge, this is the first report of cervical spondylodiscitis dut to Mycobacterium xenopi in an HIV+ patient. Antibiotic combinations using fluoroquinolones and new macrolides are usually prescribed. Such protocols may provide cure of these opportunistic infections in immunodeficient patients.