eMedicine Specialties > Infectious Diseases > Mycobacterial Infections

Mycobacterium Avium-Intracellulare: Follow-up

Author: Janak Koirala, MD, MPH, FACP, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Southern Illinois University School of Medicine
Contributor Information and Disclosures

Updated: Sep 30, 2008

Follow-up

Further Inpatient Care

  • Patients with AIDS who develop FUO are generally admitted for inpatient care. They may also need to be admitted for various other reasons, including inpatient workup of fever and hepatitis, dehydration, wasting and failure to thrive, initiation of intravenous antibiotics, nonadherence, or other concurrent illnesses.
  • Patients with pulmonary M avium complex (MAC) infection may need to be admitted for a lung biopsy or surgical resection of infected lung.
  • Children with lymphadenitis may need to be admitted for surgical excision of infected lymph nodes.

Further Outpatient Care

  • Carefully monitor patients with AIDS for adverse effects of medications, especially for hepatotoxicity and uveitis. They may also require blood transfusions if anemia is significant. Antiretroviral agents should be started concurrently for a faster and better response. Patients should also be monitored for immune reconstitution syndrome.
  • Carefully monitor patients with lung disease who develop pulmonary MAC infection for improvement in symptoms and for adverse effects of medications.
  • After completion of treatment, patients should be monitored clinically and, if needed, radiologically for relapse of the infection.
  • Patients not undergoing treatment in whom MAC infection is suspected based on a single culture result or radiographic findings but do who not meet diagnostic criteria for MAC disease require close follow-up for clinical and radiographic monitoring.

Inpatient & Outpatient Medications

  • Clarithromycin or azithromycin in combination with ethambutol and rifabutin are the first-choice drugs. Alternatively, clofazimine, streptomycin, amikacin, or levofloxacin may be used to substitute one of the first-line agents.

Transfer

  • Patients with AIDS may need to be transferred to a facility with an infectious diseases or HIV specialist for workup and treatment.
  • Patients with pulmonary infection may need to be transferred to a facility that offers bronchoscopy. They may also require transfer for surgical resection of infected lung tissue.

Deterrence/Prevention

  • The Department of Health and Human Services panel recommends that patients with AIDS and CD4 cell counts under 50 cells/µL should receive a prophylactic antibiotic to prevent MAC infection. The first-line agent for MAC prophylaxis should be a macrolide, either clarithromycin or azithromycin. Alternatively, rifabutin can be used. Patients who have received treatment for MAC should stay on the treatment regimen until their CD4 count improves to more than 100 cells/µL.

Complications

  • Patients with AIDS may develop anemia or weight loss, or they may die.
  • Patients with lung disease may develop respiratory insufficiency or weight loss, or they may die.

Prognosis

  • The life expectancy among patients with AIDS and MAC infection was once 9 months; however, patients receiving HAART probably have a much longer life expectancy.
  • Patients with lung disease and pulmonary MAC infections with focal nodules usually have a benign course. Patients with more extensive disease have a 90% chance of recovery and a 20% chance of relapse.

Patient Education

  • Instruct patients with AIDS on how to monitor for potential adverse effects of their medications as well as how to recognize signs of anemia that might indicate the need for a transfusion.
  • Educate patients with lung disease who develop pulmonary MAC infection about potential adverse effects of their medications.
  • For excellent patient education resources, visit eMedicine's Bacterial and Viral Infections Center and Procedures Center. Also, see eMedicine's patient education article Bronchoscopy.

Miscellaneous

Medicolegal Pitfalls

  • Macrolides are likely to interact with drugs metabolized in the liver.
  • Ethambutol may cause optic neuritis and blindness, especially in patients with coexisting renal dysfunction.
  • Rifampin and rifabutin may decrease the effectiveness of contraceptives. Advise patients of this potential effect. Rifabutin is also known to cause uveitis, for which patients need regular eye examinations.
  • Failing to offer prophylaxis to patients with HIV with a CD4+ lymphocyte count of below 50 cells/µL may lead to development of disseminated M avium complex (DMAC) infection.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor William B Harley, MD, to the development and writing of this article.



More on Mycobacterium Avium-Intracellulare

Overview: Mycobacterium Avium-Intracellulare
Differential Diagnoses & Workup: Mycobacterium Avium-Intracellulare
Treatment & Medication: Mycobacterium Avium-Intracellulare
Follow-up: Mycobacterium Avium-Intracellulare
Multimedia: Mycobacterium Avium-Intracellulare
References
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Further Reading

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Keywords

Mycobacterium avium complex, MAC, M avium complex , Mycobacterium avium-intracellulare, M avium-intracellulare, Mycobacterium avium, M avium, Mycobacterium intracellulare, M intracellulare, MAI, Lady Windermere syndrome, MAC lung disease, disseminated MAC, DMAC, disseminated M avium complex, MAC bacteremia, MAC infection, MAC lymphadenitis, hot-tub lung, MAC mastitis, MAC pyomyositis, Mycobacterium avium avium, M avium avium, Mycobacterium avium paratuberculosis, M avium paratuberculosis

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Contributor Information and Disclosures

Author

Janak Koirala, MD, MPH, FACP, Associate Professor, Department of Internal Medicine, Division of Infectious Diseases, Southern Illinois University School of Medicine
Janak Koirala, MD, MPH, FACP is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, Infectious Diseases Society of America, International AIDS Society, International Society for Infectious Diseases, and International Society of Travel Medicine
Disclosure: Nothing to disclose.

Medical Editor

Klaus-Dieter Lessnau, MD, FCCP, 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 Society for Artificial Internal Organs, American Thoracic Society, Physicians for Social Responsibility, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Aaron Glatt, MD, Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, New Island Hospital
Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, 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, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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