Mycobacterium avium-intracellulare infection

B. V. Wichert, R. J. Gonalez-Rothi, L. E. Straub, B. M. Wichert, and H. Schreier, Amikacin liposomes preparation, characterization, and in vitro activity against Mycobacterium avium-intracellulare infection in alveolar macrophages, Int. J. Pharm. 78 221 (1992). 

CLARITHROMYCIN, ERYTHROMYCIN PROTEASE INHIBITORS Possibly t adverse effects of macrolide with atazanavir, ritonavir (with or without lopinavir) and saquinavir Inhibition of CYP3A4- and possibly CYP1 A2-mediated metabolism. Altered transport via P-gp may be involved. Amprenavir and indinavir are also possibly t by erythromycin Consider alternatives unless there is Mycobacterium avium intracellulare infection if combined, 1 dose by 50% (75% in the presence of renal failure with a creatinine clearance of <30mL/min)... 

Kelleher P, Helbert M, Sweeney J, Anderson J, Parian J, Pinchii A. Uveitis associated with rifabutin and macrolide therapy for Mycobacterium avium intracellulare infections in ADDS patients. GenitourinMed 99 72,419-21. 

Two patients who developed reduced visual acuity after taking ethambutol for several months for Mycobacterium avium-intracellulare infection had bitemporal visual field defects that suggested damage to the optic chiasm [66 ]. 

Increasingly the existence of multiresistant strains is reported, especially in the United States but also elsewhere. Also the occurrence of infections with difficult to treat, so called atypical mycobacteria like Mycobacterium avium intracellulare and Mycobacterium kansasii is on the rise. These infections are especially seen in patients with a compromised immune system. In vitro these atypical mycobacteria often show resistance against first-choice drugs. However this in vitro lack of sensitivity does not always correspond with in vivo responses. 

Rifabutin, a semi-synthetic derivative of rifamy-cin S, is a bactericidal antibiotic primarily used in the treatment of tuberculosis. Its effect is based on blocking the DNA-dependend RNA-polymerase of the bacteria. Rifabutin is used in the treatment of infections with Mycobacterium avium intracellulare. Rifabutin is well tolerated in patients with HIV-related tuberculosis, but patients with low CD4 cell counts have a high risk of treatment failure or relapse due to acquired rifamycin resistance. 

Azithromycin, though less active against streptococci and staphylococci than erythromycin, is far more active against respiratory infections due to Haemophilus influenzae and Moraxella catarrhalis. Except for its cost, it is now the preferred therapy for urethritis caused by Chlamydia trachomatis. Its activity against Mycobacterium avium intracellulare complex has not proven to be clinically important, except in AIDS patients with disseminated infections. 

Roussel G, Igual J. Clarithromycm with minocychne and clofazimine for Mycobacterium avium intracellulare complex lung disease m patients without the acquired immune deficiency syndrome. GETIM. Groupe d Etude et de Traitement des Infections a Mycobacteries. Int J Tuberc Lung Dis 1998 2(6) 462-70. 

Barradell LB, Plosker GL, McTavish D. Clarithromycin. A review of its pharmacological properties and therapeutic use in Mycobacterium avium-intracellulare complex infection in patients with acquired immune deficiency syndrome. Drugs 1993 46(2) 289-312. 

Azithromycin has a similar spectrum but is more active, especially versus organisms associated with sinusitis or otitis media (H. influenzae, M. catarrhalis), Chlamydia (co-DOC, including co-infections with gonorrhea), and Mycobacterium avium-intracellulare. 

Infection caused by P. carinii, Toxoplasma gondii, and Mycobacterium avium-intracellulare Sickle-cell crisis Toxoplasmosis... 

SimOar spectrum, but is more active in respiratory infections, including Mycobacterium avium-intracellulare... 

Patients with PAP are at an increased risk of infections not only with common respiratory pathogens but also opportunistic organisms such as Mycobacterium tuberculosis, Mycobacterium avium-intracellulare (MAI), Aspergillus spp. Pneumocystis carinii, and Nocardia spp. (11,53). Seven cases of lung cancer in patients with iPAP have been reported (54), but whether or not this is a true association is not known. 

Infection with Mycobacterium avium or Mycobacterium intracellulare occurs in patients with the acquired immunodeficiency syndrome. These organisms infrequently cause lung disease in older adults and children with normal immunity but abnormal lungs. 

Interest in the nontuberculous (atypical) mycobacteria, especially members of the Mycobacterium avium, Mycobacterium intracellulare, Mycobacterium scro-fulaceum complex, has also been stimulated by AIDS. Infection with the M. avium complex is seen in up to 50% of patients with AIDS in some areas of the world.3 A review of U.S. cases found an overall 5.5% incidence of M. avium complex in AIDS patients.3 Leprosy, however, is clearly on the wane, although it remains a substantial problem.4 Its prevalence has been steadily diminished to a present-day worldwide figure of about 3 million registered cases and 5.5 million estimated cases, owing in part to a most effective multiple-drug regimen. The World Health Assembly has dedicated itself to the technical elimination of leprosy (that is, a prevalence of less than 1 per 10,000 population) by the turn of the century. 

Wallace RJ Jr, Brown BA, Griffith DE, Girard W, Tanaka K. Reduced serum levels of clarithromycin in patients treated with multidrug regimens including rifampin or rifabutin for Mycobacterium avium—M. intracellulare infection. J Infect Dis 1995 171(3) 747-50. 

Rao SP, Gehlsen KR, Catanzaro A (1992) Identification of a beta 1 integrin on Mycobacterium avium-Mycobacterium intracellulare. Infect Immun 60 3652-3657... 

Clarithromycin or azithromycin is recommended as first-line therapy for prophylaxis and treatment of disseminated infection caused by M. avium-intracellulare in AIDS patients and for treatment of pulmonary disease in non-HIV-infected patients. Azithromycin (1.2 g once weekly) or clarithromycin (500 mg twice daily) is recommended for primary prevention for AIDS patients with fewer than 50 CD cells per mm. Single-agent therapy should not be used for treatment of active disease or for secondary prevention in AIDS patients. Clarithromycin (500 mg twice daily) plus ethambutol (15 mg/kg once daily) with or without rifabutin is an effective combination regimen. Azithromycin (500 mg once daily) may be used instead of clarithromycin, but clarithromycin appears to be slightly more efficacious. Clarithromycin also has been used with minocychne for the treatment of Mycobacterium leprae in lepromatous leprosy. 

The infectious killer disease, tuberculosis (TB), is the leading cause of death worldwide from a single human pathogen, claiming more adult lives than diseases such as acquired immunodeficiency syndrome (AIDS), malaria, diarrhea, leprosy, and all other tropical diseases combined. The organism usually responsible, the tubercle bacillus, Mycobacterium tuberculosis (MT), was discovered by Robert Koch in 1882. However, M. bovis, which infects cattle, may also infect humans, and M. africanum is a cause of TB in West Africa. Furthermore, a number of normally nonpathogenic mycobacteria, especially M. avium, M. intracellulare, and M. scrofulaceum, cause opportunistic infectious disease in patients with AIDS. Pulmonary TB, the most common type of the disease, is usually acquired by inhalation of the bacillus from an infectious patient and causes irreversible lung destruction (Newton et al., 2000). 

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