Histoplasmosis in HIV-Infected Persons, Yaoundé, Cameroon

LETTERS isolation, as required by microbiological criteria, was not possible because a second sputum sample was unavailable. M. sherrisii is a relatively new species (6), closely related to M. simiae. Although most of the rare M. sherrisiiTechapp1.pdf) were diagnosed in Europe or the United States, about half of the strains were isolated from patients in Africa. Because M. sherrisii infection probably is further underestimated by being misidentified as M. simiae infection by the commercially available line probe assays, the hypothesis that M. sherrisii infection is not so infrequent in the African setting seems therefore reasonable. In addition , the strategy recommended by World Health Organization and based on use of immunochromatographic tests (7), does not enable NTM identification. A leitmotiv of most M. sherrisii infections reported to date is HIV co-infection, which leads to dissemination of the mycobacterial disease. This report, although it adds to the record of patients in Africa, does not support the association with HIV infection. Our findings are consistent with the view that the pathogenic potential of M. sherrisii is comparable to that of other well-known NTM species (e.g., MAC) responsible for disease both in HIV-positive and HIV-negative patients. The retrospective determination of the MICs of antimicro-bial agents potentially active against slowly growing my-cobacteria (online Technical Appendix Table 2) confirmed, for the 4 strains of M. sherrisii, the well-known multidrug resistance of the species (8). The therapeutic failure was thus not surprising because clarithromycin was the only drug among those administered during the treatment that had been shown to be active in vitro. This report provides evidence that conducting appropriate microbiological investigations is essential before initiating a treatment with second-line TB drugs (9). Bemer P, et al. The geographic diversity of nontuberculous mycobacteria isolated from pulmonary samples: an NTM-NET collaborative study. Boncoungou K, et al. Failing a re-treatment regimen does not predict MDR/XDR tuberculosis: is " blind " treatment dangerous? DNA-probes for mycobacteria incorrectly identify a number of less frequently encountered species. Stiglich SK, et al. Characterization of a novel group of mycobacteria and proposal of Mycobacterium sherrisii sp. nov. 7. World Health Organization. Use of liquid TB culture and drug susceptibility testing (DST) in low and medium income settings. To the Editor: In HIV-infected persons in Cameroon (Central Africa), histoplasmosis is still misdiagnosed as tuberculosis because of clinical similarities (1,2). These patients are automatically given presumptive antitubercu-lous therapy, although tuberculosis is not confirmed. The patients …