Mycobacterium avium Complex (MAC)(마이코박테리움 아비움 복합체 감염)(Kor/Eng)

Mycobacterium avium Complex (MAC) / 마이코박테리움 아비움 복합체 감염

 

 

 

 

 

Definition (정의)

English:
Mycobacterium avium complex (MAC) refers to infections caused by two closely related bacteria:

• Mycobacterium avium
• Mycobacterium intracellulare

They are non-tuberculous mycobacteria (NTM) — meaning they are not the same as tuberculosis (TB) but belong to the same bacterial family.
MAC infections typically occur in immunocompromised individuals, especially people with advanced HIV/AIDS, but can also affect people with chronic lung disease (like COPD, bronchiectasis).

Korean (한국어):
마이코박테리움 아비움 복합체(Mycobacterium avium complex, MAC) 는
다음의 두 가지 유사한 세균으로 인해 발생하는 비결핵성 항산균(Non-tuberculous Mycobacteria, NTM) 감염입니다:

• Mycobacterium avium
• Mycobacterium intracellulare

결핵균과는 다른 균이지만 같은 항산균(Mycobacteria) 계열에 속하며,
주로 면역저하자(특히 HIV/AIDS 환자) 또는 만성폐질환자(COPD, 기관지확장증) 에서 발생합니다.

 

 

 

 

 

 

 

 

 

 

 

Causative Agent (원인균)

EnglishKorean

Mycobacterium avium and Mycobacterium intracellulare	마이코박테리움 아비움 및 마이코박테리움 인트라셀룰라레
Together known as MAC	두 균을 합쳐 MAC 복합체라고 함
Found in water, soil, dust, and animals	물, 토양, 먼지, 동물 등 환경에 존재

 

 

 

 

 

 

 

 

 

 

 

Epidemiology (역학)

English:

• Found worldwide (environmental bacteria).
• Not contagious (does not spread person-to-person).
• Risk groups:
  • HIV/AIDS with CD4 < 50 cells/mm³
  • Older women with bronchiectasis
  • Chronic lung disease (COPD, cystic fibrosis)
  • Immunosuppressed patients (transplant, chemotherapy)

Korean:

• 전 세계 환경에 존재하는 균으로, 사람 간 전염되지 않습니다.
• 고위험군:
  • CD4 < 50 인 HIV/AIDS 환자
  • 기관지확장증 있는 고령 여성
  • 만성폐질환자 (COPD, 낭포성 섬유증)
  • 면역억제 치료 중인 환자 (이식, 항암치료 등)

 

 

 

 

 

 

 

 

Pathophysiology (병태생리)

English:
MAC bacteria enter the body via inhalation (lungs) or ingestion (GI tract).
In healthy people, the immune system destroys them.
In immunocompromised individuals, the bacteria multiply inside macrophages, leading to:

• Chronic pulmonary infection (localized)
• Disseminated infection (systemic spread to liver, spleen, bone marrow) in AIDS patients

Korean:
MAC 균은 흡입(폐) 또는 섭취(소화관) 를 통해 체내에 들어옵니다.
면역이 정상인 경우 대식세포가 균을 제거하지만,
면역저하자의 경우 대식세포 내에서 증식하여:

• 국소 폐감염 (chronic pulmonary infection) 또는
• 전신감염 (간, 비장, 골수 침범) 을 일으킵니다.

 

 

 

 

Clinical Manifestations (임상 증상)

Pulmonary MAC (폐형 MAC)

Occurs in older adults or those with chronic lung disease.

EnglishKorean

Chronic cough, sputum	만성 기침, 가래
Hemoptysis (sometimes)	혈담 (가끔)
Fatigue, weight loss	피로, 체중감소
Low-grade fever	미열
Shortness of breath	호흡곤란

Chest X-ray: nodular or cavitary lesions (similar to TB, but slower progression).
 Often confused with tuberculosis.

 

 

 

 

 

 

 

 

Disseminated MAC (전신형 MAC)

Seen mostly in AIDS patients (CD4 < 50).

EnglishKorean

Persistent fever	지속적인 발열
Night sweats	야간 발한
Diarrhea	설사
Abdominal pain	복통
Anemia, weight loss	빈혈, 체중감소
Enlarged liver/spleen	간·비장 비대
Blood cultures positive for MAC	혈액배양에서 MAC 검출

 

 

 

 

 

 

Complications (합병증)

• Disseminated infection → sepsis-like syndrome
• Anemia, hepatosplenomegaly
• Chronic respiratory failure (in pulmonary cases)
• Wasting syndrome in AIDS patients

Korean:

• 전신감염 → 패혈증 유사 증상
• 빈혈, 간·비장 비대
• 폐부전 (호흡곤란 악화)
• AIDS 환자에서는 소모성 증후군(wasting syndrome)

 

 

 

 

 

 

Diagnosis (진단)

TestEnglish DescriptionKorean Explanation

Sputum culture (AFB test)	Acid-fast bacilli seen in culture	객담 항산균 검사로 균 확인
Blood culture	Positive in disseminated MAC	전신형 MAC에서 혈액배양 양성
Chest X-ray or CT	Nodular, cavitary lesions	결절성 또는 공동성 병변
PCR (molecular test)	Detects MAC DNA	MAC DNA 검출
Biopsy	Granulomatous inflammation	육아종성 염증 소견

 

 

 

 

 

 

Treatment (치료)

Combination therapy is required to prevent resistance.

Drug ClassExamplesNotes (English + Korean)

Macrolide antibiotic	Clarithromycin or Azithromycin	핵심 약제 – 중심 치료제
Ethambutol	—	보조 항산균 약물
Rifamycin	Rifampin or Rifabutin	병용하여 내성 예방
Duration	≥ 12 months after negative cultures	배양 음전 후 최소 12개월 유지
Prophylaxis in HIV (CD4 < 50)	Azithromycin weekly	HIV 환자 예방요법 가능

 

 

 

 

 

 

 

 

Nursing Management (간호중재)

English:

• Monitor for respiratory symptoms and sputum changes.
• Ensure medication adherence to prevent resistance.
• Assess for side effects:
  • Rifampin → orange urine
  • Ethambutol → vision changes (optic neuritis)
  • Clarithromycin → GI upset
• Promote nutrition and hydration.
• Educate on infection prevention (no person-to-person spread but good hygiene).
• For HIV patients: monitor CD4 count and ensure prophylaxis compliance.

Korean:

• 호흡 증상과 객담 변화 관찰.
• 약물 복용 순응도 유지 중요 (내성 예방).
• 약물 부작용 주의:
  • 리팜핀 → 소변 주황색
  • 에탐부톨 → 시력변화 (시신경염)
  • 클라리스로마이신 → 위장장애
• 영양·수분 섭취 유지.
• 감염 예방 교육 (사람 간 전염은 없지만 위생 중요).
• HIV 환자는 CD4 수치와 예방약 복용 여부 확인.

 

 

 

 

 

 

Summary Table (요약표)

CategoryEnglish SummaryKorean Summary

Cause	M. avium & M. intracellulare	마이코박테리움 아비움, 인트라셀룰라레
Type	Non-tuberculous mycobacteria	비결핵성 항산균
Transmission	Environmental (not person-to-person)	환경 감염 (사람 간 전염 아님)
Risk group	AIDS, COPD, bronchiectasis	AIDS, COPD, 기관지확장증
Symptoms	Chronic cough, fever, weight loss	만성기침, 발열, 체중감소
Diagnosis	Culture, PCR, imaging	배양, PCR, 영상검사
Treatment	Clarithromycin + Ethambutol + Rifampin	클라리스로마이신 + 에탐부톨 + 리팜핀
Prevention (HIV)	Azithromycin prophylaxis	아지스로마이신 예방요법

 

 

 

 

Quick Nursing Tip

 Think “slow TB-like infection in immunocompromised”.
MAC = Mycobacterium avium + intracellulare
 Always treat with 3 drugs for ≥12 months.
 Not contagious — environmental exposure only.