Is Mycobacterium avium complex a long-term antibiotic treatment for nontuberculous pulmonary disease?
Abstract The pathogen Mycobacterium aviumcomplex (MAC) is the most common cause of nontuberculous mycobacterial pulmonary disease worldwide. The decision to initiate long-term antibiotic treatment is difficult for the physician due to inconsistent disease progression and adverse effects associated with the antibiotic treatment.
How is Mycobacterium avium (Mac) lung disease manifested?
MAC lung disease is manifested either by fibrocavitary radiographic changes similar to pulmonary tuberculosis or by bronchiectasis with nodular and reticulonodular radi</span> … <span><i>Mycobacterium avium</i> complex (MAC) is the most commonly isolated nontuberculous mycobacterial respiratory pathogen worldwide.
What is the global prevalence of Mycobacterium avium infection?
The prevalence of M. avium and other mycobacterial diseases is approximately 10 to 15 cases per 100,000 individuals and is increasing at a rate of 5 to 8% per year in the United States and Canada ( 1, 2 ). The majority of those cases are caused by M. avium.
What is the epidemiology of nontuberculous mycobacteria infection?
Epidemiology of infection by nontuberculous mycobacteria: Mycobacterium avium, Mycobacterium intracellulare, and Mycobacterium scrofulaceum in acid, brown-water swamps of the southeastern United States and their association with environmental variables. Am Rev Respir Dis 1992 ;145: 271 – 275. 14 .
How long can you live with MAC?
The studies identified in this systematic review show that, in general, patients with MAC lung disease are at a high risk of death following their diagnosis, with a pooled estimate of five-year all-cause mortality of 27%.
How long does it take to get rid of Mycobacterium?
You will be treated with a combination of several antibiotics. It takes a long time to kill all the NTM bacteria, so you may be treated for a year or two. If you take all your medication as prescribed, the infection should go. However, it is possible to get an NTM infection again.
Can Mycobacterium avium complex be cured?
Can MAC lung disease be cured? Providers consider MAC lung disease to be cured if sputum cultures show no evidence of infection for 12 months. But the infection can come back, either from a new exposure or lingering bacteria in the lungs, especially since the condition that made you susceptible to MAC is still present.
How serious is Mycobacterium avium?
MAC infection is a serious condition that can cause damage to the lungs. MAC infection is not contagious. Common signs and symptoms of MAC lung disease include fatigue, chronic cough, shortness of breath, night sweats, coughing up blood and weight loss.
How long does Mycobacterium take to grow?
As much as 70% of NTM were detected within 14 days, 20% were detected within 21 days, and 10% were detected within 28 days. More than 28 days were not necessary to observe growth in any of our cases. Truly, our evaluation is based only on a very small number of specimens.
How fast does Mycobacterium grow?
The RGM are environmental organisms found worldwide that usually grow in subculture within one week (eg, rapidly, as compared with other mycobacteria). M.
Does bronchiectasis shorten your life?
Most people diagnosed with bronchiectasis have a normal life expectancy with treatment tailored to their needs. Some adults with bronchiectasis developed symptoms when they were children and live with bronchiectasis for many years. Some people, who have very severe bronchiectasis, may have a shorter life expectancy.
Is bronchiectasis a terminal illness?
Living with bronchiectasis can be stressful and frustrating, but most people with the condition have a normal life expectancy. For people with very severe symptoms, however, bronchiectasis can be fatal if the lungs stop working properly.
How long does it take for Mycobacterium avium to grow?
avium, and MAC [8,9,14] typically take 2–3 weeks to grow in the traditional solid media phase, whereas broth media can produce more rapid results [1]. Both methods use media optimized for mycobacterial growth, most commonly 7H9 broth and 7H10 agar plates [1,8,9,14].
How can you prevent Mycobacterium avium intracellulare?
avium in household plumbing, increasing hot water temperature, reducing aerosol (mist) exposures in bathrooms and showers, and installing filters that prevent the passage of mycobacteria will likely reduce M. avium exposure.
What are the symptoms of Mycobacterium?
abscessus is usually red, warm, tender to the touch, swollen, and/or painful. Infected areas can also develop boils or pus-filled vesicles. Other signs of M. abscessus infection are fever, chills, muscle aches, and a general feeling of illness.
Does Mycobacterium avium need to be treated?
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, are also used as additional agents.
CME Editor
P. Lynne Stockton Taylor, VMD, MS, ELS (D), Technical Writer/Editor, Emerging Infectious Diseases. Disclosure: P. Lynne Stockton Taylor, VMD, MS, ELS (D), has disclosed no relevant financial relationships.
CME Author
Laurie Barclay, MD, freelance writer and reviewer, Medscape, LLC. Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Authors
Disclosures: Sarah Brode, MD, MPH; Hannah Chung, MPH; Michael Campitelli, MPH; Jeff Kwong, MD; Alex Marchand-Austin, MD, MSc; and Frances B. Jamieson, MD, have disclosed no relevant financial relationships.
CME Questions
1. You are advising a public health department regarding the need for physician education on the proper treatment of Mycobacterium avium complex pulmonary disease (MAC-PD) and M. xenopi pulmonary disease (Mx-PD).
Abstract
The incidence of nontuberculous mycobacterial (NTM) pulmonary disease caused by Mycobacterium avium complex (MAC) in apparently immune-competent people is increasing worldwide.
Background
Nontuberculous mycobacteria (NTM) are ubiquitous environmental bacteria, present in soil and water sources [ 1 ]. NTM are thought of as opportunistic pathogens, with disseminated NTM disease being seen in patients with systemic impaired immunity (e.g. HIV) [ 2, 3 ].
Methods
Database searches were carried out in Medline® and Embase®, using PubMed® and ProQuest Dialog™ search tools, respectively, with a cut-off of 1st August 2017, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 11 ]. English language studies were selected.
Results
The PubMed® search of Medline® returned 845 studies, and the ProQuest Dialog search (using Embase® and Medline® databases) returned 1311 studies. Following comparison of the results and de-duplication, 1035 publications remained. This selection was screened by title, abstract content and full text if needed.
Discussion
The studies identified in this systematic review show that, in general, patients with MAC lung disease are at a high risk of death following their diagnosis, with a pooled estimate of five-year all-cause mortality of 27%.
Conclusions
In conclusion, our structured literature review has identified 17 data sets reporting five-year mortality in patients with NTM-PD caused by MAC. Most (i.e.
Acknowledgements
Medical writing and literature search support was provided by Physicians World Europe GmbH, Mannheim, Germany and was financially supported by Insmed Inc.
How often should I clean my humidifier?
If a humidifier must be used, water should never be left in the reservoir, and it should be regularly (i.e., every 2 wk) scrubbed and cleaned with detergent to get rid of the biofilm and disinfected with household bleach. For individuals suffering from sinusitis, irrigation with tap water is not recommended ( 31 ).
How much does it cost to treat M. avium?
That cost is estimated to be $321 (Canadian) per month; for a median duration of treatment of 14 months, the total cost would be $4,916 ( 38 ).
How is M. avium transmitted?
M. avium is not transmitted from person to person; rather, infection occurs through the inhalation of aerosolized droplets containing M. avium cells. Aerosolized droplets can be generated from natural waters ( 35 ), showerheads and water taps ( 36 ), hot tubs and spas, hydrotherapy pools, humidifiers, and humidified air from HVAC systems.
Is mycobacteria in showerhead biofilms?
Evidence that mycobacteria, particularly M. avium, were pre valent in showerhead biofilms sampled across the United States ( 20) suggests that humans are surrounded by M. avium and, likely, are continually exposed. The number of M. avium cells and their innate virulence would be expected to influence infection.
Will the prevalence of M. avium disease increase?
As the proportion of the United States population over 60 years continues to grow and the number of individuals with cancer immunosuppressed individuals is anticipated to increase, it is likely that the prevalence of M. avium disease will continue to increase.
Can you change genetic factors for M. avium?
Unfortunately, it is impossible to change genetic factors pred isposing individuals to M. avium infection. However, because those individuals are susceptible to reinfection ( 12 ), it behooves us to determine whether it is possible to reduce their exposure to M. avium. Sources of M. avium Infection.
Is there a minimal dose of M. avium?
avium cells and their innate virulence would be expected to influence infection. Unfortunately, there is no knowledge of the minimal dose required for infection, and there are few, if any, known virulence markers of M. avium and other mycobacteria. Table 1.
What are the conditions that make it difficult to fight off infections?
Genetic diseases like primary ciliary dyskinesia or alpha-1 antitrypsin deficiency. Immune system conditions that make it difficult to fight off infections. Aspirating (breathing in) things like fluids, stomach acid, or foods into the lungs.
What is the treatment for coughing mucus?
Treatment might also include: Airway clearance devices to break up mucus and help you cough it out. Positive expiratory pressure (PEP) devices that you can hold in your hands.
Why does CF get worse over time?
This is called idiopathic bronchiectasis. However, in other cases, causes include: Past severe infection that has damaged the lung. Genetic diseases like primary ciliary dyskinesia or alpha-1 antitrypsin deficiency.