Mycobacterium Avium Complex (MAC) Infection
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: A31.0 DESCRIPTION Atypical mycobacterium, causing disease in extremely immunocompromised patients. MAC infection in HIV-infected children usually presents with disseminated disease, often enlarged intra-abdominal lymph nodes and pancytopenia. Pulmonary, GIT or skin disease is less common
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: A31.0
DESCRIPTION
Atypical mycobacterium, causing disease in extremely immunocompromised patients.
MAC infection in HIV-infected children usually presents with disseminated disease, often enlarged intra-abdominal lymph nodes and pancytopenia. Pulmonary, GIT or skin disease is less common.
DIAGNOSTIC CRITERIA
- MAC may be isolated from blood, bone marrow, lymph node, other sterile fluids and tissues.
- Confirm diagnosis with a biopsy for histology and culture or 2 culturepositive sputa or gastric aspirates. MAC commonly colonizes the lungs and when isolated is most frequently not of clinical relevance. When diagnosis is in doubt, consult a paediatric infectious disease specialist or microbiologist prior to initiating therapy.
- PCR line probe test can be used for diagnosis
GENERAL AND SUPPORTIVE MEASURES
If MAC infection is localised to a single enlarged peripheral lymph node, an excision of the lymph node is therapeutic.
MEDICINE TREATMENT
Specialist initiated
Identify and treat predisposing immune suppression.
Therapy consists of a combination of at least 3 medicines:
- Macrolide, e.g.:
- Clarithromycin, oral, 7.5 mg/kg/dose 12 hourly.
OR - Azithromycin, oral, 10 mg/kg/day, if currently on efavirenz.
- Clarithromycin, oral, 7.5 mg/kg/dose 12 hourly.
PLUS
- Ethambutol, oral, 20–25 mg/kg once daily.
PLUS
- Rifampicin, oral, 10–20 mg/kg once daily.
- Max dose: 600 mg.
REFERRAL
- Poor response to treatment should be referred for consideration of a quinolone, amikacin, or rifabutin.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 8: Infective/Infectious Diseases, 8.15 Mycobacterium Avium Complex (mac) Infection