Mycobacterium Avium Complex (MAC) Lung Disease
in Two Inner City Community Hospitals: Recognition,
Prevalence, Co-Infection with Mycobacterium
Tuberculosis (MTB) and Pulmonary Function (PF)
Improvements After Treatment
Zinobia Khan*, Albert Miller, Moses Bachan, Joseph Donath
CARITAS Health Care Inc, Mary Immaculate Hospital-Pulmonary Division, 152-11 89th Ave, Jamaica, New York 11432, USA
The purpose of this study was to separate MAC lung disease from colonization and to define
indications for treatment.
Materials and Methodology:
Over 4 years, we evaluated patients who had positive MAC cultures, MAC infection and coinfection
with MTB. In the first study, 42 immunocompetent patients with sputum or BAL culture positive only for MAC
during a single year (2004) were reviewed. On clinical and radiographic review, they were classified as disease related to
MAC, likely related to MAC or unrelated to MAC. In the second study, we reviewed all immunocompetent patients,
during two years (2004-2005), whose respiratory secretions cultured both MTB and nontuberculous mycobacteria (NTM).
In the last study, we evaluated pulmonary function (PF) in patients with MAC infection before and after therapy (2006-
2007). PF was evaluated in patients following ATS guidelines.
Lung disease was related/likely related to MAC in 21 patients (50%) and not related in 21 (50%). In patients with
MAC-related lung disease, the primary physician did not consider the diagnosis except when that physician was a
pulmonologist. Half of those with MAC-related lung disease were smokers, white and US-born. There were 12
immunocompetent patients with MTB and NTM cultures. Eleven were non-white and all were foreign-born. Presentation
and clinical course were consistent with MTB. All 8 patients with abnormal PF improved.
The prevalence of MAC lung infection in two inner city hospitals was four times higher than that of TB. The
indication for treatment of MAC infection should also rely heavily on clinical and radiological evidence when there is
only one positive sputum culture. The diagnosis was considered only when the admitting physician was a pulmonologist.
Most patients with combined infection were clinically consistent with MTB and responded to anti MTB treatment alone.
Treatment with anti-MAC therapy improved PF in those patients whose PF was abnormal to begin with.
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
* Address correspondence to this author at the James J. Peters VA Medical
Center, 130 W. Kingsbridge Road, Bronx, New York, NY 10468, USA; Tel:
(718) 496-9531, (718) 496-9854; Fax: 718-741-4623;