4,5,7-12,15,16,26,27 Hepatomegaly, splenomegaly, or lymphadenopathy (paratracheal, retroperitoneal, para-aortic, or less commonly peripheral) may be identified on physical examination or by radiographic or other imaging studies.
#APPENDIX PPT FOR MAC MAC#
Laboratory abnormalities particularly associated with disseminated MAC disease include anemia (often out of proportion to that expected for the stage of HIV disease) and elevated liver alkaline phosphatase levels. Symptoms may include fever, night sweats, weight loss, fatigue, diarrhea, and abdominal pain. 21-25 Early symptoms may be minimal and can precede detectable mycobacteremia by several weeks. In people living with HIV with advanced immunosuppression who are not on ART, MAC disease often is a disseminated, multi-organ infection, although localized disease may also be seen.
avium antigens, possibly reflecting defects in T-cell repertoire. MAC disease typically occurs in people with HIV with CD4 T lymphocyte (CD4) cell counts 1,000 copies/mL, ongoing viral replication despite ART, previous or concurrent OIs, and reduced in vitro lymphoproliferative immune responses to M. 1,14 Household or close contacts of those with MAC disease do not appear to be at increased risk of disease, and person-to-person transmission is unlikely. The mode of MAC transmission is thought to be through inhalation, ingestion, or inoculation of MAC bacteria via the respiratory or gastrointestinal (GI) tract. 2,4,8,11,12 Although epidemiologic associations have been identified, no environmental exposure or behavior has been consistently linked to subsequent risk of developing MAC disease. 13 An estimated 7% to 12% of adults have previously contracted MAC, although rates of disease vary in different geographic locations. 4,7-12 Recent studies conducted using newer bacterial typing technology suggest organisms causing bacteremia in people with HIV include a diversity of species, including the M. avium was the etiologic agent in >95% of people living with HIV with advanced immunosuppression who acquired disseminated MAC disease.
1-6 In the era prior to the availability of effective antiretroviral therapy (ART), M. Organisms of the Mycobacterium avium complex (MAC) are ubiquitous in the environment.