Mycobacterium avium complex - Revision history

Aidan at 19:23, 1 December 2023

2023-12-01T19:23:23Z

@@ Line 25: / Line 25: @@
 == Clinical Manifestations ==
-=== Pulmonary disease ===
+=== Pulmonary Disease ===
 * Incubation period [[Usual incubation period::months to years]]
 * Typically presents with non-specific subacute to chronic respiratory syndrome
@@ Line 37: / Line 37: @@
 ** Hot tub lung disease: a hypersensitivity pneumonitis associated with inhalation
-=== Disseminated disease ===
+=== Disseminated Disease ===
 * Almost exclusive to HIV patients with CD4 &lt;100
 ** Median CD4 was 13
@@ Line 46: / Line 46: @@
 * Mortality 50% at 4 months
-=== Cervical lymphadenitis ===
+=== Cervical Lymphadenitis ===
 * Disease of children, usually &lt;3 (80% aged 1 to 5 years)
 * Presents as painless unilateral lymph node enlargement
@@ Line 58: / Line 58: @@
 == Diagnosis ==
-=== Pulmonary disease ===
+=== Pulmonary Disease ===
 * Diagnosis based on presence of both clinical and microbiological evidence
 * Clinical:
@@ Line 68: / Line 68: @@
 ** Transbronchial or other lung biopsy with mycobacterial histopathologic features, and either positive culture for NTM or one or more sputum or BALs positive for NTM
-=== Disseminated disease ===
+=== Disseminated Disease ===
 * Diagnosis based on MAC in culture of sterile site
 == Management ==
-=== Pulmonary disease ===
+=== Pulmonary Disease ===
 * Nodular/bronchiectatic disease:
 ** [[Clarithromycin]] (1,000 mg) or [[azithromycin]] (500 mg)
@@ Line 86: / Line 86: @@
 * Refer to Ophthalmology for monitoring while on [[ethambutol]]
-=== Disseminated disease ===
+=== Disseminated Disease ===
 * Antibiotics
 ** [[Clarithromycin]] (1,000 mg/d) or [[azithromycin]] (250 mg/d)
@@ Line 92: / Line 92: @@
 ** ± [[rifabutin]] (150–350 mg/d)
 * Duration is until resolution of symptoms and reconstitution of cell-mediated immune function (e.g. CD4 &gt;100)
 === Prophylaxis ===
@@ Line 98: / Line 165: @@
 * Second-line: [[rifabutin]] 300 mg/day (less well tolerated)
 [[Category:Non-tuberculous mycobacteria]]

Aidan at 20:30, 13 July 2022

2022-07-13T20:30:45Z

← Older revision		Revision as of 20:30, 13 July 2022
Line 16:		Line 16:
	** Natural water, indoor water, pools, hot tubs		** Natural water, indoor water, pools, hot tubs
	* Risk factors		* Risk factors
	** Pulmonary disease: COPD, ~~preior~~ pneumonia, prior TB, steroid use, silicosis, scoliosis, pectus excavatum		** Pulmonary disease: [[COPD]], prior [[pneumonia]], prior [[TB]], [[Corticosteroids\|steroid]] use, [[silicosis]], [[scoliosis]], [[pectus excavatum]]
	** Disseminated disease: HIV, interferon-gamma defects		** Disseminated disease: [[HIV]], interferon-gamma defects
	** Cervical lymphadenitis: children 1-5 years old, HIV with IRIS		** [[Cervical lymphadenitis]]: children 1-5 years old, [[HIV]] with [[IRIS]]

	=== Pathophysiology ===		=== Pathophysiology ===
	* In pulmonary disease, likely inhalation ± microaspiration		* In pulmonary disease, likely inhalation ± microaspiration
	* In disseminated disease in AIDS, likely GI colonization then replication and dissemination		* In disseminated disease in [[AIDS]], likely GI colonization then replication and dissemination

	== Clinical Manifestations ==		== Clinical Manifestations ==

Aidan at 20:29, 13 July 2022

2022-07-13T20:29:25Z

← Older revision		Revision as of 20:29, 13 July 2022
Line 74:		Line 74:
	=== Pulmonary disease ===		=== Pulmonary disease ===
	* Nodular/bronchiectatic disease:		* Nodular/bronchiectatic disease:
	** Clarithromycin (1,000 mg) or azithromycin (500 mg)		** [[Clarithromycin]] (1,000 mg) or [[azithromycin]] (500 mg)
	** Rifampin (600 mg)		** [[Rifampin]] (600 mg)
	** Ethambutol (25 mg/kg)		** [[Ethambutol]] (25 mg/kg)
	** Three times weekly (because daily never tolerated)		** Three times weekly (because daily never tolerated)
	* If fibrocavitary MAC lung disease or severe nodular/bronchiectatic disease:		* If fibrocavitary MAC lung disease or severe nodular/bronchiectatic disease:
	** Clarithromycin (500–1,000 mg) or azithromycin (250 mg) daily		** [[Clarithromycin]] (500–1,000 mg) or [[azithromycin]] (250 mg) daily
	** Rifampin (600 mg) or rifabutin (150–300 mg) daily		** [[Rifampin]] (600 mg) or [[rifabutin]] (150–300 mg) daily
	** Ethambutol (15 mg/kg) daily		** [[Ethambutol]] (15 mg/kg) daily
	** And consider adding three-times-weekly amikacin or streptomycin early in therapy		** And consider adding three-times-weekly [[amikacin]] or [[streptomycin]] early in therapy
	* Duration is until culture negative on therapy for at least 1 year		* Duration is until culture negative on therapy for at least 1 year
	* Refer to Ophthalmology for monitoring while on ethambutol		* Refer to Ophthalmology for monitoring while on [[ethambutol]]

	=== Disseminated disease ===		=== Disseminated disease ===
	* Antibiotics		* Antibiotics
	** Clarithromycin (1,000 mg/d) or azithromycin (250 mg/d)		** [[Clarithromycin]] (1,000 mg/d) or [[azithromycin]] (250 mg/d)
	** Ethambutol (15 mg/kg/d)		** [[Ethambutol]] (15 mg/kg/d)
	** ± rifabutin (150–350 mg/d)		** ± [[rifabutin]] (150–350 mg/d)
	* Duration is until resolution of symptoms and reconstitution of cell-mediated immune function (e.g. CD4 >100)		* Duration is until resolution of symptoms and reconstitution of cell-mediated immune function (e.g. CD4 >100)

	=== Prophylaxis ===		=== Prophylaxis ===
	* Indicated for adults with (AIDS) with CD4 <50; but not done and no longer in the HIV guidelines		* Indicated for adults with (AIDS) with CD4 <50; but not done and no longer in the HIV guidelines
	* Antibiotics: azithromycin 1,200 mg/week or clarithromycin 1,000 mg/day		* Antibiotics: [[azithromycin]] 1,200 mg/week or [[clarithromycin]] 1,000 mg/day
	* Second-line: rifabutin 300 mg/day (less well tolerated)		* Second-line: [[rifabutin]] 300 mg/day (less well tolerated)

	{{DISPLAYTITLE:''Mycobacterium avium'' complex}}		{{DISPLAYTITLE:''Mycobacterium avium'' complex}}

Aidan at 19:54, 20 August 2020

2020-08-20T19:54:52Z

← Older revision		Revision as of 19:54, 20 August 2020
Line 99:		Line 99:

	{{DISPLAYTITLE:''Mycobacterium avium'' complex}}		{{DISPLAYTITLE:''Mycobacterium avium'' complex}}
	[[Category:~~Mycobacteria~~]]		[[Category:Non-tuberculous mycobacteria]]

Aidan: /* Pulmonary disease */

2020-08-05T13:59:04Z

Pulmonary disease

← Older revision		Revision as of 13:59, 5 August 2020
Line 26:		Line 26:
	== Clinical Manifestations ==		== Clinical Manifestations ==
	=== Pulmonary disease ===		=== Pulmonary disease ===
	* Incubation months to years		* Incubation period [[Usual incubation period::months to years]]
	* Typically presents with non-specific subacute to chronic respiratory syndrome		* Typically presents with non-specific subacute to chronic respiratory syndrome
	** Productive cough, weight loss, fevers, night sweats		** Productive cough, weight loss, fevers, night sweats

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-19T10:36:11Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 10:36, 19 July 2020
Line 24:		Line 24:
	* In disseminated disease in AIDS, likely GI colonization then replication and dissemination		* In disseminated disease in AIDS, likely GI colonization then replication and dissemination

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==
	=== Pulmonary disease ===		=== Pulmonary disease ===
	* Incubation months to years		* Incubation months to years

Aidan: rearranged headings and fixed a link

2019-11-06T18:07:20Z

rearranged headings and fixed a link

← Older revision		Revision as of 18:07, 6 November 2019
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	== ~~Microbiology~~ ==		== Background ==
			=== Microbiology ===

	* A slow-growing [[~~Non-tuberculous mycobacteria (NTM)\|~~non-tuberculous mycobacterium]]		* A slow-growing [[non-tuberculous mycobacterium]]
	* Comprises ''M. avium'' (subspecies ''hominissuis'' in humans) and ''M. intracellulaire''		* Comprises ''M. avium'' (subspecies ''hominissuis'' in humans) and ''M. intracellulaire''
	** 28 serovars between the two		** 28 serovars between the two
	* Can colonize airways and GI tract as well as causing disease		* Can colonize airways and GI tract as well as causing disease

	== Differential Diagnosis ==		=== Differential Diagnosis ===

	* Pulmonary disease		* Pulmonary disease
	** ''M. kansasii''		** ''M. kansasii''
	** ''M. abscessus''		** ''M. abscessus''

	== Epidemiology ==		=== Epidemiology ===

	* Common in the environment, likely acquired by inhalation or ingestion (not person-to-person)		* Common in the environment, likely acquired by inhalation or ingestion (not person-to-person)
	** Water, soil, and animals		** Water, soil, and animals
Line 22:		Line 20:
	** Cervical lymphadenitis: children 1-5 years old, HIV with IRIS		** Cervical lymphadenitis: children 1-5 years old, HIV with IRIS

	== Pathophysiology ==		=== Pathophysiology ===

	* In pulmonary disease, likely inhalation ± microaspiration		* In pulmonary disease, likely inhalation ± microaspiration
	* In disseminated disease in AIDS, likely GI colonization then replication and dissemination		* In disseminated disease in AIDS, likely GI colonization then replication and dissemination

	== Clinical Presentation ==		== Clinical Presentation ==

	=== Pulmonary disease ===		=== Pulmonary disease ===

	* Incubation months to years		* Incubation months to years
	* Typically presents with non-specific subacute to chronic respiratory syndrome		* Typically presents with non-specific subacute to chronic respiratory syndrome
Line 43:		Line 38:

	=== Disseminated disease ===		=== Disseminated disease ===

	* Almost exclusive to HIV patients with CD4 <100		* Almost exclusive to HIV patients with CD4 <100
	** Median CD4 was 13		** Median CD4 was 13
Line 53:		Line 47:

	=== Cervical lymphadenitis ===		=== Cervical lymphadenitis ===

	* Disease of children, usually <3 (80% aged 1 to 5 years)		* Disease of children, usually <3 (80% aged 1 to 5 years)
	* Presents as painless unilateral lymph node enlargement		* Presents as painless unilateral lymph node enlargement
Line 59:		Line 52:

	== Investigations ==		== Investigations ==

	=== Pulmonary disease ===		=== Pulmonary disease ===

	* (1) chest radiograph or, in the absence of cavitation, chest high-resolution computed tomography (HRCT) scan		* (1) chest radiograph or, in the absence of cavitation, chest high-resolution computed tomography (HRCT) scan
	* (2) three or more sputum specimens for acid-fast bacilli (AFB) analysis		* (2) three or more sputum specimens for acid-fast bacilli (AFB) analysis
Line 67:		Line 58:

	== Diagnosis ==		== Diagnosis ==

	=== Pulmonary disease ===		=== Pulmonary disease ===

	* Diagnosis based on presence of both clinical and microbiological evidence		* Diagnosis based on presence of both clinical and microbiological evidence
	* Clinical:		* Clinical:
Line 80:		Line 69:

	=== Disseminated disease ===		=== Disseminated disease ===

	* Diagnosis based on MAC in culture of sterile site		* Diagnosis based on MAC in culture of sterile site

	== Management ==		== Management ==

	=== Pulmonary disease ===		=== Pulmonary disease ===

	* Nodular/bronchiectatic disease:		* Nodular/bronchiectatic disease:
	** Clarithromycin (1,000 mg) or azithromycin (500 mg)		** Clarithromycin (1,000 mg) or azithromycin (500 mg)
Line 101:		Line 87:

	=== Disseminated disease ===		=== Disseminated disease ===

	* Antibiotics		* Antibiotics
	** Clarithromycin (1,000 mg/d) or azithromycin (250 mg/d)		** Clarithromycin (1,000 mg/d) or azithromycin (250 mg/d)
Line 109:		Line 94:

	=== Prophylaxis ===		=== Prophylaxis ===
		⚫	* Indicated for adults with (AIDS) with CD4 <50; but not done and no longer in the HIV guidelines

⚫	* Indicated for adults with (AIDS) with ~~CD4􏰀~~ <50; but not done and no longer in the HIV guidelines
	* Antibiotics: azithromycin 1,200 mg/week or clarithromycin 1,000 mg/day		* Antibiotics: azithromycin 1,200 mg/week or clarithromycin 1,000 mg/day
	* Second-line: rifabutin 300 mg/day (less well tolerated)		* Second-line: rifabutin 300 mg/day (less well tolerated)

Aidan at 09:51, 16 August 2019

2019-08-16T09:51:30Z

← Older revision		Revision as of 09:51, 16 August 2019
Line 1:		Line 1:
	= Microbiology =		== Microbiology ==

	* A slow-growing [[Non-tuberculous mycobacteria (NTM)\|non-tuberculous mycobacterium]]		* A slow-growing [[Non-tuberculous mycobacteria (NTM)\|non-tuberculous mycobacterium]]
Line 6:		Line 6:
	* Can colonize airways and GI tract as well as causing disease		* Can colonize airways and GI tract as well as causing disease

	= Differential Diagnosis =		== Differential Diagnosis ==

	* Pulmonary disease		* Pulmonary disease
Line 12:		Line 12:
	** ''M. abscessus''		** ''M. abscessus''

	= Epidemiology =		== Epidemiology ==

	* Common in the environment, likely acquired by inhalation or ingestion (not person-to-person)		* Common in the environment, likely acquired by inhalation or ingestion (not person-to-person)
Line 22:		Line 22:
	** Cervical lymphadenitis: children 1-5 years old, HIV with IRIS		** Cervical lymphadenitis: children 1-5 years old, HIV with IRIS

	= Pathophysiology =		== Pathophysiology ==

	* In pulmonary disease, likely inhalation ± microaspiration		* In pulmonary disease, likely inhalation ± microaspiration
	* In disseminated disease in AIDS, likely GI colonization then replication and dissemination		* In disseminated disease in AIDS, likely GI colonization then replication and dissemination

	= Clinical Presentation =		== Clinical Presentation ==

	== Pulmonary disease ==		=== Pulmonary disease ===

	* Incubation months to years		* Incubation months to years
Line 42:		Line 42:
	** Hot tub lung disease: a hypersensitivity pneumonitis associated with inhalation		** Hot tub lung disease: a hypersensitivity pneumonitis associated with inhalation

	== Disseminated disease ==		=== Disseminated disease ===

	* Almost exclusive to HIV patients with CD4 <100		* Almost exclusive to HIV patients with CD4 <100
Line 52:		Line 52:
	* Mortality 50% at 4 months		* Mortality 50% at 4 months

	== Cervical lymphadenitis ==		=== Cervical lymphadenitis ===

	* Disease of children, usually <3 (80% aged 1 to 5 years)		* Disease of children, usually <3 (80% aged 1 to 5 years)
Line 58:		Line 58:
	** 10% bilateral		** 10% bilateral

	= Investigations =		== Investigations ==

	== Pulmonary disease ==		=== Pulmonary disease ===

	* (1) chest radiograph or, in the absence of cavitation, chest high-resolution computed tomography (HRCT) scan		* (1) chest radiograph or, in the absence of cavitation, chest high-resolution computed tomography (HRCT) scan
Line 66:		Line 66:
	* (3) exclusion of other disorders, such as tuberculosis		* (3) exclusion of other disorders, such as tuberculosis

	= Diagnosis =		== Diagnosis ==

	== Pulmonary disease ==		=== Pulmonary disease ===

	* Diagnosis based on presence of both clinical and microbiological evidence		* Diagnosis based on presence of both clinical and microbiological evidence
Line 79:		Line 79:
	** Transbronchial or other lung biopsy with mycobacterial histopathologic features, and either positive culture for NTM or one or more sputum or BALs positive for NTM		** Transbronchial or other lung biopsy with mycobacterial histopathologic features, and either positive culture for NTM or one or more sputum or BALs positive for NTM

	== Disseminated disease ==		=== Disseminated disease ===

	* Diagnosis based on MAC in culture of sterile site		* Diagnosis based on MAC in culture of sterile site

	= Management =		== Management ==

	== Pulmonary disease ==		=== Pulmonary disease ===

	* Nodular/bronchiectatic disease:		* Nodular/bronchiectatic disease:
Line 100:		Line 100:
	* Refer to Ophthalmology for monitoring while on ethambutol		* Refer to Ophthalmology for monitoring while on ethambutol

	== Disseminated disease ==		=== Disseminated disease ===

	* Antibiotics		* Antibiotics
Line 108:		Line 108:
	* Duration is until resolution of symptoms and reconstitution of cell-mediated immune function (e.g. CD4 >100)		* Duration is until resolution of symptoms and reconstitution of cell-mediated immune function (e.g. CD4 >100)

	== Prophylaxis ==		=== Prophylaxis ===

	* Indicated for adults with (AIDS) with CD4􏰀 <50; but not done and no longer in the HIV guidelines		* Indicated for adults with (AIDS) with CD4􏰀 <50; but not done and no longer in the HIV guidelines

Aidan at 03:22, 15 August 2019

2019-08-15T03:22:40Z

← Older revision		Revision as of 03:22, 15 August 2019
Line 114:		Line 114:
	* Second-line: rifabutin 300 mg/day (less well tolerated)		* Second-line: rifabutin 300 mg/day (less well tolerated)

			{{DISPLAYTITLE:''Mycobacterium avium'' complex}}
	[[Category:Mycobacteria]]		[[Category:Mycobacteria]]

Aidan: Aidan moved page Mycobacterium avium complex (MAC) to Mycobacterium avium complex

2019-08-15T03:22:23Z

Aidan moved page Mycobacterium avium complex (MAC) to Mycobacterium avium complex

← Older revision		Revision as of 03:22, 15 August 2019
(No difference)