Mycobacterium avium-intracellulare also known as Mycobacterium avium complex causes pulmonary infections in immune compromised patients. Mycobacterium avium complex (MAC) consists of two species: M. avium and M. intracellulare. As these species are difficult to differentiate, they are collectively referred to as Mycobacterium avium-intracellulare. MAC is the most common infection caused due to nontuberculous mycobacterium in acquired immunodeficiency syndrome (AIDS) patients. Mycobacterium avium-intracellulare infections are rarely found in immunocompetent individuals. According to Medscape, M. intracellulare accounts for 40% of infections in immunocompetent patients with underlying lung diseases. Mycobacterium avium-intracellulare is ubiquitous and has been isolated from various samples such as household hot water systems, dust, soil, cigarette filters and others. This ubiquitous nature has been responsible for higher rate of infections in immunocompromised patients and patients with lung disorders such as chronic obstructive pulmonary disease (COPD), pulmonary malignancy, and cystic fibrosis. Literature suggests that individuals acquire the infections via inhalation or through the gastrointestinal tract by ingestion of food contaminated with the bacterium. The infection may also lead to lymphadenitis in children aged 1 to 4 years of age. Commonly affected lymphnodes include submandibular, parotid, postauricular.submaxillary, and preauricular.
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Common symptoms for Mycobacterium avium-intracellulare are cough, excessive sputum production, dysponea, fever with night sweat, fatigue and weight loss. Diagnosis is confirmed through acid fast staining of sputum samples. Various publications report that Mycobacterium avium-intracellulare is resistant to antibiotics and antituberculosis drugs. Currently, following antibiotics have been prescribed for treatment of MAC infections:
> Aminoglycosides (amikacin and streptomycin)
> Fluoroquinolones (ciprofloxacin, levofloxacin, and moxifloxacin)
> Macrolides (clarithromycin, and azithromycin)
> Rifamycins (rifampin, and rifabutin)
Pulmonary Mycobacterium avium-intracellulare infection in patients with lung disease can be treated by surgical excision of pulmonary nodules. Surgeons also advocate that lobectomy has been effective in treating extensive lung infection in patients with antibiotic resistance.
Mycobacterium avium-intracellulare lymphadenitis in children is mostly treated by surgical excision of affected lymph nodes. Several of the above mentioned drugs are on WHO’s list of essential medicines.
Although various drugs are available for treatment of the infection, weak research pipeline has posed a threat to the market. Higher prevalence of infectious diseases exists in low and middle income countries. According to World Health Organization (WHO), more than 95% of HIV infected individuals live in developing countries; sub-Saharan region contributes over 25 million HIV infected people while Asia-Pacific contributes 7 million HIV patients. In the U.S. and U.K. however over 1 million individuals suffer from AIDS. Pulmonary diseases are also major predisposing factors for Mycobacterium avium-intracellulare infections. WHO estimates that over 60 million individuals globally have been known to suffer from moderate to severe chronic obstructive pulmonary disease (COPD). It is predicted that over 90% of COPD deaths occur in low and middle income countries.
The statistics also forecast that COPD is expected to become third leading cause of death worldwide by 2030. According to statistics published by World Health Organization, lung cancer accounts for over 1.5 million deaths globally. Majority of these mortalities are accounted to developing countries. These statistics suggest that chances of Mycobacterium avium-intracellulare infections are higher in developing countries. Low awareness of disease and related medical treatment, poor reimbursements and financial inability are major restraints impeding market growth in developing countries. In addition, rapidly developing healthcare sector and increasing per capita income in countries such as India, China, and Brazil have created a profitable market in these courtiers. Rapid diagnosing techniques such as dipsticks will help accumulate accurate perspective of the disease and the population it affects in developing countries. Due to low sanitation in many regions, incidence recorded may well be below the actual number.
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