Overview Snapshot A 36-year-old HIV positive female, non-compliant with treatment, presents in the clinic with a one month history of fever, fatigue, and weight loss. Her last visit to the HIV clinic was six months ago. Temperature is 102.2°F (39°C). Patient appears wasted and markedly pale on physical exam. CD4+ count is 39 cells/mm3. Complete blood count revealed a hematocrit of 22% and leukocyte count of 4000/mm3. Serum albumin was 2.5g/dL. Liver function tests revealed elevated transaminases and alkaline phosphatase. Blood was taken for culture and the patient started on azithromycin and ethambutol. Introduction Classification acid fact, facultative intracellular bacteria Mycobacterium other than tuberculosis (MOTTS) M. avium intracellulare M. kansasii M. scrofulaceum M. marinum Organisms and Associated Diseases M. avium intracellulare also known as MAC (Mycobacterium avium complex) most common MOTTS AIDS patients with CD4 < 50 cells/mm3 common cause of fever of unknown origin treat with macrolide (clarithromycin and azithromycin) + ethambutol often drug resistant M. kansasii resembles TB second most common cause of lung disease from MOTTS average age of onset 60 years treat with rifampin + ethambutol Evaluation Blood cultures Lymph node biopsy and culture (in lymphadenitis) DNA probe distinguishes MOTTS from M. tuberculosis Prognosis, Prevention, and Complications Prognosis because of antibiotic resistance, they are highly difficult to treat Prevention azithromycin should be started in all HIV patients with CD4 counts < 50cells/mm3 Complications disseminated MAC can be fatal