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Mycobacterium Avium Complex
disease (MAC) is one of the most common bacterial infections in people
with AIDS. MAC is the term for two related bacteria: Mycobacterium
avium and Mycobacterium intracellulare. These bacteria are found in
water, dust, soil and bird droppings. They enter the body in food and
water or sometimes through the lungs. MAC is most likely to occur in
people with CD4+ cell counts below 50 and at least one other
opportunistic infection (OI). Most people usually have small numbers
of these bacteria growing in their gut or lungs, but do not have any
symptoms. This is because a weakened immune system allows the bacteria
to attack the lining of the gut and multiply. From there, they can
enter the blood and spread through the body, which is called disseminated
infection.
The most common symptoms of
MAC are persistent fevers plus night sweats, loss of appetite, weight
loss, tiredness or worsening diarrhea. Symptoms of early disease often
involve the gut: stomach cramps, nausea and vomiting. Disseminated
disease can lead to bone, brain or skin infections, or cause painful
joints. Signs of MAC include swollen abdominal lymph nodes, usually on
only one side of the body, and an enlarged liver and spleen. Since
many of these symptoms are similar to symptoms of other opportunistic
infections (OIs), it's important to get a correct diagnosis before you
start treatment. If you have symptoms like these, talk to your doctor.
If you develop MAC disease,
treatment can ease symptoms and improve your quality of life. MAC is
diagnosed by culture from blood, tissue or bone marrow. 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).
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, as with antiretrovirals for HIV,
is effective and may slow the development of drug resistance. The
standard of treatment for MAC infection is Clarithromycin or
Azithromycin together with Ethambutol and Rifabutin.
Drugs can also be used to
prevent or delay the onset of MAC in people with HIV. The decision to
start MAC prevention/prophylaxis should take into account possible
drug side effects and interactions with other drugs. The Public Health
Service recommends that people with CD4+ cell counts below 50 should
take preventative medications for MAC.
If you would
like more information on MAC, or any other opportunistic infection
please call one of the Women Alive Treatment Advocates today.
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