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Drugs Jul 1997Since the start of the acquired immunodeficiency syndrome (AIDS) epidemic, the role of Mycobacterium avium complex (MAC) as an opportunistic pathogen in advanced AIDS... (Review)
Review
Since the start of the acquired immunodeficiency syndrome (AIDS) epidemic, the role of Mycobacterium avium complex (MAC) as an opportunistic pathogen in advanced AIDS patients has become more and more clear. Once identified in an advanced AIDS patient it is possible to find evidence that the MAC organism and infection is not only present in the pulmonary tree, but has also disseminated to a wide variety of body organs. Treatment of MAC or disseminated MAC (DMAC) infections has historically been very difficult due to the inherent resistance of the MAC pathogen to most standard antimycobacterial agents. This has resulted in the development of new agents for the prevention of DMAC infection as well as combinations of both new and standard agents for its treatment. Three drugs are currently approved for single-agent DMAC prophylaxis, including rifabutin, azithromycin and clarithromycin. Combinations of agents for DMAC treatment are highly variable in content but most experts agree that all combinations should contain one of the advanced generation macrolides (azithromycin or clarithromycin). Both of these agents have favourable intracellular pharmacokinetics and pharmacodynamics which maximise their effects against this mostly intracellular pathogen. Due to the paucity of comparative data, no one macrolide can be recommended over the other. However, the expected increase in compliance, lower weekly and annual costs, and lack of any drug interactions may make azithromycin a preferable choice, but this should be decided on a case-by-case basis.
Topics: Anti-Bacterial Agents; Humans; Macrolides; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection
PubMed: 9211081
DOI: 10.2165/00003495-199754010-00006 -
The Journal of Antibiotics Feb 2020In this study we aimed to evaluate the effect of the combination of clarithromycin and four inhibitors of efflux pumps (EPIs), including berberine (BER), carbonyl...
In this study we aimed to evaluate the effect of the combination of clarithromycin and four inhibitors of efflux pumps (EPIs), including berberine (BER), carbonyl cyanide m-chlorophenylhydrazone (CCCP), piperine (PIP) and tetrandrine (TET), against 12 Mycobacterium avium complex clinical isolates. The minimum inhibitory concentration (MIC) of clarithromycin showed at least a fourfold reduction in presence of BER (83% of total isolates), CCCP (67%), PIP (25%) and TET (75%). Our results showed that the EPIs tested are active against both clarithromycin susceptible and resistant isolates. In particular, among the six resistant isolates, TET reversed the resistance phenotype of three strains, BER of two strains, and CCCP and PIP of one strain. Overall, our findings show the importance of these compounds in increasing the efficacy of clarithromycin in MAC clinical isolates.
Topics: Anti-Bacterial Agents; Clarithromycin; Drug Resistance, Bacterial; Humans; Membrane Transport Proteins; Mycobacterium avium Complex
PubMed: 31624335
DOI: 10.1038/s41429-019-0245-1 -
Emerging Infectious Diseases Mar 2019Attention to environmental sources of Mycobacterium avium complex (MAC) infection is a vital component of disease prevention and control. We investigated MAC...
Attention to environmental sources of Mycobacterium avium complex (MAC) infection is a vital component of disease prevention and control. We investigated MAC colonization of household plumbing in suburban Philadelphia, Pennsylvania, USA. We used variable-number tandem-repeat genotyping and whole-genome sequencing with core genome single-nucleotide variant analysis to compare M. avium from household plumbing biofilms with M. avium isolates from patient respiratory specimens. M. avium was recovered from 30 (81.1%) of 37 households, including 19 (90.5%) of 21 M. avium patient households. For 11 (52.4%) of 21 patients with M. avium disease, isolates recovered from their respiratory and household samples were of the same genotype. Within the same community, 18 (85.7%) of 21 M. avium respiratory isolates genotypically matched household plumbing isolates. Six predominant genotypes were recovered across multiple households and respiratory specimens. M. avium colonizing municipal water and household plumbing may be a substantial source of MAC pulmonary infection.
Topics: Adult; Aged; Aged, 80 and over; Environmental Microbiology; Female; Genotype; History, 21st Century; Humans; Male; Middle Aged; Minisatellite Repeats; Multilocus Sequence Typing; Mycobacterium avium; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Philadelphia; Phylogeny; Public Health Surveillance; Water Microbiology; Whole Genome Sequencing
PubMed: 30789130
DOI: 10.3201/eid2503.180336 -
Emerging Infectious Diseases Apr 2009
Topics: Child, Preschool; Communicable Diseases, Emerging; Female; Genes, Bacterial; Humans; Lymphatic Diseases; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Polymerase Chain Reaction
PubMed: 19331753
DOI: 10.3201/eid1504.081436 -
Zhonghua Jie He He Hu Xi Za Zhi =... Jul 2018To investigate the antimicrobial susceptibility and genotyping of . A total of 150 . isolates were collected. The susceptibility against 15 antimicrobial agents...
To investigate the antimicrobial susceptibility and genotyping of . A total of 150 . isolates were collected. The susceptibility against 15 antimicrobial agents widely used for treatment of non-tuberculosis mycobacteria (NTM) infections, was tested by broth microdilution assay. Variable number of tandem repeats (VNTR) assay was also performed using the 16-loci genotyping method. The drug susceptibility test revealed that clarithromycin (97.3%, 146/150), moxifloxacin (94.0%, 141/150) and amikacin (90.0%, 135/150) had the best antimicrobial activities against the . isolates. Secondly, 75.3%(113/150), 64.0%(96/150), 52.7%(79/150) and 8.7%(13/150) of the strains were susceptible to rifampicin, linezolid, capreomycin, and ethambutol, respectively. The MIC(50) and MIC(90) values of the 3 injectable anti-tuberculosis drugs were as follows: amikacin 4 mg/L and 16 mg/L, streptomycin 4 mg/L and 16 mg/L, capreomycin 8 mg/L and 16 mg/L. The MIC(50) and MIC(90) values of the 5 different fluoroquinolones were 0.5 mg/L and 2 mg/L for moxifloxacin , 1 mg/L and 8 mg/L for ciprofloxacin, 1 mg/L and 8ug/ml for levofloxacin, 2 mg/L and 16 mg/L for antoflolxacin, 2 mg/L and 16 mg/L for ofloxacin. The Hunter-Gaston Discriminatory Index (HGDI) value for the 16-loci VNTR typing of . isolates was 0.994. VNTR differentiated the 150 isolates into 21 clusters and acquired a total of 121 unique patterns. Drug resistance profile was not independently associated with cluster strains. Clarithromycin, moxifloxacin and amikacin had the best antimicrobial activities against . isolates. The 16-loci VNTR typing revealed a highly discriminatory power and drug resistance profile was not independently associated with cluster strains.
Topics: Amikacin; Anti-Bacterial Agents; Clarithromycin; Drug Resistance, Bacterial; Genotype; Humans; Microbial Sensitivity Tests; Moxifloxacin; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection
PubMed: 29996350
DOI: 10.3760/cma.j.issn.1001-0939.2018.07.007 -
Clinical Infectious Diseases : An... Apr 1994Because the symptoms and laboratory abnormalities associated with disseminated disease due to the Mycobacterium avium complex (MAC) are nonspecific, diagnosis requires... (Review)
Review
Because the symptoms and laboratory abnormalities associated with disseminated disease due to the Mycobacterium avium complex (MAC) are nonspecific, diagnosis requires recovery of the organism from blood or other normally sterile body sites. Isolation of MAC by conventional mycobacterial culture on tubed solid medium generally takes 3-4 weeks. This interval can be decreased to 5-12 days with the radiometric BACTEC TB system and to 12-19 days with Septi-Chek AFB. For diagnosis of MAC bacteremia, blood is inoculated directly into a BACTEC TB 13A blood culture vial. For quantitative cultures, blood is collected in an Isolator lysis-centrifugation tube, and the sediment of the processed sample is inoculated onto agar plates. MAC is identified by conventional biochemical tests, which take several weeks or months, or with commercial DNA probes or chromatography, each of which provides results in a few hours. No standardized reference method for antimicrobial susceptibility testing exists, and no correlation between in vitro results and clinical efficacy is clear. Isolates appear more sensitive in broth than on agar. Evaluation of susceptibility in macrophage and animal models is helpful because drugs concentrated in cells may be more efficacious against MAC--an intracellular pathogen--than would be predicted by results in cell-free systems.
Topics: AIDS-Related Opportunistic Infections; Bacteriological Techniques; Humans; Microbial Sensitivity Tests; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Specimen Handling; Staining and Labeling; Time Factors
PubMed: 7515701
DOI: 10.1093/clinids/18.supplement_3.s227 -
International Journal of... 2017Disseminated Mycobacterium avium complex (DMAC) has historically been described in the immunocompromised. The current epidemiologic research suggests that the incidence...
Disseminated Mycobacterium avium complex (DMAC) has historically been described in the immunocompromised. The current epidemiologic research suggests that the incidence of nontuberculous mycobacterial infections is increasing. We present a case of DMAC infection manifesting as hepatic granulomas in a 35-year-old immunocompetent female. This case suggests DMAC infection in a patient without traditional epidemiological risk factors.
Topics: Adult; Female; Humans; Immunocompromised Host; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection
PubMed: 28559528
DOI: 10.4103/ijmy.ijmy_28_17 -
Antimicrobial Agents and Chemotherapy Dec 2019We evaluated the efficacy of intermittent azithromycin and ethambutol therapy for noncavitary complex pulmonary disease (MAC-PD). Twenty-nine (76%) of 38 patients...
We evaluated the efficacy of intermittent azithromycin and ethambutol therapy for noncavitary complex pulmonary disease (MAC-PD). Twenty-nine (76%) of 38 patients achieved sputum culture conversion after 12 months of treatment, and sputum smear positivity was an independent factor for failure to achieve culture conversion (adjusted odds ratio, 26.7; 95% confidence interval, 2.1 to 339.9; = 0.011). Intermittent azithromycin and ethambutol may be an optional treatment regimen for noncavitary MAC-PD.
Topics: Antitubercular Agents; Azithromycin; Body Mass Index; Drug Therapy, Combination; Ethambutol; Female; Humans; Lung Diseases; Male; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Odds Ratio; Treatment Outcome
PubMed: 31611366
DOI: 10.1128/AAC.01787-19 -
The Journal of Hospital Infection Mar 1993The peroxygen-based disinfectant, 'Virkon' (at concentrations of 2, 3 and 4%) was tested against Mycobacterium tuberculosis and M. avium-intracellulare over exposure... (Comparative Study)
Comparative Study
The peroxygen-based disinfectant, 'Virkon' (at concentrations of 2, 3 and 4%) was tested against Mycobacterium tuberculosis and M. avium-intracellulare over exposure times ranging between 30 and 120 min. Two test procedures were used: (a) a standard plate method, (b) a method incorporating the use of the 'Bactec' 460 radiometric system to chart bacterial growth following exposure to 'Virkon'. In our hands and under the conditions of the two test methods, 'Virkon' did not produce a satisfactory kill of the test strains over 60 or 120 min.
Topics: Disinfectants; Disinfection; Humans; Microbial Sensitivity Tests; Mycobacterium avium Complex; Mycobacterium tuberculosis; Peroxides; Sulfuric Acids; Time Factors
PubMed: 8099093
DOI: 10.1016/0195-6701(93)90024-t -
Research in Microbiology May 1992
Review
Topics: AIDS-Related Opportunistic Infections; Acquired Immunodeficiency Syndrome; Animals; Humans; Macrophages; Mycobacterium avium Complex; Mycobacterium avium-intracellulare Infection; Paratuberculosis; Polymorphism, Restriction Fragment Length
PubMed: 1360693
DOI: 10.1016/0923-2508(92)90057-u