195.2 📚 國考版

195.2.0.1 必背 — NTM vs TB

• Environmental, not person-to-person (mostly)
• Not contagious in TB sense
• Treatment longer + multi-drug
• AST critical (species + R patterns vary)

195.2.0.2 必背 — MAC Forms

• Disseminated AIDS (CD4 < 50)
• Pulmonary: fibrocavitary (老男 COPD) + nodular bronchiectasis (Lady Windermere 中年瘦女 RML/lingula)
• Hot tub lung (hypersensitivity)
• Lymphadenitis (cervical, 兒童)

195.2.0.3 必背 — MAC Pulmonary Treatment

• Clarithro/azithro + ethambutol + rifampin × 18-24 mo (12 mo after culture-neg)
• Severe / fibrocavitary: add streptomycin/amikacin × 8-12 wk

195.2.0.4 必背 — Specific Species

• M. kansasii: TB mimic, photochromogen, rifampin + INH + EMB × 12-18 mo
• M. marinum: fish-tank granuloma, clarithromycin + EMB × 3-6 mo
• M. ulcerans: Buruli ulcer Africa, rifampin + clarithromycin × 8 wk (WHO)
• M. abscessus: MDR, hard to treat, CF cluster
• M. fortuitum/chelonae: rapid grow, cosmetic outbreaks
• M. chimaera: cardiac heater-cooler, late surgery infection

195.2.0.5 必背 — MAC Disseminated AIDS

• CD4 < 50 = high risk
• Prophylaxis: azithromycin 1.2 g/wk if CD4 < 50 (historical; less used with effective ART)
• Treat with macrolide + EMB + rifabutin

195.2.0.6 必背 — Lady Windermere Syndrome

• Middle-aged thin Caucasian women
• RML/lingula bronchiectasis
• “Habitual cough suppression” — non-anatomic pulmonary clearance
• MAC pulmonary

195.2.0.7 必背 — Diagnostic Criteria (ATS/IDSA 2020)

• 3 criteria: clinical + radiographic + microbiologic
• Multiple positive cultures needed

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