195.4 📌 章末速蚘

  • NTM: environmental, not contagious (mostly)
  • MAC (M. avium complex) main:
    • Disseminated AIDS (CD4 < 50)
    • Pulmonary: fibrocavitary (老男 COPD) + nodular bronchiectasis (Lady Windermere 䞭幎瘊女 RML/lingula)
    • Hot tub lung (HP-like)
    • Lymphadenitis 兒童 (excisional biopsy preferred)
  • MAC Tx: clarithro/azithro + EMB + rifampin × 12 mo after culture-neg
  • M. abscessus: CF cluster, MDR very hard; amikacin + cefoxitin/imipenem + macrolide combo long course
  • M. kansasii: TB mimic, photochromogen → rifampin + INH + EMB
  • M. marinum: fish-tank granuloma → clarithromycin + EMB
  • M. ulcerans (Buruli ulcer): Africa/Australia, mycolactone toxin → rifampin + clarithromycin × 8 wk
  • M. fortuitum/chelonae: rapid grow, cosmetic outbreaks
  • M. chimaera: cardiac heater-cooler late infection
  • Inhaled amikacin (Arikayce) for refractory MAC lung — FDA 2018
  • ATS/IDSA 2020 criteria for MAC pulmonary: clinical + radiographic + microbiologic
  • AST critical for treatment planning