MAC is diagnosed by culture from blood, tissue or bone marrow.
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- Untreated Patients with Nodular Bronchiectatic MAC Lung Disease Fare Poorly Over Time, Study Finds.
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If MAC bacteria are found in stool and sputum samples, this could mean the infection has spread. Doctors may have to use special methods to get cells or tissue for MAC diagnosis. These include taking bone marrow from the hip using a needle, or inserting a flexible tube into the stomach or bowels endoscopy or the lungs bronchoscopy. Some doctors choose to treat MAC infection while waiting for the test results, which can take several weeks. New tests are being developed to give a faster diagnosis.
Severe anemia and liver problems can occur in MAC, so doctors may take blood samples to look for a low red blood cell count or raised alkaline phosphatase levels. Treatment reduces the symptoms of MAC disease and improves your quality of life. However, treating MAC is difficult for several reasons:. Treating MAC infection requires several drugs because no one drug by itself is effective.
MAC bacteria can quickly become resistant to a drug and to other drugs in the same family. Combination therapy is more effective and may slow the development of drug resistance. Use of clofazimine Lamprene has been shown to increase the risk of death during MAC treatment in several studies, so it should not be used. Azithromycin and clarithromycin are related antibiotics. They are approved for treating serious bacterial infections including MAC in combination with at least one other drug.
Resistance to clarithromycin develops quickly when used alone. The higher the level of bacteria in the blood before starting therapy, the more rapid resistance develops. Clarithromycin has been studied together with various anti-MAC therapies. Studies show that a combination of clarithromycin, ethambutol and rifabutin may prevent developing resistance to clarithromycin, which is common with two-drug combinations.
One study also showed that people using the three drugs had fewer symptoms and lower levels of MAC bacteria in their blood. Survival was also longer on three-drug regimens. This suggests that using clarithromycin or azithromycin together with ethambutol and rifabutin should now be the standard treatment for people with MAC disease. However, several studies have shown that people taking 1,mg of clarithromycin twice a day had a higher death rate than those taking mg twice a day.
The higher dose should not be used. Doctors have had less experience with azithromycin for treating MAC compared to clarithromycin. Studies are underway to find the best treatment combination using azithromycin. Several pharmaceutical companies have payment assistance programs for their anti-MAC drugs. Doctors should call the toll-free number:.
Azithromycin: Pfizer, Inc. The most common side effects with azithromycin and clarithromycin are nausea, vomiting, diarrhea and abdominal pain. A rare side effect is hearing loss. Azithromycin may also cause swelling of the blood vessels and liver damage. Ethambutol can cause nausea and vomiting. It may lead to impaired vision, so people taking this drug should have regular eye check-ups.
Common side effects of rifabutin include orange urine, stomach upsets and rashes. In some studies, up to a quarter of people taking rifabutin developed uveitis, a painful inflammation in the eye. This occurred more often among people who also took clarithromycin. Interactions may occur between clarithromycin and rifabutin.
Increased levels of rifabutin could cause more severe side effects like uveitis. It's important to talk to your doctor about potential drug interactions. Rifabutin and clarithromycin may interact with protease inhibitors PIs. Azithromycin is not thought to interact with PIs so it may be the best choice for people taking a protease inhibitor.
Fighting a MAC Attack?
In general, people taking PIs should avoid rifabutin. If a person has to take rifabutin, indinavir is the PI of choice, and the dose of rifabutin should be cut in half. Rifabutin may also interact with some non-nucleoside reverse transcriptase inhibitors. Although PIs might also raise clarithromycin levels, there are not enough data on this to say whether the dose of either drug should be changed.
Clarithromycin may also decrease blood levels of AZT. Macrophages are scavenger cells that eat up and kill bacteria and viruses. They circulate in the blood or live in organs like the liver, spleen or lungs.
The bacteria grow inside the macrophages and can be spread through the body. Cells of the immune system release chemicals, called cytokines, that enable them to signal and work with each other to fight infections. In the future, cytokines may be given to enhance the effect of anti-MAC drugs by helping macrophages kill MAC bacteria. A study combining azithromycin with granulocyte macrophage-colony stimulating factor GM-CSF is looking at this, and interleukin IL is in early studies as well.
It is difficult to avoid contact with MAC bacteria, but there are some ways to reduce the risk. The decision to start MAC prevention should take into account possible drug side effects and interactions with other drugs. In addition, MAC bacteria may become resistant to a drug when it is used alone for preventing the disease. There is a risk of developing resistance to clarithromycin, so azithromycin might be the best first choice. Both drugs also protect against bacterial infections in the lungs and airways.
Combinations of these drugs have been tested for MAC prevention, but in all cases increased side effects and cost outweigh any added protection from disease. A Mild bronchiectasis in anterior and posterior segments of right upper lobe of year-old man, scored as 1 point, with bronchus diameter greater than adjacent vessel diameter arrows.
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B Moderate bronchiectasis in superior segment of right lower lobe of year-old woman, scored as 2 points, with bronchus diameter two to three times vessel diameter arrow. C Severe bronchiectasis in superior segment of left lower lobe of year-old man, scored as 3 points, with bronchus diameter greater than three times vessel diameter arrow.
D Mucus plugging associated with severe bronchiectasis in posterior basal segment of right lower lobe of year-old man arrow. A Mild cellular bronchiolitis in superior segment of right lower lobe of year-old woman, scored as 1 point, manifesting as tree-in-bud patterns in the peripheral lung, 1 cm from the pleura arrow.
B Moderate cellular bronchiolitis in posterior basal segment of right lower lobe of year-old man, scored as 2 points, showing centrilobular nodules or tree-in-bud patterns involved greater than 1—3 cm from the pleura arrow. C Severe cellular bronchiolitis in superior segment of left lower lobe and lingular segment of left upper lobe of year-old man, scored as 3 points, showing centrilobular nodules or tree-in-bud patterns extending to the central lung arrows.
The differences in score between initial and follow-up chest CTs were evaluated using the paired t-test and the Wilcoxon signed rank test. Because our study violated this assumption, the Greenhouse-Geisser correction was used to adjust to the F-test in terms of degrees of freedom.
The interobserver agreements on each subtotal score of bronchiectasis, cellular bronchiolitis, consolidation, and nodule in both initial and follow-up CT studies were assessed by intraclass correlation coefficient ICC. The ICC value was interpreted as follows: 0—0. All statistical analyses were performed using SPSS version Among the 40 patients, 33 Positive acid fast staining AFB smear rate was Diabetes mellitus and malignancy were the most common comorbidities.
The mean interval between the initial and last follow-up chest CT scan was 6. After 4 years of follow-up periods, 15 of 40 patients received treatment. The strength of interobserver agreement on five CT features of initial and follow-upper studies ranged strong to almost perfect the ICC value range, 0. During the follow-up period, 39 patients We observed score increases for bronchiectasis in 33 patients The total score on follow-up CT increased by a mean 4.
The mean final follow-up CT score for all five parenchymal abnormalities increased significantly from the initial CT score. When we compared within each of the 10 subcategories, all mean final follow-up CT scores, except mucus plugging, increased statistically from the initial CT scores Table 4. Additionally, we investigated the correlations between four parameters bronchiectasis, cellular bronchiolitis, nodule and consolidation and the absolute number of involved segments.
The consensus recommendation for the nodular BE form of MAC lung disease is long-term follow-up without immediate treatment because it progresses slowly over a long period.
This recommendation was supported by clinical and radiologic studies that demonstrated that MAC lung disease is characterized by slow progression[ 12 , 18 ]. However, herein, although all patients did not received treatment due to minimal or mild symptoms, Furthermore, bronchiectasis and cavity were associated with disease progression. In addition, half of these patients remained stable without treatment, and the clinician did not start treatment at the time of diagnosis.
The recent study, which is investigated the natural course of MAC lung disease, indicates that patients However, these studies only evaluated poor prognostic parameters and outcome differences according to treatment, and individual clinicians made treatment decisions without common guidelines. For these reasons, we lack a complete understanding of the long-term natural course of nodular BE form of untreated MAC lung disease.
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- Untreated Patients with Nodular Bronchiectatic MAC Lung Disease Fare Poorly Over Time, Study Finds.
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In our study, we included 40 patients who did not treated at least 4 years due to minimal symptoms. According to the recent study, our study populations could be defined as stationary group. However, we found that In particular, five parenchymal abnormalities showed an increase in mean CT score compared with initial CT score. These findings suggest that even though patients were stationary, most of the nodular BE form of MAC lung cases eventually progress if appropriate treatment is not administered.
Characteristic findings of MAC lung disease include bronchiectasis, cavity, cellular bronchiolitis, consolidation, and nodules. Some of these parameters, especially cellular bronchiolitis, are reversible after treatment. To investigate this, we conducted pairwise comparisons and a correlation analysis of the relationships between observation time and radiologic changes of five parameters.
We found that cavity showed the largest increase of score on follow-up chest CT. Additionally, bronchiectasis showed the largest increase of involved segment compared with nodules and consolidation. The known risk factors of treatment failure are low BMI, atelectasis, cavity, and bronchiectasis.
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