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 pancytopaenia.
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 culture-positive 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 two medicines.
- Macrolide e.g.:
- Clarithromycin, oral, 7.5mg/kg/dose 12 hourly.
OR - Azithromycin, oral 10 mg/kg/day, if currently on efavirenz.
PLUS - Ethambutol, oral, 20–25 mg/kg once daily.
REFERRAL
- Poor response to treatment should be referred for consideration of a quinolone, amikacin, or rifabutin.