Mycobacterium avium complex

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Última revisão: 11 Aug 2025

Última atualização: 03 Apr 2025

Mycobacterium avium complex (MAC) has variable presenting features including chronic cough, weight loss, and fevers.

Increased incidence in patients with underlying lung disease, heavy smoking, and excessive alcohol consumption.

HIV-infected patients with CD4 cell count <50 cells/microliter are also at increased risk of infection.

Diagnosis of pulmonary disease in non-HIV-infected individuals requires repeated isolation of the organism from respiratory secretions, in addition to compatible symptoms and radiographic presentation.

Combination treatment with at least two drugs is essential.

Definição

MAC, also known as Mycobacterium avium-intracellulare (MAI), consists of two mycobacterium species, M avium and M intracellulare.[1] Although MAC isolates can be identified as M avium or M intracellulare by molecular techniques, there is no prognostic or treatment advantage for doing so.[2]

In humans, MAC traditionally causes three disease syndromes: pulmonary disease, cervical lymphadenitis, and disseminated disease.[3][4][5] A fourth syndrome, a hypersensitivity pneumonitis associated with hot tub use, has also been described.[6]

História e exame físico

Principais fatores diagnósticos

underlying lung disease
chronic productive cough
dyspnea
weight loss
fatigue
fever
lymphadenopathy
immunocompromised
hot tub use

Detalhes completos

Outros fatores diagnósticos

age under 5 years
middle-to-old age
night sweats
abdominal pain
diarrhea
rhonchi/crackles
hepatomegaly
splenomegaly
thin body habitus
pectus excavatum
scoliosis
systolic click and murmur

Detalhes completos

Fatores de risco

underlying lung diseases
smoking
excessive alcohol use
increasing age
hot tub use
HIV/AIDS
severe immunosuppression
genetic cytokine defects

Detalhes completos

Investigações diagnósticas

Primeiras investigações a serem solicitadas

CBC with differential
LFT
chest x-ray
sputum culture
blood culture

Detalhes completos

Investigações a serem consideradas

high-resolution CT (HRCT) scanning
bone marrow aspirate for culture
bronchoscopy/bronchial lavage
lung biopsy
lymph node biopsy

Detalhes completos

Novos exames

polymerase chain reaction

Algoritmo de tratamento

CONTÍNUA

pulmonary MAC

disseminated MAC

MAC lymphadenitis

MAC hypersensitivity pneumonitis

Colaboradores

Autores

Zelalem Temesgen, MD, FIDSA

Professor of Medicine

Director, Mayo Clinic Center for Tuberculosis

Director, HIV Program

Consultant, Division of Infectious Diseases

Mayo Clinic

Rochester

Declarações

ZT declares that he has no competing interests.

Agradecimentos

Dr Temesgen would like to gratefully acknowledge Dr Dereje S. Ayo, a previous contributor to this topic.

Declarações

DSA declares that he has no competing interests.

Revisores

Jonathan P. Parsons, MD

Assistant Professor

Division of Pulmonary, Allergy, Critical Care and Sleep Medicine

Ohio State University Medical Center

Columbus

Declarações

JPP declares that he has no competing interests.

Sandro Vento, MD

Director

Infectious Diseases Unit

Annunziata Hospital

Cosenza

Italy

Declarações

SV declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: Disseminated mycobacterium avium complex disease. 2024 [internet publication].Texto completo

Griffith DE, Aksamit T, Brown-Elliott BA, et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med. 2007 Feb 15;175(4):367-416.Texto completo Resumo

Daley CL, Iaccarino JM, Lange C, et al. Treatment of nontuberculous mycobacterial pulmonary disease: an official ATS/ERS/ESCMID/IDSA clinical practice guideline. Clin Infect Dis. 2020 Aug 14;71(4):e1-36.Texto completo Resumo

Haworth CS, Banks J, Capstick T, et al. British Thoracic Society guidelines for the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD). Thorax. 2017 Nov;72(suppl 2):ii1-64.Texto completo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais
- Pulmonary tuberculosis
- Other nontuberculous mycobacteria (NTM)
- HIV-related lymphoma
Mais Diagnósticos diferenciais
Diretrizes
- Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV
- Guidelines for the prevention and treatment of opportunistic infections in children with and exposed to HIV
Mais Diretrizes
Folhetos informativos para os pacientes
Quitting smoking
Mais Folhetos informativos para os pacientes
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Mycobacterium avium complex

Resumo

Definição

História e exame físico

Principais fatores diagnósticos

Outros fatores diagnósticos

Fatores de risco

Investigações diagnósticas

Primeiras investigações a serem solicitadas

Investigações a serem consideradas

Novos exames

Algoritmo de tratamento

pulmonary MAC

disseminated MAC

MAC lymphadenitis

MAC hypersensitivity pneumonitis

Colaboradores

Autores

Zelalem Temesgen, MD, FIDSA

Declarações

Agradecimentos

Declarações

Revisores

Jonathan P. Parsons, MD

Declarações

Sandro Vento, MD

Declarações

Peer reviewer acknowledgements

Disclosures

Referências

Principais artigos

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.

Diagnósticos diferenciais

Diretrizes

Folhetos informativos para os pacientes

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se ou assinar para acessar todo o BMJ Best Practice

Conectar-se para acessar todo o BMJ Best Practice