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Mycobacterium avium
  1. #1
    qddeb is offline New Member
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    Default Mycobacterium avium

    Hi everyone! I have never been to a forum so if anyone has any advise to help me get answers please let me know. I have just been diagnosed with this disease of the lungs. I am told it is not TB but it is? What is so scary is the differences of opinion from the med community on the treatment. Does any one else have experience with this disease or has anyone gone through the treatment? What were your experiences?
    Thanks for reading this. Deb [?]

  2. #2
    theamazingjoe is offline New Member
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    This is a blatant copy and paste from emedicine.com. I would have just included a link to it but you need an account to access some of their articles. There is a lot of info below which should help and provide some areas you may wish to do additional reading on. Sorry if the format doesn't carry over well when I post this.



    Mycobacterium Avium-Intracellulare

    Internal Medicine - Infectious Diseases

    Last Updated: November 11, 2004 Format for Printing Get CME/CE for article
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    Synonyms and related keywords: Lady Windermere syndrome, Mycobacterium avium complex, MAC, Mycobacterium avium, Mycobacterium intracellulare, M avium, M intracellulare, HIV infection, pulmonary MAC, cervical adenitis

    AUTHOR INFORMATION Section 1 of 10 Next

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    Author: William B Harley, MD , Clinical Assistant Professor, Department of Internal Medicine, Carolinas Medical Center, University of North Carolina

    William B Harley, MD, is a member of the following medical societies: American College of Physicians , American Medical Association , American Society of Tropical Medicine and Hygiene , Infectious Diseases Society of America , and International Society of Travel Medicine

    Editor(s): Klaus-Dieter Lessnau, MD, FCCP , Clinical Assistant Professor of Medicine, New York University School of Medicine; Medical Director, Pulmonary Physiology Laboratory, Department of Medicine, Section of Pulmonary Medicine, Lenox Hill Hospital; Francisco Talavera, PharmD, PhD , Senior Pharmacy Editor, eMedicine; Aaron Glatt, MD , Associate Dean and Professor of Clinical Medicine, New York Medical College; Chairman, Department of Medicine, Our Lady of Mercy Medical Center; Eleftherios Mylonakis, MD, PhD , Graduate Assistant in Medicine, Instructor in Medicine, Division of Infectious Disease, Massachusetts General Hospital, Harvard University; and Burke A Cunha, MD , Professor of Medicine, State University of New York at Stony Brook School of Medicine; Chief, Infectious Disease Division, Vice-Chair, Department of Internal Medicine, Winthrop-University Hospital

    Disclosure INTRODUCTION Section 2 of 10 Prev Top Next

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    Background: Mycobacterium avium complex (MAC) consists of 2 predominant species, M avium and Mycobacterium intracellulare . More than 95% of infections in patients with AIDS are caused by M avium, while 40% of infections in immunocompetent patients are caused by M intracellulare .

    An environmental source of infection is difficult to determine. MAC has been recovered from potable water supplies in hospitals where patients were admitted prior to infection. It has also been isolated from household water supplies. Other potential associations include ingestion of raw fish or hard cheese, daily showering, and occupational exposure to water.


    Pathophysiology: The modes of transmission include inhalation through the respiratory tract and ingestion via the gastrointestinal tract. Colonization of either site in patients with AIDS has been associated with an increased risk of developing MAC bacteremia. Approximately 60% of patients colonized in one series progressed to develop bacteremia; however, screening cultures from the respiratory or gastrointestinal tract is not useful because the majority of patients who develop bacteremia are not colonized prior to developing disseminated disease.

    The most important risk factor for MAC infection in patients negative for HIV is underlying lung disease. Pulmonary infection is the most common manifestation in these patients. It can also cause lymphadenitis in children. MAC has surpassed Mycobacterium scrofulaceum as the most common cause of cervical adenitis in developed countries.


    Frequency:


    In the US: Prior to the availability of more potent antiretroviral medications, 30% of patients positive for HIV developed disseminated MAC (DMAC). In a 1996 study, patients taking highly active antiretroviral therapy (HAART), including a protease inhibitor, had an incidence of only 2%.
    Mortality/Morbidity:

    Prior to the availability of clarithromycin, the life expectancy of a patient with AIDS and DMAC was 4 months. In a 1999 study, patients treated with rifabutin, ethambutol, and clarithromycin had a median survival time of 9 months. Life expectancy is longer now with the advent of HAART. The most common complication of DMAC is anemia that may require transfusion.
    The clinical course of pulmonary MAC in patients positive for HIV is usually indolent. Approximately 50% of patients in one study were still alive 5 years after diagnosis. Patients with extensive parenchymal involvement may die of progressive respiratory failure, but patients with more limited disease have a low mortality rate.
    In children, lymphadenitis has a benign course.
    Race:

    MAC infection has no predilection for any race.
    HIV infection affects different groups at different rates because of socioeconomic reasons and possibly genetic factors.
    Sex: MAC infection has no predilection for either sex.

    Age:

    Male patients with chronic obstructive pulmonary disease (COPD) may have a higher probability of contracting MAC disease.
    Elderly women may have a higher probability of contracting pulmonary MAC disease of the middle lobe and/or the lingula. This is known as Lady Windermere syndrome.
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    History:

    Symptoms of MAC infection in patients with AIDS include fever, sweats, weight loss, fatigue, diarrhea, and shortness of breath.
    Symptoms of pulmonary MAC infection in patients negative for HIV with lung disease include cough, sputum production, weight loss, fever, and hemoptysis.
    The most common symptom of lymphadenitis in children is unilateral, nontender, enlarged lymph nodes.
    Physical:

    MAC infection in patients with AIDS can cause wasting, tender hepatosplenomegaly, lymphadenopathy, and skin pallor.
    Pulmonary MAC infection in patients with lung disease can cause crackles, rhonchi, and dullness in chest percussion.
    Lymphadenitis in children can cause unilateral enlargement of submandibular, preauricular, parotid, or postauricular lymph nodes.
    Causes:

    MAC infection in patients with AIDS is associated with CD4 + lymphocyte count of less than 50 cells per m L.
    Pulmonary MAC infection in patients with lung disease is associated with COPD, chronic bronchitis, bronchiectasis, cystic fibrosis, mitral valve prolapse, skeletal abnormalities (eg, pectus excavatum, mild scoliosis, straight back), or lung cancer.
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    Aspergillosis
    Benign Lung Tumors
    Catscratch Disease
    Cryptococcosis
    Fatty Liver
    Infectious Mononucleosis
    Lung Cancer, Non-Small Cell
    Lung Cancer, Oat Cell (Small Cell)
    Lymphoma, B-Cell
    Lymphoma, Mediastinal
    Lymphoma, Non-Hodgkin
    Pneumonia, Aspiration
    Pneumonia, Bacterial
    Pneumonia, Fungal
    Tuberculosis



    Other Problems to be Considered:

    Chronic cough
    Lung cancer, large cell
    Lung cancer, squamous cell
    Mumps
    Parotid stone
    Parotid tumor
    HIV wasting





    WORKUP Section 5 of 10 Prev Top Next

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    Lab Studies:


    Several laboratory studies are recommended for patients with AIDS.
    A CBC count is recommended to test for anemia and neutropenia.
    A liver panel detects elevated transaminases and alkaline phosphatase.
    Blood culture should employ special mycobacterial and/or fungal media. These techniques may consist of inoculating 5 mL of blood into a vial of BACTEC (such as TB 13A) or 7-10 mL into an Isolator bottle. The average time for cultures to turn positive is 5-12 days. Early in the course of infection, bacteremia may be low level or intermittent, in which case blood cultures may not be positive. Later in the course of infection, blood cultures are invariably positive.
    A sputum culture in patients with lung disease and pulmonary MAC infection may be difficult to interpret because, in these patients, MAC can colonize the respiratory tract without causing clinical infection. The American Thoracic Society states that at least 3 positive sputum cultures or 2 cultures with 1 positive smear should be present to entertain a diagnosis of pulmonary MAC disease. One culture of usually sterile fluid such as blood or cerebrospinal fluid may also be sufficient.
    Imaging Studies:


    Imaging studies are recommended for patients with AIDS.
    CT scanning of the chest reveals mediastinal lymphadenopathy. High-resolution CT scanning may reveal parenchymal involvement.
    CT scanning of the abdomen reveals retroperitoneal or periaortic lymphadenopathy and hepatosplenomegaly.
    Chest radiography in patients with pulmonary MAC infection may reveal thin-walled cavitary infiltrates, nodular infiltrates without cavities in the upper lobes, lingula or middle lobe infiltrates, and isolated nodules.
    Procedures:


    Several procedures are indicated for patients with AIDS and MAC infection, including lymph node biopsy, bone marrow biopsy, liver biopsy, and transbronchial biopsies.
    Procedures for pulmonary MAC infection in patients with lung disease include bronchoscopy and CT-guided needle biopsy.
    Procedures for lymphadenitis in children include lymph node biopsy, needle aspiration, or complete excision of lymph nodes at the point they overlay the facial nerve.
    Histologic Findings: Histologic findings include necrotizing and nonnecrotizing granulomas and positive acid-fast bacilli (AFB) smears. The number of AFB is usually higher compared to Mycobacterium tuberculosis infection.
    TREATMENT Section 6 of 10 Prev Top Next

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    Medical Care:

    Treatment for patients with AIDS and MAC infection involves antimicrobial agents with activity against MAC, including clarithromycin, azithromycin, rifabutin, ethambutol, levofloxacin, and/or amikacin. Second-line antituberculosis (anti-TB) drugs may also rarely play a role.
    Treatment should consist of at least 2 drugs. The macrolide antibiotics (clarithromycin, azithromycin) are the most active agents. Clear evidence demonstrates the efficacy of clarithromycin, and it (or azithromycin) should be included in any regimen. Monotherapy with clarithromycin has led to resistance. Fewer published data establish the efficacy of azithromycin for MAC infection. Ethambutol appears to be the best second choice to combine with clarithromycin. If a third drug is needed, use rifabutin. A study comparing clarithromycin and ethambutol with clarithromycin, ethambutol, and rifabutin showed improved microbiological clearance and survival in the triple-therapy arm. One problem with rifabutin is drug interactions. Higher doses of clarithromycin (1000 mg bid) are associated with higher mortality rates. Higher doses of rifabutin (600 mg per d) are associated with higher rates of uveitis.
    Fever should improve within 2-4 weeks of beginning therapy. If patients remain febrile longer than expected, repeat blood cultures and perform susceptibilities to clarithromycin. Studies have not shown a correlation between clinical outcome and in-vitro susceptibilities to drugs other than clarithromycin. If the isolate is susceptible to clarithromycin and the patient is not responding to therapy, consider adding amikacin.
    Chemoprophylaxis is recommended for patients positive for HIV with a CD4 + lymphocyte count of less than 50 cells per m L. The ideal time to stop prophylaxis in patients starting HAART is unclear. If a patients' CD4 count rises above 50 for a sustained period and viral load response is good, prophylaxis can possibly be discontinued.
    The drug of choice is either clarithromycin or azithromycin. One study comparing clarithromycin with placebo revealed an incidence of MAC bacteremia of 5.6% in patients taking clarithromycin and 15.5% in those taking placebo. An improved survival rate was also observed in patients taking clarithromycin. More than 50% of patients taking clarithromycin who developed bacteremia were infected with isolates resistant to clarithromycin.

    Azithromycin also is superior to placebo (incidence of MAC 8.2% >> 23.3%). Patients taking azithromycin had no survival advantage, but the study was not powered to detect a survival difference. Azithromycin resistance was not detected in treated patients who developed bacteremia.

    Rifabutin is an alternative to the macrolides for MAC prophylaxis. In one study, the combination of azithromycin and rifabutin was more effective than either drug alone, but cost and increased incidence of adverse effects precludes using these 2 drugs together. The combination of clarithromycin and rifabutin may not be more effective than clarithromycin alone.
    Treatment of pulmonary MAC infection in patients with lung disease involves a combination of clarithromycin, ethambutol, and rifabutin. Streptomycin may be used for the first 6-12 weeks in patients with cavitary disease.

    Six months of therapy is recommended.

    Clarithromycin is probably useful for treating pulmonary MAC, but fewer data support clarithromycin in this setting compared to studies of patients with AIDS. However, extrapolating the data and substituting clarithromycin for the more toxic streptomycin seems reasonable.

    Antibiotics are not required to treat lymphadenitis in children.
    Surgical Care:

    Pulmonary MAC infection in patients with lung disease may require surgical excision of focal pulmonary nodules. Lobectomy has also been recommended for more extensive lung infection in patients who have not responded to antibiotics in the past. This, however, does not occur as often now that more potent antibiotics are available.
    Surgical excision of the infected nodes is curative in more than 95% of children with lymphadenitis.
    Consultations:

    Consultants for MAC infections in patients with AIDS include an infectious diseases specialist, a general surgeon for lymph node biopsy, a gastroenterologist for liver biopsy, and a hematologist-oncologist for bone marrow biopsy.
    Consultants for patients with lung disease who develop pulmonary MAC infection include an infectious diseases specialist, a pulmonologist, and a cardiothoracic surgeon.
    Consultants for lymphadenitis in children include an infectious diseases specialist, a general surgeon, and an ear, nose, and throat (ENT) specialist.

    MEDICATION Section 7 of 10 Prev Top Next

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    The drugs used most often for treatment of MAC are clarithromycin, ethambutol, and rifabutin. Amikacin is used for refractory cases. Combination therapy is important to enhance efficacy and prevent resistance. Duration of treatment is not established. If it is too short, relapse may occur. If it is too long, medication adverse effects are of concern.



    Drug Category: Antibiotics -- Empiric antimicrobial therapy must be comprehensive.
    Drug Name
    Clarithromycin (Biaxin) -- Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, arresting RNA-dependent protein synthesis.
    Adult Dose 500 mg PO bid or 1 g PO qd if Biaxin XL
    Pediatric Dose 15 mg/kg/d PO divided bid
    Contraindications Documented hypersensitivity; coadministration of pimozide
    Interactions Toxicity increases with coadministration of fluconazole and pimozide; clarithromycin effects decrease and GI adverse effects may increase with coadministration of rifabutin or rifampin; may increase toxicity of anticoagulants, cyclosporine, tacrolimus, digoxin, omeprazole, carbamazepine, ergot alkaloids, triazolam, and HMG CoA-reductase inhibitors; serious cardiac arrhythmias may occur with coadministration of cisapride; plasma levels of certain benzodiazepines may increase, prolonging CNS depression; arrhythmias and increase in QTc intervals occur with disopyramide; coadministration with omeprazole may increase plasma levels of both agents
    Pregnancy C - Safety for use during pregnancy has not been established.
    Precautions Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; administer half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies

    Drug Name
    Ethambutol (Myambutol) -- Impairs cell metabolism by inhibiting synthesis of 1 or more metabolites, which in turn causes cell death. No cross-resistance demonstrated. Mycobacterial resistance is frequent with previous therapy. Use in these patients in combination with second-line drugs that have not been administered previously.
    Adult Dose Patients with AIDS: 15 mg/kg/d PO
    Patients with lung disease: 25 mg/kg/d PO for 2 months then 15 mg/kg/d for pulmonary MAC infection
    Pediatric Dose 15 mg/kg/d PO
    Contraindications Documented hypersensitivity; optic neuritis (unless clinically indicated)
    Interactions Aluminum salts may delay and reduce absorption (administer several hours before or after ethambutol dose)
    Pregnancy C - Safety for use during pregnancy has not been established.
    Precautions Reduce dose in patients with low CrCl; monitor visual acuity and color vision monthly; clarithromycin can rarely lead to elevation in uric acid levels and cause acute gout

    Drug Name
    Rifabutin (Mycobutin) -- Ansamycin antibiotic derived from rifamycin S. Inhibits DNA-dependent RNA polymerase, preventing chain initiation, in susceptible bacterial strains. If GI upset occurs, administer dose bid with food.
    Adult Dose 300 mg/d PO
    Pediatric Dose Not established; suggested dose is 5 mg/kg/d PO
    Contraindications Documented hypersensitivity
    Interactions Steady-state zidovudine plasma levels may decrease after repeated rifabutin dosing but does not affect inhibition of HIV by zidovudine; decreases activity of dapsone, narcotics, anticoagulants, steroids, cyclosporine, PO contraceptives, quinidine, PO hypoglycemics, ketoconazole, beta-blockers, mexiletine, theophylline, anticonvulsants, and chloramphenicol
    Pregnancy B - Usually safe but benefits must outweigh the risks.
    Precautions Perform hematologic studies periodically because of association with neutropenia and, more rarely, thrombocytopenia; monitor visual acuity because it may cause uveitis; monitor liver function

    Drug Name
    Amikacin (Amikin) -- Irreversibly binds to 30S subunit of bacterial ribosomes; blocks recognition step in protein synthesis; causes growth inhibition. Use the patient's IBW for dosage calculation.
    Adult Dose 10-15 mg/kg/d IV
    Pediatric Dose Administer as in adults
    Contraindications Documented hypersensitivity; renal insufficiency
    Interactions Coadministration with other aminoglycosides and amphotericin B increases nephrotoxicity; enhances effects of neuromuscular blocking agents; causes respiratory depression; irreversible hearing loss may occur with coadministration of loop diuretics
    Pregnancy D - Unsafe in pregnancy
    Precautions Monitor renal function; prolonged very high aminoglycoside serum levels have been associated with ototoxicity, vestibular toxicity, difficulty in walking, and acute muscular paralysis; avoid administering concurrently with loop diuretics

    Drug Name
    Azithromycin (Zithromax) -- Inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, arresting RNA-dependent protein synthesis.
    Adult Dose 500 mg PO/IV qd
    Pediatric Dose 10 mg/kg PO qd
    Contraindications Documented hypersensitivity to azithromycin, erythromycin, or any macrolide antibiotic
    Interactions Aluminum- and magnesium-containing antacids reduce the peak serum levels but not the AUC of PO administered azithromycin; although no drug interactions have been reported in clinical trials with azithromycin, because interactions have been documented with other macrolides, careful monitoring is recommended with the following drugs: digoxin (elevated digoxin levels), ergotamine or dihydroergotamine (acute ergot toxicity), triazolam (increased pharmacologic effect of triazolam by decreasing the clearance of triazolam), and drugs metabolized by the cytochrome P450 system (elevated levels of carbamazepine, terfenadine, cyclosporine, hexobarbital, and phenytoin)
    Pregnancy B - Usually safe but benefits must outweigh the risks.
    Precautions Coadministration with ranitidine or bismuth citrate is not recommended with CrCl <25 mL/min; administer half dose or increase dosing interval if CrCl <30 mL/min; diarrhea may be sign of pseudomembranous colitis; superinfections may occur with prolonged or repeated antibiotic therapies

    Drug Name
    Levofloxacin -- Fluorinated quinolone that inhibits bacterial DNA gyrase and topoisomerase IV.
    Adult Dose 500 mg PO/IV qd
    Pediatric Dose Not for pediatric use
    Contraindications Documented hypersensitivity to levofloxacin or other quinolone antibiotics
    Interactions Concurrent administration with antacids containing aluminum or magnesium as well as sucralfate, iron, buffered didanosine, and multivitamins containing zinc may interfere with the GI absorption of levofloxacin, resulting in lower than desired systemic levels; concomitant administration of NSAIDs and levofloxacin may increase the risk of seizures; disturbances of blood glucose, including hypoglycemia and hyperglycemia, have been reported in patients treated concomitantly with levofloxacin and antidiabetic medications
    Pregnancy C - Safety for use during pregnancy has not been established.
    Precautions Because of possible hypotension with rapid or bolus IV infusion, levofloxacin should be infused over a 60- to 90-min period; levofloxacin should be administered with caution in patients with renal insufficiency, and patients should maintain adequate hydration; moderate-to-severe phototoxicity has been observed in patients taking this class of antibiotics; levofloxacin should be used with caution in patients with known or suspected CNS disorders; some quinolones have been associated with prolonged QT intervals
    FOLLOW-UP Section 8 of 10 Prev Top Next

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    Further Inpatient Care:


    Patients with AIDS may need to be admitted for blood transfusions, or they may need IV amikacin if they do not respond to oral antibiotics.
    Patients with lung disease who develop pulmonary MAC infection may need to be admitted for 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 and for anemia that may require transfusion.
    Carefully monitor patients with lung disease who develop pulmonary MAC infection for adverse effects of medications.
    In/Out Patient Meds:


    Clarithromycin, ethambutol, rifabutin, and amikacin may be administered on an inpatient or outpatient basis.
    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.
    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:


    In recent studies, life expectancy for patients with AIDS and MAC infection is 9 months, but with HAART, it is probably much longer.
    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 Section 9 of 10 Prev Top Next

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    Medical/Legal Pitfalls:


    Failing to offer prophylaxis to patients positive for HIV with a CD4 + lymphocyte count of fewer than 50 cells per m L may cause problems.
    Ethambutol may cause optic neuritis and blindness, especially with coexisting renal dysfunction.
    Rifampin and rifabutin may decrease the effectiveness of contraceptives. Advise patients of this potential effect.
    BIBLIOGRAPHY Section 10 of 10 Prev Top

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    Chaisson RE, Benson CA, Dube MP: Clarithromycin therapy for bacteremic Mycobacterium avium complex disease. A randomized, double-blind, dose-ranging study in patients with AIDS. AIDS Clinical Trials Group Protocol 157 Study Team. Ann Intern Med 1994 Dec 15; 121(12): 905-11 [Medline] .
    Gordin FM, Sullam PM, Shafran SD: A randomized, placebo-controlled study of rifabutin added to a regimen of clarithromycin and ethambutol for treatment of disseminated infection with Mycobacterium avium complex. Clin Infect Dis 1999 May; 28(5): 1080-5 [Medline] .
    Havlik JA Jr, Metchock B, Thompson SE 3d: A prospective evaluation of Mycobacterium avium complex colonization of the respiratory and gastrointestinal tracts of persons with human immunodeficiency virus infection. J Infect Dis 1993 Oct; 168(4): 1045-8 [Medline] .
    Havlir DV, Dube MP, Sattler FR: Prophylaxis against disseminated Mycobacterium avium complex with weekly azithromycin, daily rifabutin, or both. California Collaborative Treatment Group. N Engl J Med 1996 Aug 8; 335(6): 392-8 [Medline] .
    Horsburgh CR Jr, Chin DP, Yajko DM: Environmental risk factors for acquisition of Mycobacterium avium complex in persons with human immunodeficiency virus infection. J Infect Dis 1994; 170(2): 362-7 [Medline] .
    Nightingale SD, Cameron DW, Gordin FM: Two controlled trials of rifabutin prophylaxis against Mycobacterium avium complex infection in AIDS. N Engl J Med 1993; 329(12): 828-33 [Medline] .
    Oldfield EC 3rd, Fessel WJ, Dunne MW: Once weekly azithromycin therapy for prevention of Mycobacterium avium complex infection in patients with AIDS: a randomized, double-blind, placebo-controlled multicenter trial. Clin Infect Dis 1998 Mar; 26(3): 611-9 [Medline] .
    Pierce M, Crampton S, Henry D: A randomized trial of clarithromycin as prophylaxis against disseminated Mycobacterium avium complex infection in patients with advanced acquired immunodeficiency syndrome. N Engl J Med 1996; 335: 384-91 [Medline] .
    Reich JM, Johnson RE: Mycobacterium avium complex pulmonary disease presenting as an isolated lingular or middle lobe pattern. The Lady Windermere syndrome. Chest 1992 Jun; 101(6): 1605-9 [Medline] .
    Sison JP, Yao Y, Kemper CA: Treatment of Mycobacterium avium complex infection: do the results of in vitro susceptibility tests predict therapeutic outcome in humans? J Infect Dis 1996; 173: 677-83 [Medline] .
    von Reyn CF, Maslow JN, Barber TW: Persistent colonisation of potable water as a source of Mycobacterium avium infection in AIDS. Lancet 1994 May 7; 343(8906): 1137-41 [Medline] .


  3. #3
    biotechguy0331 is offline New Member
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    http://www.designerdiagnostics.com has a TB and NTM test that can diagnosis whether you have an NTM, such as M Avium Complex or Tuberculosis.

    http://www.designerdiagnostics.com

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