eMedicine Specialties > Dermatology > Mycobacterial Infections

Mycobacterium Avium-Intracellulare Infection: Follow-up

Author: Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Coauthor(s): Supriya Tomar, MD, Consulting Staff, Mohs College; Douglas W Kress, MD, Program Director, Medical Director of Clinical Services, Department of Dermatology, University of Pittsburgh Medical Center; Nicole Restauri, MD, Staff Physician, Radiology, University of Pittsburgh School of Medicine; Jessica M Allan, MD, Consulting Staff, Private Practice
Contributor Information and Disclosures

Updated: Jul 15, 2008

Follow-up

Further Inpatient Care

  • Patients hospitalized with DMAI disease require inpatient care.
  • Primary cutaneous MAI infection and cervical adenitis may be treated in an outpatient setting if patients are medically compliant.

Further Outpatient Care

  • In cases of cervical adenitis and primary cutaneous MAI infection, follow-up care is required to assess for toxicity due to therapeutic agents and to monitor patients for possible disease recurrence or surgical complications.
  • Patients with DMAI disease may need to be started on a prophylactic regimen for MAI infection prevention, and they may need to be monitored for recurrence.

Inpatient & Outpatient Medications

Deterrence/Prevention

  • Medical prophylaxis with rifabutin (300 mg PO qd) is indicated for patients who are immunosuppressed.
  • Prevention of primary cutaneous MAI infection has not been addressed in the literature because the disease is rare.

Complications

  • Cervical adenitis can be complicated by local destruction of an overlying structure. Furthermore, the proximity to the trachea and the oropharynx may result in airway compromise and should be considered when evaluating patients with cervical adenitis.
  • Patients receiving treatment for DMAI infection are often on multiple medications, and care should be taken to address possible interactions before initiating pharmacotherapy.

Prognosis

  • The relationship between cutaneous lesions and mortality in DMAI infection is unknown.
  • If untreated, DMAI disease is associated with an increased mortality rate in patients with AIDS.
  • Primary cutaneous MAI infection and atypical Mycobacterium -induced cervical adenitis are responsive to combined surgical and medical treatment and may result in significant cosmetic deformity and/or scarring.

Patient Education

  • Patients receiving prophylaxis with rifabutin should be educated regarding the purpose of the therapy and the potential adverse effects.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider cutaneous infection with MAI in patients with antibiotic-resistant cellulitis, in those with nonhealing nodules and ulcers, and in patients who are immunosuppressed with evidence of DMAI infection is a pitfall. Primary cutaneous infection is rare, but it does not necessarily mandate a workup for immunosuppression. Of note, isoniazid is a first-line agent in the treatment of M tuberculosis, but it is ineffective for DMAI infection.
  • Failure to refer cases of cervical adenitis to a surgeon is a pitfall. Surgical referral for all cases of cervical adenitis is appropriate.
  • MAI infection can be related to infliximab use.13
 


More on Mycobacterium Avium-Intracellulare Infection

Overview: Mycobacterium Avium-Intracellulare Infection
Differential Diagnoses & Workup: Mycobacterium Avium-Intracellulare Infection
Treatment & Medication: Mycobacterium Avium-Intracellulare Infection
Follow-up: Mycobacterium Avium-Intracellulare Infection
References
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References

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Further Reading

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Keywords

Mycobacterium avium complex, Mycobacterium avium-intracellulare, MAI, MAC, disseminated Mycobacterium avium-intracellulare, DMAI, cutaneous MAI, cervical adenitis, cervical lymphadenitis, atypical mycobacterial disease

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Contributor Information and Disclosures

Author

Noah S Scheinfeld, MD, JD, FAAD, Assistant Clinical Professor, Department of Dermatology, Columbia University; Consulting Staff, Department of Dermatology, St Luke's Roosevelt Hospital Center, Beth Israel Medical Center, New York Eye and Ear Infirmary; Private Practice
Noah S Scheinfeld, MD, JD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Optigenex Consulting fee Independent contractor

Coauthor(s)

Supriya Tomar, MD, Consulting Staff, Mohs College
Disclosure: Nothing to disclose.

Douglas W Kress, MD, Program Director, Medical Director of Clinical Services, Department of Dermatology, University of Pittsburgh Medical Center
Douglas W Kress, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Nicole Restauri, MD, Staff Physician, Radiology, University of Pittsburgh School of Medicine
Disclosure: Nothing to disclose.

Jessica M Allan, MD, Consulting Staff, Private Practice
Disclosure: Nothing to disclose.

Medical Editor

Takeji Nishikawa, MD, Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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