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MAC pulmonary disease — SCE Respiratory MCQ

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HardRespiratory infectionsMAC pulmonary diseaseSCE Respiratory

A 72-year-old thin woman has chronic cough, fatigue and nodular bronchiectasis affecting the right middle lobe and lingula. Three sputum cultures over two months grow Mycobacterium avium complex, and smear is intermittently positive. There is no fever and HIV testing is negative. She has troublesome symptoms despite airway clearance. What is the most appropriate management?

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Correct answer: A — Macrolide-based multidrug therapy after susceptibility testing

Symptomatic nodular-bronchiectatic MAC disease with repeated positive cultures meets criteria for treatment consideration using multidrug therapy. Macrolide monotherapy risks resistance and should be avoided. NTM diagnosis requires clinical, radiological and microbiological correlation because single isolates may be contamination.

Reference: BTS NTM Guideline 2017; ERS/ATS/IDSA NTM guidance