MAC infection in patients with AIDS or lymphoreticular malignancies is associated with a CD4+ T-lymphocyte count of fewer than 50 cells/µL. MAC infection develops in up to half of people with AIDS. Posttransplantation immunosuppressive therapy also is a risk factor for MAC infection.

Nishiuchi Y, Maekura R, Kitada S, et al. The recovery of Mycobacterium avium-intracellulare complex (MAC) from the residential bathrooms of patients with pulmonary MAC. Clin Infect Dis. 2007 Aug 1. 45(3):347-51. [QxMD MEDLINE Link].

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The clinical course of pulmonary MAC infection in patients without HIV infection usually is indolent. In one study, approximately 50% of patients were alive 5 years after diagnosis. Treatment success rate in patients without HIV infection have ranged from 20-90% in various studies, with an average of 50-60% clinical success and 60-75% of sputum conversion rates.

Mycobacterium avium Complex. Centers for Disease Control and Prevention. Available at https://www.cdc.gov/ncidod/dbmd/diseaseinfo/mycobacteriumavium_t.htm. Accessed: August 15, 2011.

M avium and M intracellulare can be differentiated by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) based on the rpoB gene. Patients with M intracellulare may have more fibrocavitary disease (26% vs 13%), more smear-positive sputum (56% vs 38%), and a less favorable microbiologic response after combination antimycobacterials. [13]

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MAC is present in soil and water. It adheres to surfaces in plumbing systems and forms biofilm, which is believed to be the most common source for human infection. [11]

Griffith DE. Treatment of Mycobacterium avium Complex (MAC). Semin Respir Crit Care Med. 2018 Jun. 39 (3):351-361. [QxMD MEDLINE Link].

Shah NM, Davidson JA, Anderson LF, Lalor MK, Kim J, Thomas HL, et al. Pulmonary Mycobacterium avium-intracellulare is the main driver of the rise in non-tuberculous mycobacteria incidence in England, Wales and Northern Ireland, 2007-2012. BMC Infect Dis. 2016 May 6. 16:195. [QxMD MEDLINE Link].

Freeman J, Morris A, Blackmore T, et al. Incidence of nontuberculous mycobacterial disease in New Zealand, 2004. N Z Med J. 2007 Jun 15. 120(1256):U2580. [QxMD MEDLINE Link].

Falkinham JO. Mycobacterium avium complex: Adherence as a way of life. AIMS Microbiol. 2018. 4 (3):428-438. [QxMD MEDLINE Link].

[Guideline] Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007 Feb 15. 175(4):367-416. [QxMD MEDLINE Link]. [Full Text].

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Lam PK, Griffith DE, Aksamit TR, Ruoss SJ, Garay SM, Daley CL. Factors related to response to intermittent treatment of Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2006 Jun 1. 173(11):1283-9. [QxMD MEDLINE Link].

In the United States, MAC infection is considered a nonreportable infectious disease. However, CDC surveillance data from Houston and Atlanta suggest an incidence of 1 case per 100,000 persons per year. [15] A 2009 study in Oregon estimated an annualized rate of 5.6 cases of MAC pulmonary infection per 100,000 population, with most cases (60%) affecting females. [16] One case series revealed cutaneous involvement in 6 of 30 cases of DMAC infection.

MAC infections are caused by M avium and M intracellulare, which are acid-fast atypical mycobacteria that belong to group III in the Runyon classification of nontuberculous mycobacteria. Additional species of MAC have been identified using genetic sequencing technology. However, their role in causing human disease has not been established except for Mycobacterium chimaera, whose role also remains controversial. [8] M avium is further divided into four subspecies based on molecular, biochemical, and growth characteristics: M avium subspecies hominissuis, M avium subspecies avium, M avium subspecies paratuberculosis,​and M avium subspecies ​silvaticum. [9, 10]  M aviumhominissuis is the only important subspecies associated with human infection, although M avium paratuberculosis has a possible association with Crohn disease.M avium paratuberculosis is a well-known cause of paratuberculosis (Johne Disease) in cattle, but its role in the etiology of Crohn disease in humans remains to be proven. [9]

[Guideline] Haworth CS, Banks J, Capstick T, Fisher AJ, Gorsuch T, Laurenson IF, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017 Nov. 72 (Suppl 2):ii1-ii64. [QxMD MEDLINE Link].

Infections with NTM began to be reported more frequently after the incidence of tuberculosis declined in the 1950s. During 1979-80, NTM represented one third of mycobacterial isolates reported to the Centers for Disease Control and Prevention (CDC), and 61% of these were MAC. MAC and Mycobacterium kansasii are two of the most predominant NTM infections in the United States .

DMAC is the most common mycobacterial infection in patients with advanced AIDS. The overall prevalence of DMAC infection increased in the 1980s and early 1990s in the United States following the advent of HIV and AIDS. The highest incidence of DMAC, 37,000 cases, was measured in 1994, at the peak in the AIDS epidemic.

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Kitada S, Kobayashi K, Ichiyama S, et al. Serodiagnosis of Mycobacterium avium-complex pulmonary disease using an enzyme immunoassay kit. Am J Respir Crit Care Med. 2008 Apr 1. 177(7):793-7. [QxMD MEDLINE Link].

Tsai HW, Fennelly K, Wheeler-Hegland K, Adams S, Condrey J, Hosford JL, et al. Cough physiology in elderly women with nontuberculous mycobacterial lung infections. J Appl Physiol (1985). 2017 May 1. 122 (5):1262-1266. [QxMD MEDLINE Link].

Janak Koirala, MD, MPH, FACP, FIDSA Professor Emeritus, Division of Infectious Diseases, Department of Internal Medicine, Southern Illinois University School of Medicine Janak Koirala, MD, MPH, FACP, FIDSA is a member of the following medical societies: American College of Physicians, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, HIV Medicine Association, Infectious Diseases Society of America, International Society for Infectious Diseases, Nepal Medical AssociationDisclosure: Nothing to disclose.

Paidmedicaltrials Manchester UK

Thomson RM, Armstrong JG, Looke DF. Gastroesophageal reflux disease, acid suppression, and Mycobacterium avium complex pulmonary disease. Chest. 2007 Apr. 131(4):1166-72. [QxMD MEDLINE Link].

Disseminated MAC (DMAC) infection usually develops in patients with AIDS and/or lymphomas whose CD4 count has fallen below 50 cells/µL. In patients with AIDS, colonization of the GI or respiratory tract has been associated with an increased risk of developing MAC bacteremia. Approximately 60% of patients with MAC colonization in one series developed bacteremia; however, screening cultures from the respiratory or GI tract are not useful because most patients who develop bacteremia are not colonized prior to developing disseminated disease.

M avium is prevalent worldwide. A surveillance study in France from 2001-2003 estimated that the incidence of NTM pulmonary infections in patients without HIV infection was over 0.7 per 100,000 inhabitants. [17] Similarly, a population-based UK study showed an increase in the incidence of pulmonary MAC infections between 2007 and 2012, from 1.3 cases to 2.2 cases per 100,000 population. Most of these cases occurred in individuals older than 60 years. [18] In 2004, a similar study in New Zealand estimated the incidence of NTM disease at 1.92 per 100,000 population. [19] In these countries, most of the infections were caused by MAC. MAC infection also has been reported from other parts of the world, including Australia, Japan, Tanzania, and Zambia, among others. In countries with a high TB prevalence, many cases of MAC are misdiagnosed and treated as TB since most of the diagnoses are made based on positive AFB sputum results and positive findings on chest radiography. In these high-burden TB areas, 3-39% of suspected cases of TB and 12-30% of patients initially believed to have chronic TB and multiple drug–resistant TB (MDR TB) were found to have NTM infection. [3]

MAC medicalanesthesia

Children are at risk of developing lymphadenitis secondary to MAC infection. Elderly women are at an increased risk for pulmonary MAC disease of the middle lobe, lingula, or both (also known as Lady Windermere syndrome).

[Guideline] Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection. Available at https://clinicalinfo.hiv.gov/en/guidelines/hiv-clinical-guidelines-adult-and-adolescent-opportunistic-infections/disseminated?view=full#_ENREF_6. Last Reviewed: July 13, 2022; Accessed: December 10, 2022.

Dhillon SS, Watanakunakorn C. Lady Windermere syndrome: middle lobe bronchiectasis and Mycobacterium avium complex infection due to voluntary cough suppression. Clin Infect Dis. 2000 Mar. 30(3):572-5. [QxMD MEDLINE Link].

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Pierce M, Crampton S, Henry D, et al. A randomized trial of clarithromycin as prophylaxis against disseminated Mycobacterium avium complex infection in patients with advanced acquired immunodeficiency syndrome. N Engl J Med. 1996 Aug 8. 335(6):384-91. [QxMD MEDLINE Link].

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For patient education information, see the Bacterial and Viral Infections Center and Procedures Center, as well as Bronchoscopy.

MAC medicalabbreviation

Risk factor for primary cutaneous MAI infection includes traumatic inoculation. Cervical lymphadenitis more commonly occurs in children.

MAC is ubiquitous in distribution. It has been isolated from fresh water and salt water worldwide. The common environmental sources of MAC include piped plumbing systems, including household and hospital water supplies, bathrooms, hot tubs, aerosolized water, house dust, soil, birds, farm animals, and cigarette components (eg, tobacco, filters, paper). [1, 2, 3]

Mycobacterium avium complex (MAC) infection in humans is caused by two main species: M avium and Mycobacterium intracellulare; because these species are difficult to differentiate, they also are collectively referred to as Mycobacterium avium-intracellulare (MAI). MAC is the atypical Mycobacterium most commonly associated with human disease.

MACClinical Research Jobs

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Hayashi M, Takayanagi N, Kanauchi T, Miyahara Y, Yanagisawa T, Sugita Y. Prognostic factors of 634 HIV-negative patients with Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2012 Mar 1. 185 (5):575-83. [QxMD MEDLINE Link].

Busatto C, Vianna JS, da Silva LV Junior, Ramis IB, da Silva PEA. Mycobacterium avium: an overview. Tuberculosis (Edinb). 2019 Jan. 114:127-134. [QxMD MEDLINE Link].

Davis KK, Kao PN, Jacobs SS, et al. Aerosolized amikacin for treatment of pulmonary Mycobacterium avium infections: an observational case series. BMC Pulm Med. 2007 Feb 23. 7:2. [QxMD MEDLINE Link].

de Silva TI, Cope A, Goepel J, et al. The use of adjuvant granulocyte-macrophage colony-stimulating factor in HIV-related disseminated atypical mycobacterial infection. J Infect. 2007 Apr. 54(4):e207-10. [QxMD MEDLINE Link].

In patients who may have pulmonary infection with MAC, diagnostic testing includes acid-fast bacillus (AFB) staining and culture of sputum specimens. If disseminated MAC (DMAC) infection is suspected, culture specimens also should include blood and urine. (See Workup.) In areas with a high prevalence of tuberculosis (TB), most cases of MAC infection are misdiagnosed and treated as TB. [3]

Perrin C. A patient with acquired immunodeficiency syndrome (AIDS) and a cutaneous Mycobacterium avium intracellulare infection mimicking histoid leprosy. Am J Dermatopathol. 2007 Aug. 29(4):422. [QxMD MEDLINE Link].

MAC infection has no racial predilection. Han and Tarrand found that, regardless of any underlying disease, M intracellulare is more pathogenic and tends to infect women increasingly beyond menopause. The prevalence of MAC infection in postmenopausal women was 1.86% in this study. [20] The female-to-male ratio of MAC pulmonary infection was found to be 3:2 in Oregon. [16]

Jeong BH, Jeon K, Park HY, Kim SY, Lee KS, Huh HJ, et al. Intermittent antibiotic therapy for nodular bronchiectatic Mycobacterium avium complex lung disease. Am J Respir Crit Care Med. 2015 Jan 1. 191 (1):96-103. [QxMD MEDLINE Link].

The most important risk factor for MAC infection in patients without HIV infection is underlying lung disease. Pulmonary disease is the most common manifestation of MAC infection in these patients. It also can cause lymphadenitis in children. MAC has surpassed Mycobacterium scrofulaceum as the most common cause of cervical adenitis in developed countries.

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MACClinical Research salary

Sood A, Sreedhar R, Kulkarni P, Nawoor AR. Hypersensitivity pneumonitis-like granulomatous lung disease with nontuberculous mycobacteria from exposure to hot water aerosols. Environ Health Perspect. 2007 Feb. 115(2):262-6. [QxMD MEDLINE Link].

Lady Windermere syndrome is believed to be associated with suppression of cough in otherwise healthy, thin, elderly women. Further studies have shown an increased threshold for urge-to-cough sensation in this group of patients. [5]

Nishiuchi Y, Iwamoto T, Maruyama F. Infection Sources of a Common Non-tuberculous Mycobacterial Pathogen, Mycobacterium avium Complex. Front Med (Lausanne). 2017. 4:27. [QxMD MEDLINE Link].

Chaisson RE, Keiser P, Pierce M, Fessel WJ, Ruskin J, Lahart C, et al. Clarithromycin and ethambutol with or without clofazimine for the treatment of bacteremic Mycobacterium avium complex disease in patients with HIV infection. AIDS. 1997 Mar. 11(3):311-7. [QxMD MEDLINE Link].

Koh WJ, Jeong BH, Jeon K, Lee NY, Lee KS, Woo SY, et al. Clinical Significance of the Differentiation between Mycobacterium avium and Mycobacterium intracellulare in M. avium Complex Lung Disease. Chest. 2012 May 24. [QxMD MEDLINE Link].

Lindeboom J. Conservative wait-and-see therapy versus antibiotic treatment for nontuberculous mycobacterial cervicofacial lymphadenitis in children. Clin Infect Dis. Jan 15 2011. 52(2):180-4.

Koirala J, Adamski A, Koch L, Stueber D, El-Azizi M, Khardori NM, et al. Interferon-gamma receptors in HIV-1 infection. AIDS Res Hum Retroviruses. 2008 Aug. 24(8):1097-102. [QxMD MEDLINE Link].

Daley CL, Iaccarino JM, Lange C, Cambau E, Wallace RJ, Andrejak C, et al. Treatment of Nontuberculous Mycobacterial Pulmonary Disease: An Official ATS/ERS/ESCMID/IDSA Clinical Practice Guideline. Clin Infect Dis. 2020 Aug 14. 71 (4):905-913. [QxMD MEDLINE Link].

Ichikawa K, van Ingen J, Koh WJ, Wagner D, Salfinger M, Inagaki T, et al. Genetic diversity of clinical Mycobacterium avium subsp. hominissuis and Mycobacterium intracellulare isolates causing pulmonary diseases recovered from different geographical regions. Infect Genet Evol. 2015 Oct 2. [QxMD MEDLINE Link].

MAC is primarily a pulmonary pathogen that affects individuals who are immune compromised (eg, from AIDS, hairy cell leukemia, immunosuppressive chemotherapy). In this clinical setting, MAC has been associated with osteomyelitis, tenosynovitis, synovitis, and disseminated disease involving lymph nodes, CNS, liver, spleen, and bone marrow. MAC is the most common cause of infection by nontuberculous mycobacteria (NTM) in patients with AIDS. M avium is the isolate in more than 95% of patients with AIDS who develop MAC infections.

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Jenkins PA, Campbell IA, Banks J, Gelder CM, Prescott RJ, Smith AP. Clarithromycin vs ciprofloxacin as adjuncts to rifampicin and ethambutol in treating opportunist mycobacterial lung diseases and an assessment of Mycobacterium vaccae immunotherapy. Thorax. 2008 Jul. 63(7):627-34. [QxMD MEDLINE Link].

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Kasperbauer SH, Daley CL. Diagnosis and treatment of infections due to Mycobacterium avium complex. Semin Respir Crit Care Med. 2008 Oct. 29(5):569-76. [QxMD MEDLINE Link].

The incidence of DMAC has declined since the adoption of highly active antiretroviral therapy (HAART). Prior to the widespread use of combination antiretroviral therapy (ART), 30% of patients infected with HIV developed DMAC infection, whereas in a 1996 study, only 2% of patients receiving HAART including a protease inhibitor developed DMAC infection. The decrease in DMAC also may reflect the use of antimicrobial prophylaxis in HIV-infected patients.

In general, MAC infection is treated with 2 or 3 antimicrobials for at least 12 months. Commonly used first-line drugs include macrolides (clarithromycin or azithromycin), ethambutol, and rifamycins (rifampin, rifabutin). Aminoglycosides, such as streptomycin and amikacin, also are used as additional agents. MAC lymphadenitis in children is treated with surgical excision of the affected lymph nodes. (See Treatment.)

Aaron E Glatt, MD, MACP, FIDSA, FSHEA Chairman, Department of Medicine, Chief, Division of Infectious Diseases, Hospital Epidemiologist, Mount Sinai South Nassau; Professor of Medicine, Icahn School of Medicine at Mount Sinai Aaron E Glatt, MD, MACP, FIDSA, FSHEA is a member of the following medical societies: American Association for Physician Leadership, American College of Chest Physicians, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, Society for Healthcare Epidemiology of AmericaDisclosure: Nothing to disclose.

Pulmonary MAC infection is associated with chronic lung diseases, such as chronic obstructive pulmonary disease (COPD), chronic bronchitis, bronchiectasis, cystic fibrosis, and lung cancer. It also is associated with thoracic skeletal abnormalities (eg, pectus excavatum, mild scoliosis, straight back), as may occur in people with mitral valve prolapse.

Hayashi M, Takayanagi N, Kanauchi T, Miyahara Y, Yanagisawa T, Sugita Y. Prognostic Factors of 634 HIV-Negative Patients with Mycobacterium avium Complex Lung Disease. Am J Respir Crit Care Med. 2012 Mar 1. 185(5):575-83. [QxMD MEDLINE Link].

MAC is ubiquitous in the environment. It is considered an opportunistic pathogen whose source in nature is water and soil. The common environmental sources of MAC include piped plumbing systems, including household and hospital water supplies, bathrooms, hot tubs, aerosolized water, house dust, soil, birds, farm animals, and cigarette components (eg, tobacco, filters, paper). [1, 2, 3]

MAC lung disease occurs rarely in immunocompetent hosts. Patients with underlying lung disease or immunosuppression may develop progressive MAC lung disease. M intracellulare is responsible for 40% of such infections in immunocompetent patients.

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Benson CA, Williams PL, Currier JS, Holland F, Mahon LF, MacGregor RR, et al. A prospective, randomized trial examining the efficacy and safety of clarithromycin in combination with ethambutol, rifabutin, or both for the treatment of disseminated Mycobacterium avium complex disease in persons with acquired immunodeficiency syndrome. Clin Infect Dis. 2003 Nov 1. 37 (9):1234-43. [QxMD MEDLINE Link].

MAI also causes cutaneous disease. These infections occur by 3 separate mechanisms, which occur in unique patient populations with different morphologic manifestations. MAI infection may involve the skin primarily via posttraumatic inoculation, secondarily as a manifestation of disseminated Mycobacterium avium-intracellulare (DMAI) systemic disease, and by direct extension as a complication of cervical lymphadenitis.

MAC also has been associated with pulmonary infection and bronchiectasis in elderly women without pre-existing lung disease. Pulmonary MAC infection in this population is believed to be due to voluntary cough suppression that results in stagnation of secretions, which creates an environment suitable for growth of the organisms. [4] This particular type of infection also is referred to as Lady Windermere syndrome (see the image below). A study comparing elderly women with NTM infection to a matching control group found no difference in cough reflex between the two groups; however, when a low intensity of cough stimulus was administered, the group with NTM infection did not sense the urge to cough. The authors concluded that these elderly women with NTM infection might have blunted airway afferent sensation and reduced central neural sensory processing. [5]

Field SK, Cowie RL. Treatment of Mycobacterium avium-intracellulare complex lung disease with a macrolide, ethambutol, and clofazimine. Chest. 2003 Oct. 124(4):1482-6. [QxMD MEDLINE Link].

Feller M, Huwiler K, Stephan R, et al. Mycobacterium avium subspecies paratuberculosis and Crohn's disease: a systematic review and meta-analysis. Lancet Infect Dis. 2007 Sep. 7(9):607-13. [QxMD MEDLINE Link].

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Provide instructions on potential adverse effects of antimicrobial medications in patients with lung disease who develop pulmonary MAC infection, as well as patients with AIDS who are receiving antimicrobial prophylaxis. Patients with AIDS and MAC infection should be instructed on how to recognize anemia, which can complicate MAC infection and may require transfusion.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical InvestigationDisclosure: Nothing to disclose.

Boyle DP, Zembower TR, Reddy S, Qi C. Comparison of Clinical Features, Virulence, and Relapse among Mycobacterium avium Complex Species. Am J Respir Crit Care Med. 2015 Jun 1. 191 (11):1310-7. [QxMD MEDLINE Link].

MAC medicaldisease

Park TY, Chong S, Jung JW, Park IW, Choi BW, Lim C, et al. Natural course of the nodular bronchiectatic form of Mycobacterium Avium complex lung disease: Long-term radiologic change without treatment. PLoS One. 2017. 12 (10):e0185774. [QxMD MEDLINE Link].

IsMACClinical Research legit

MAC also has been associated with a hypersensitivity pneumonitis-like reaction (known as hot-tub lung) in patients exposed to aerosolized MAC. [6, 2] Hot-tub lung is thought to be caused by a pulmonary response to infectious aerosols of MAC. However, the roles of other organic and inorganic cofactors present in the aerosols and host predispositions have not been established.

Deficiency of IFN-gamma and TNF-alpha production and absence or defects of IFN-gamma receptors also are associated with infections with MAC and other mycobacteria. Familial outbreaks have been reported in association with genetic defects related to IFN-gamma receptors. Patients in advanced stages of HIV infection/AIDS also show decreased production of IFN-gamma and dysregulation of IFN-gamma receptors. [12]

Gordin FM, Sullam PM, Shafran SD, et al. A randomized, placebo-controlled study of rifabutin added to a regimen of clarithromycin and ethambutol for treatment of disseminated infection with Mycobacterium avium complex. Clin Infect Dis. 1999 May. 28(5):1080-5. [QxMD MEDLINE Link].

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Maugein J, Dailloux M, Carbonnelle B, et al. Sentinel-site surveillance of Mycobacterium avium complex pulmonary disease. Eur Respir J. 2005 Dec. 26(6):1092-6. [QxMD MEDLINE Link].

Kang YA, Koh WJ. Antibiotic treatment for nontuberculous mycobacterial lung disease. Expert Rev Respir Med. 2016. 10 (5):557-68. [QxMD MEDLINE Link].

Both tumor necrosis factor (TNF)–alpha and interferon (IFN)–gamma play important roles in defending against mycobacterial infections. Like other mycobacteria, MAC can cause disseminated infection in multiple family members who have a deficiency of IFN-gamma receptor expression or IFN-gamma production due to genetic defects.

MAC lymphadenitis in children generally has a benign course. Untreated cases may resolve spontaneously, or the affected lymph node may rupture and form a sinus tract.

Other possible risk factors for MAC infections include gastroesophageal reflux disease (GERD), peptic acid suppression, and aspiration or microaspiration. [14]

Fibrocavitary pulmonary disease, BMI less than 18.5 kg/m2, and anemia are negative prognostic factors for both all-cause and MAC-specific mortality in HIV-negative patients. Therefore treatment should not be delayed in these patients with positive MAC cultures. [22]

Cassidy PM, Hedberg K, Saulson A, McNelly E, Winthrop KL. Nontuberculous mycobacterial disease prevalence and risk factors: a changing epidemiology. Clin Infect Dis. 2009 Dec 15. 49(12):e124-9. [QxMD MEDLINE Link].

Hartman TE, Jensen E, Tazelaar HD, et al. CT findings of granulomatous pneumonitis secondary to Mycobacterium avium-intracellulare inhalation: "hot tub lung". AJR Am J Roentgenol. 2007 Apr. 188(4):1050-3. [QxMD MEDLINE Link].

Klaus-Dieter Lessnau, MD, FCCP Former Clinical Associate Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory, Director of Research in Pulmonary Medicine, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital Klaus-Dieter Lessnau, MD, FCCP is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Medical Association, American Thoracic Society, Society of Critical Care MedicineDisclosure: Nothing to disclose.

CONVERT Study Group, Griffith DE, Eagle G, Thomson R, Aksamit TR, Hasegawa N, et al. Amikacin Liposome Inhalation Suspension for Treatment-Refractory Lung Disease Caused by Mycobacterium avium Complex (CONVERT): A Prospective, Open-Label, Randomized Study. Am J Respir Crit Care Med. 2018 Sep 14. [QxMD MEDLINE Link].

Some studies have reported an association between M aviumparatuberculosis and Crohn disease. A clear causation has not been established, however, and the pathophysiology remains largely unexplored. [7]

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. for: Medscape.

Prior to the availability of newer macrolides, the life expectancy of a patient with AIDS and DMAC infection was 4 months. In a 1999 study, the median survival time was 9 months in patients treated with rifabutin, ethambutol, and clarithromycin. [21] Although HIV-infected patients with DMAC infections still have high rates of morbidity and mortality because of their advanced stage of AIDS, those receiving antiretroviral therapy and anti-MAC treatment have a relatively better prognosis.

MAC medicalabbreviation surgery

Patients with more extensive disease have a 90% chance of recovery and a 20% chance of relapse after treatment with anti-MAC drugs. Untreated patients with significant lung disease may develop respiratory insufficiency or weight loss. Severe disability or death may result from respiratory failure.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author William B Harley, MD,to the development and writing of the source article.

MAC is transmitted via inhalation into the respiratory tract and ingestion into the GI tract. It then translocates across mucosal epithelium, infects the resting macrophages in the lamina propria and spreads in the submucosal tissue. MAC is then carried to the local lymph nodes by lymphatics. In immunocompromised hosts, such as those with AIDS, the bacteria subsequently spread hematogenously to the liver, spleen, bone marrow, and other sites.

Selby W, Pavli P, Crotty B, et al. Two-year combination antibiotic therapy with clarithromycin, rifabutin, and clofazimine for Crohn's disease. Gastroenterology. 2007 Jun. 132(7):2313-9. [QxMD MEDLINE Link].

Han XY, Tarrand JJ, Infante R, et al. Clinical significance and epidemiologic analyses of Mycobacterium avium and Mycobacterium intracellulare among patients without AIDS. J Clin Microbiol. 2005 Sep. 43(9):4407-12. [QxMD MEDLINE Link].