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complicated in structure; consisting of interconnected parts; "a complex set of variations based on a simple folk melody"; "a complex mass of diverse laws and customs"
a compound described in terms of the central atom to which other atoms are bound or coordinated (同)coordination_compound
a conceptual whole made up of complicated and related parts; "the complex of shopping malls, houses, and roads created a new town" (同)composite
(psychoanalysis) a combination of emotions and impulses that have been rejected from awareness but still influence a persons behavior

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『いくつかの部分から成る』,複合の,合成の / 『複雑な』,入りくんだ,こみいった(complicated) / 複合体,合成物 / コンプレックス,複合(抑圧されて心に残った複雑なしこり)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/10/16 05:18:05」(JST)

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Mycobacterium avium complex (MAC) is a group of genetically related bacteria belonging to the genus Mycobacterium. It includes Mycobacterium avium and Mycobacterium intracellulare.^[1]^[2]

Some sources also include Mycobacterium avium subspecies paratuberculosis (MAP).^[3]

Mycobacterium avium complex (MAC) include ubiquitous atypical bacteria found in the environment which can infect patients with HIV and low CD4 cell count (below 100/microliter).; mode of infection is usually inhalation or ingestion.

MAC causes disseminated disease in up to 40% of patients with human immunodeficiency virus (HIV) in the United States, producing fever, sweats, weight loss, and anemia.^[4]^[5]^[6] Disseminated MAC characteristically affects patients with advanced HIV disease and peripheral CD4+ T-lymphocyte counts less than 100 cells/uL. Effective prevention and therapy of MAC has the potential to contribute substantially to improved quality of life and duration of survival for HIV-infected persons.^[7]

Diagnosis[edit]

Disseminated MAC is most readily diagnosed by one positive blood culture. Blood cultures should be performed in patients with symptoms, signs, or laboratory abnormalities compatible with mycobacterium infection. Blood cultures are not routinely recommended for asymptomatic persons, even for those who have CD4+ T-lymphocyte counts less than 100 cells/uL.^[7]

Prevention[edit]

Patients with HIV infection and less than 100 CD4+ T-lymphocytes/uL should be administered prophylaxis against MAC. Prophylaxis should be continued for the patient's lifetime unless multiple drug therapy for MAC becomes necessary because of the development of MAC disease.^[7]

Clinicians must weigh the potential benefits of MAC prophylaxis against the potential for toxicities and drug interactions, the cost, the potential to produce resistance in a community with a high rate of tuberculosis, and the possibility that the addition of another drug to the medical regimen may adversely affect patients' compliance with treatment. Because of these concerns, therefore, in some situations rifabutin prophylaxis should not be administered.^[7]

Before prophylaxis is administered, patients should be assessed to ensure that they do not have active disease due to MAC, M. tuberculosis, or any other mycobacterial species. This assessment may include a chest radiograph and tuberculin skin test.^[7]

Rifabutin, 300 mg by mouth daily, is recommended for the patient's lifetime unless disseminated MAC develops, which would then require multiple drug therapy. Although other drugs, such as azithromycin and clarithromycin, have laboratory and clinical activity against MAC, none has been shown in a prospective, controlled trial to be effective and safe for prophylaxis. Thus, in the absence of data, no other regimen can be recommended at this time.The 300-mg dose of rifabutin has been well tolerated. Adverse effects included neutropenia, thrombocytopenia, rash, and gastrointestinal disturbances.^[7]

Treatment[edit]

Although studies have not yet identified an optimal regimen or confirmed that any therapeutic regimen produces sustained clinical benefit for patients with disseminated MAC, the Task Force concluded that the available information indicated the need for treatment of disseminated MAC. The Public Health Service therefore recommends that regimens be based on the following principles:^[7]

Treatment regimens outside a clinical trial should include at least two agents.
Every regimen should contain either azithromycin or clarithromycin; many experts prefer ethambutol as a second drug. Many clinicians have added one or more of the following as second, third, or fourth agents: clofazimine, rifabutin, rifampin, ciprofloxacin, and in some situations amikacin. Isoniazid and pyrazinamide are not effective for the therapy of MAC.
Therapy should continue for the lifetime of the patient if clinical and microbiologic improvement is observed.

Clinical manifestations of disseminated MAC—such as fever, weight loss, and night sweats—should be monitored several times during the initial weeks of therapy. Microbiologic response, as assessed by blood culture every 4 weeks during initial therapy, can also be helpful in interpreting the efficacy of a therapeutic regimen.Most patients who ultimately respond show substantial clinical improvement in the first 4–6 weeks of therapy. Elimination of the organisms from blood cultures may take somewhat longer, often requiring 4–12 weeks.^[7]

HIV-infected children[edit]

HIV-infected children less than 12 years of age also develop disseminated MAC. Some age adjustment is necessary when clinicians interpret CD4+ T-lymphocyte counts in children less than 2 years of age. Diagnosis, therapy, and prophylaxis should follow recommendations similar to those for adolescents and adults.^[7]

References[edit]

This article incorporates public domain material from the Centers for Disease Control and Prevention document "Recommendations on Prophylaxis and Therapy for Disseminated Mycobacterium avium Complex for Adults and Adolescents Infected with Human Immunodeficiency Virus".

^ LOIS WHITE (7 July 2004). FOUNDATIONS OF NURSING. Cengage Learning. pp. 1298–. ISBN 978-1-4018-2692-5. Retrieved 5 November 2010.
^ "Disease Listing, Mycobacterium avium Complex, Tech Info | CDC Bacterial, Mycotic Diseases". Retrieved 2010-11-04.
^ Peter Irving; David Rampton; Fergus Shanahan (21 July 2006). Clinical dilemmas in inflammatory bowel disease. Wiley-Blackwell. pp. 36–. ISBN 978-1-4051-3377-7. Retrieved 5 November 2010.
^ Horsburgh CR. Mycobacterium avium complex infection in theacquired immunodeficiency syndrome. N Engl J Med 1991;324:1332-8.
^ Chaisson RE, Moore RD, Richman DD, Keruly J, Creagh T, the Zidovudine Epidemiology Study Group. Incidence and natural history of Mycobacterium avium complex infection in patients with advanced HIV disease treated with zidovudine. Am Rev Respir Dis 1992;146:285-9.
^ Havlik JA, Horsburgh CR, Metchock B, Williams P, Fann SA, Thompson SE. Disseminated Mycobacterium avium complex infection: clinical identification and epidemiologic trends. J Infect Dis 1992;165:577-80.
^ ^a ^b ^c ^d ^e ^f ^g ^h ⁱ http://www.cdc.gov/mmwr/preview/mmwrhtml/00021272.htm

UpToDate Contents

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1. HIV陰性患者における非結核性抗酸菌感染症の概要 overview of nontuberculous mycobacterial infections in hiv negative patients
2. HIV感染患者におけるMycobacterium avium complex (MAC）感染症 mycobacterium avium complex mac infections in hiv infected patients
3. HIV陰性患者における肺非結核性抗酸菌感染症の治療 treatment of nontuberculous mycobacterial infections of the lung in hiv negative patients
4. 小児における非結核性抗酸菌性肺感染症の概要 overview of nontuberculous mycobacterial pulmonary infections in children
5. 非結核性抗酸菌感染症の疫学 epidemiology of nontuberculous mycobacterial infections

English Journal

The significance of M. abscessus ssp abscessus isolation during Mycobacterium avium complex (MAC) lung disease therapy.

Griffith DE, Philley JV, Brown-Elliott BA, Benwill J, Shepherd S, York D, Wallace RJ Jr.
Chest.Chest.2014 Oct 30. doi: 10.1378/chest.14-1297. [Epub ahead of print]
Abstract: Background:Isolation of Mycobacterium abscessus subsp abscessus (MAA) is common during Mycobacterium avium complex (MAC) lung disease therapy but there is limited information about the clinical significance of the MAA isolates. Methods:We identified 53/180 patients (29%) treated for MAC lu
PMID 25357074

Evaluation of PCR-Reverse blot hybridization assay for the differentiation and identification of Mycobacterium species in liquid cultures.

Wang HY1, Kim H, Kim S, Bang H, Kim DK, Lee H.
Journal of applied microbiology.J Appl Microbiol.2014 Oct 27. doi: 10.1111/jam.12670. [Epub ahead of print]
AIMS: The purpose of this study was to evaluate the usefulness of REBA Myco-ID® assay based on the principle of reverse blot hybridization assay (REBA) for the rapid detection of Mycobacterium tuberculosis (MTB), the differentiation of MTB from nontuberculous mycobacteria (NTM), and the identificat
PMID 25346202

Opportunistic infections and AIDS malignancies early after initiating combination antiretroviral therapy in high-income countries.

HIV-CAUSAL Collaboration.
AIDS (London, England).AIDS.2014 Oct 23;28(16):2461-73. doi: 10.1097/QAD.0000000000000456.
BACKGROUND: There is little information on the incidence of AIDS-defining events which have been reported in the literature to be associated with immune reconstitution inflammatory syndrome (IRIS) after combined antiretroviral therapy (cART) initiation. These events include tuberculosis, mycobacteri
PMID 25265230

Japanese Journal

結核,非結核性抗酸菌治療薬 : リファブチン(ミコブティン) (特集新しい治療薬と呼吸器感染症診療の展開)

森本耕三,吉山崇,倉島篤行
日本胸部臨床 71(9), 883-892, 2012-09
NAID 40019422753

肺Mycobacterium avium complex症治療における副作用の検討

市木拓,渡邉彰,植田聖也 [他]
結核 87(7), 487-490, 2012-07
NAID 40019390594

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★リンクテーブル★

リンク元	「ラニヨン分類」「マイコバクテリウム・アビウムコンプレックス」「MAC」「Mycobacterium avium-intracellulare complex」「Mycobacterium avium-intracellulare」
拡張検索	「Mycobacterium avium complex感染症」「Mycobacterium avium complex infection」
関連記事	「complex」「complexed」「complexes」「avium」「Mycobacterium」

「ラニヨン分類」

　　[★]

英: Runyon classification
同: Runyon分類
関: 抗酸菌

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ラニアン分類 : 1 件
ラニャン分類 : nothing
ラニヤン分類 : 
ラニョン分類 : 
ラニヨン分類 : 4 件

ラニアン分類 Runyon : nothing
ラニャン分類 Runyon : nothing
ラニヤン分類 Runyon : 
ラニョン分類 Runyon : 
ラニヨン分類 Runyon : 3 件

分類				菌種名
培養可能菌	遅発育菌	結核菌群		Mycobacterium tuberculosis
				Mycobacterium bovis
				Mycobacterium microti
				Mycobacterium africanum
		非結核性抗酸菌群	I群菌光発色菌	Mycobacterium kansasii
				Mycobacterium marinum
				Mycobacterium simiae
				Mycobacterium asiaticum
			II群菌暗発色菌	Mycobacterium flavescens
				Mycobacterium gordonae
				Mycobacterium scrofulaceum
				Mycobacterium szulgai
			III群菌非光発色菌	Mycobacterium avium complex
				Mycobacterium celatum
				Mycobacterium haemophilum
				Mycobacterium gastri
				Mycobacterium genavense
				Mycobacterium malmoense
				Mycobacterium nonchromogenicum
				Mycobacterium shimoidei
				Mycobacterium terrae
				Mycobacterium trivale
				Mycobacterium ulcerans
				Mycobacterium xenopi
	迅速発育菌		IV群菌	Mycobacterium abscessus
				Mycobacterium fortuitum group
				Mycobacterium chelonae group
				Mycobacterium phlei
				Mycobacterium smegmatis
				Mycobacterium vaccae
培養不能菌				Mycobacterium leprae