**7. Infections with non-tuberculous mycobacteria in HIV patients**

Nontuberculous mycobacteria induce CNS lesions especially in AIDS patients with advanced stages of immunodepression. Sporadic cases triggered by M. avium, M. kanssasi, M. fortui‐ tum, M gordonae, M. genavense and M. terrae were reported [105,106]. As a rule CNS infec‐ tionswithnon-tuberculousmycobacteriaaretheresultofMACinfection.Nevertheless infection with MAC shows no predilection for the CNS as it frequently colonises the respiratory and gastrointestinal tract. Disseminated infections occur as a result of a severe immune dysfunc‐ tion at a CD4 count under 60 cells/mm3 [57]. Under 10 cells/ mm3 the neurological dissemina‐ tionisalsopossible [107].Howeveracase studyreportedbyFletcherdisclosedacerebralabscess with a double etiology involving M tbc and MAC in an AIDS patient with a CD+4 count of 140 cells/mm3 [108]. Higher values of the CD4+ count were also found in cases of MAC–related IRIS intheabsenceofasystemicinfection[109].MostMACneurologicmanifestations inHIVinfected patients are cerebral abscesses and meningoencephalitis. Localized mass lesions (including singleormultipleabscesses) containalargenumberofmycobacteriaintheabsenceofthe typical granulomatous structure. These findings are frequently accompanied by pleocytosis and an occasionally high protein level on CSF examination. The diagnosis should be confirmed by a histological exam (in cerebral localized forms) or by using minimum 2 hemocultures (in disseminated forms). MAC was also isolated in the CSF in disseminated forms. NeuroIRIS-MAC associated manifestations were sporadically reported in HIV patients [110].
