Background:  Mycobacterium avium-intracellulare complex (MAC) is one of the commonest opportunistic infections in HIV⁺ adults in the developed world. However, there are few reports on the presentation and prevalence of MAC in children and no prevalence reports of MAC in children from African settings. Several studies claim that MAC occurs infrequently in the HIV-positive population in Africa.

Methods:  We sought to describe the prevalence, presenting features, and outcome of MAC in HIV⁺ children attending Harriet Shezi Children’s Clinic, Chris Hani Baragwanath Hospital, Soweto, Johannesburg. We retrospectively reviewed 2158 records within our database of HIV⁺ children, aged 6 weeks to 17 years, attending the clinic between January 2004 and June 2007. We defined MAC infection as:  2 culture-positive sputum specimens or 1 culture-positive blood Bactec or biopsy specimen per child from an accredited national laboratory in the presence of symptoms suggestive of MAC infection.

Results: A total of 13 children (4 girls and 9 boys) were diagnosed with MAC infection, giving an overall clinic prevalence of 0.6%. Among the cohort of children with CD4 percentage <10% and a separate cohort with total CD4 count <100, prevalence was 1.5 % and 2.6 %, respectively. The median age of our case-series was 10 years (Q1-Q3 5 to 13 years). The commonest presenting symptoms were non specific—cough in 10 of 13 (77%), LOW in 8 of 9 (89%), fatigue in 8 of 11 (73%), and fever in 7 of 13 (54%). Symptoms suggestive of gastrointestinal tract involvement were noted in 5 of 11 (45%) patients. Median expected weight for age at time of MAC diagnosis was 67%. The median total CD4 count at time of MAC presentation was 16 (range 1 to 61), and median CD4 percentage was 1% (range 0.16 to 8.16). At the time of MAC diagnosis, 10 children (77%) were on ART, raising the possibility that these infections may have occurred within the context of immune reconstitution. Clinical features and outcomes of these children are discussed.

Conclusions:  Although not common, MAC infection does occur in our population and is associated with poor clinical outcomes. A high index of suspicion for MAC infection is needed amongst HIV⁺ children with severe immune suppression because early diagnosis and treatment may reduce associated morbidity and mortality.