Mycobacteria is a type of bacteria that can cause infection within the body. Atypical mycobacterium is any mycobacterium other than Tuberculosis mycobacterium. The most common form of atypical mycobacterium, which also most commonly affects the lungs is the mycobacterium avium intracellulare complex. Mycobacterium avium complex (MAC) has been isolated in freshwater and saltwater worldwide, with other common sources including aerosolized water, piper hot water systems, bathrooms, house dust, soil, birds, farm animals and cigarette components such as tobacco, filters and paper.
Mycobacterium avium complex (MAC) consists of two species— M avium and M intracellular -these species are difficult to differentiate. It is thought that MAC is acquired by exposure to soil, air, or water, especially in temperate and sub tropical areas. People who are affected are usually those with low immune systems (patients with AIDS), or those suffering from chronic lung conditions (bronchiectasis, heavy smoking, or cystic fibrosis) MAC causes 2 general patterns of lung disease, one pattern involves nodules and cavities, whilst the other involves nodules and bronchietasis.
MAC is transmitted into the body through inhalation via the respiratory tract or digestion via the GI tract. There is no known human to human transmission therefore the mycobacterium avium intracellular complex is considered NOT contagious.
Treatment can involve a range of drugs but often includes Rifampicin, Ethambutol and Clarithromycin.
Regular daily exercise including walking, Yoga, Pilates, and strength training is highly recommended. MAC patients must remember that effort is required to maintain exercise due to chronic and sometimes extreme fatigue. It is very easy to become tired and not feel up to exercising. However, the continued plan will eventually contribute to improving daily quality of life.
Proper nutrition and adequate caloric intake to prevent weight loss and even encourage weight gain is helpful for MAC patients. Regular rest periods and sleep patterns assist to lessen fatigue. There may be some benefit for regular counseling visits and taking prescribed medications for depression and anxiety due to the stress of chronic illness. MAC patients can help themselves by maintaining a proactive stance and keeping up to date regarding current knowledge about the disease.
A major issue with MAC disease is fatigue or tiredness. Routines may need to be altered and assistance with activities of daily living may be required. Enlistment of others’ help and support is essential.
Keep on top of it!
Patients must pay attention to symptoms, take medications indefinitely, exercise regularly, and provide good nourishment to maintain a healthy weight. It is essential to envelope rigorous pulmonary hygiene, providing sputum cultures or getting bronchoscopes as needed. It is also important to avoid exposure to known infections, rest periodically as needed, and promote good sleep patterns. It is possible to maintain a good quality of life by following these suggestions.
MAC lung patients are initially treated for 15-18 months. Monthly follow up visits are recommended that include blood work. Less frequent testing is done via sputum samples, CT scans, chest films, and pulmonary function studies about every 6 months. Bronchoscopy may be required for those patients unable to produce sputum samples for culture.
Patients whose sputum remains culture positive for MAC after 12 months of drug treatment are considered treatment failures. Patients whose sputum cultures become negative for MAC almost always do so within 6 months of starting their drugs. If the condition worsens with symptoms or if the tests appear to change, then the physician would need to reevaluate the treatment plan and possibly consider another regimen of antibiotic therapy.
Mycobacterium avium complex (MAC) has also been associated with pulmonary infection and bronchiectasis in middle-aged women without a preexisting 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 a suitable environment for growth of the organisms.