Exploring Mycobacterium Avium Complex: A Deep Dive into Lung Health with Dr. Mark J. Pamer

What is Mycobacteria Avium Complex (MAC)?

Unlock the enigma of lung health as we sit down with distinguished pulmonologist Dr. Mark J. Pamer for an eye-opening conversation about Mycobacterium Avium Complex (MAC). Our discussion traverses the landscape of these formidable bacteria, offering insights into how they impact the human body and their prevalence in our everyday environment. Tune in to learn why MAC infections occur in some individuals while others remain untouched, and explore the strengths and weaknesses of the immune system in this microscopic battleground.

Dr. Pamer illuminates the intricate differences between bacterial classes, including the lesser-known mycobacterium, a class that has evolved to possess fungal-like durability, making them the 'Abrams tanks' of the microbial realm. As we navigate the specifics of MAC and its relatives, you'll be captivated by Dr. Pamer's expertise on the subject. Prepare to be educated on this pervasive group of microorganisms and arm yourself with knowledge about combating MAC and protecting your lung health. Join Dr. Pamer for an enlightening episode that goes beyond the surface of bacteria and dives deep into the essence of pulmonary well-being.

To learn more about Dr. Pamer, go to:
https://www.markpamerdo.com/

Dr. Mark J. Pamer DO
573 NW Lake Whitney Place, Suite 105
Port Saint Lucie, FL 34986
(772) 785-5864

Transcript

Speaker 1: 0:00

Welcome to the Dr Mark J Pamer podcast, a doctor who uses his heart to treat your lungs. Here's your host, Dr Mark J Pamer.

Speaker 2: 0:14

Curious about the mysteries of lung health, dive into an exclusive interview with a leading penologist for Port St Lucie, where we unravel the complexity of microbacteria avian complex MAC. Welcome back everyone. Garfield Bullen, co-host, slash producer, back in the studio with Dr Mark Pamer. Dr Pamer, how you doing. I'm great, garfield, let's get this going. So what is microbacteria avian complex?

Speaker 3: 0:43

Awesome question. I get asked this question multiple times a week because it's a very prevalent bacteria. To answer it, let's do a very, very quick overview of bacteria in itself. There's four different bacteria classes. Two of them are kind of just regular old bacteria. We call them gram positives, gram negatives. The third one's called mycoplasma. And the fourth one is this one we're going to call mycobacterium.

Speaker 3: 1:07

Mycobacterium, gram positives, gram negatives, gram positives everybody's heard of Staph strep. Those are the famous ones. Gram negatives, e coli, pseudomonas you know everybody's heard of those. So that just has to do with how they stain the bacteria and really whether it turns pink, blue, whether it's got a slime layer or not. That's your usual bacteria that we're taking antibiotics for.

Speaker 3: 1:28

That third one I talked about, mycoplasma. They're tiny little bacteria. They get inside of the cells. They've got some stuff in common with fungus. Mycoplasma pneumonia is a famous one that causes walking pneumonia in college kids. Chlamydophthora pneumonia those are the mycoplasmas Not as relevant to most of us as adults, certainly don't cause a big burden of disease. But then there's this fourth one, mycobacterium. And myco M-Y-C-O refers to fungus. So mycobacterium are some kind of a fusion and evolution where you've got bacteria that have really adopted fungal properties on their cell wall and that has made them extremely resistant to destruction. They can live for a long, long time. They're resistant to white blood cells taking over. They're resistant to death. They're like an Abrams tank, I mean, you just can't kill the thing. And so that makes them quite the potent adversary to the immune system. They're everywhere, they're in the dirt, they're in the water, but you know, most of us aren't getting infected with it. So the most famous member of that class if you will the Hitler, the one that's, you know, the most famous throughout history that's mycobacterium tuberculosis. Everybody's heard of that one TB, and that one's been devastating throughout history. But there's some other members in the family that are less well-known but still cause a lot of disease. And then there's multiple in the family that don't really do anything. They don't affect humans.

Speaker 3: 3:01

The one that we're going to talk about today is called Mycobacterium Avium Complex, mac, m-a-c. There's several members of that community in MAC. Mycobacterium Avium is a famous one. Mycobacterium Intracellular is another one. You've got Mycobacterium Avium Intracellular M-A-I. There's other members in there. We're not going to go through all eight of them, but MAC is the group Now.

Speaker 3: 3:25

Mac's everywhere. As I said, it's in your shower water. It's in freestanding water. It could be in your hot tub. It's in the dirt when you go gardening. I mean, it's everywhere, you can't get away from it. But the reality is we're all not walking around with Mac, any more than we're all walking around with strep throat or anything else.

Speaker 3: 3:44

Something happens and some people get infected and others don't. So the people really kind of get infected with MAC. It may just be bad luck, but there's something you know, there's an indictment there of the immune system where this pathogen has been allowed to be, you know, engulfed by the cells, and now it's set up shop and it's created, perhaps an infection. That may or may not be relevant. So people may get some little lung nodules that are picked up just, you know, as a happenstance, and we'll follow it from there. Or they may present because they've got cough. It may be a very, very advanced stage where they've had significant lung destruction with what we call bronchiectasis, all kinds of nodules, they coughing up sputum. That would be a much more advanced stage, but we may find it very, very early. We may find it completely asymptomatic.

Speaker 3: 4:34

Not everybody that has this needs to be treated, that's for sure. Now, mac is not necessarily difficult to kill, but it takes a long time to kill it. It usually requires at least three antibiotics. It's at risk of becoming infectious if you mess around with it and you're going to start stop on the antibiotics. Even once you start to treat it with a significant regimen of usually three antibiotics rifampin, azithromycin, ethambutol. That's the most common regimen. Even once you've cleared the airway of growing this, you still need to stay on therapy for another year. There's still a chance that this thing will come back or may not go away.

Speaker 3: 5:17

There's a national center out in Denver, national Jewish, who is world famous. They're the world leader in MAC and mycobacterial diseases and many people travel there and they've got state-of-the-art testing and diagnosis and treatment. That's certainly where I send my more refractory patients. But the diagnosis is you know, cough up sputum, got to grow. It takes six weeks usually to grow it and then I have a discussion with patients on the treatment of it. Some patients want to get treated, some people don't even need treatment, some we just watch it, but some really do need treatment and from there that's a prolonged course.

Speaker 3: 5:56

So one of the things that's interesting about Mac is I think most of us tend to see the same general person showing up with MAC over and over. Not always, but the majority of people, I think, in the offices showing up tend to be women. They tend to be thin to medium build and the MAC usually is in the mid zones of the lungs, the right middle lobe and what we call the lingula Over here. If you thought of it as the left middle lobe, that would sort of be accurate, even though it's a pocket off of the left middle lobe. That would sort of be accurate even though it's a pocket off of the left upper lobe. But this mid zone in thin women or medium-sized women dry cough bronchiectasis that's what we call it these enlarged airways with what we call a tree-in-bud nodularity in those mid zones is many, many times this atypical mycobacterium that's growing in there. So it's interesting that it's the same physical appearance of people that keep getting the same infection that hopefully will work itself out in the genetic understanding in the years to come.

Speaker 2: 6:59

Are there like some symptoms that's commonly known? I know it could be multiple things, but what are some signs that people should look for that they may have this particular bacteria?

Speaker 3: 7:13

Great question. Generally it's a dry cough. It could be completely asymptomatic and a person got a chest x-ray or a CAT scan for whatever reason. Maybe they were a smoker and it was a CT lung screen or something happened. They got a CAT scan and there were. Maybe they were a smoker and it was a CT lung screen or something happened. They got a CAT scan and there were some little nodules that showed up. That may be it and they might be completely asymptomatic. But it might be a dry cough. In a more advanced stage it might be a wet cough with production of sputum and at this point the airways have become enlarged, thickened, they're making a lot of mucus. In a, the airways have become enlarged, thickened, they're making a lot of mucus. In a much more advanced stage, with a lot of mucus production, they may be losing weight and even have shortness of breath and other problems, but for the most part it's usually chronic cough for the majority of people.

Speaker 2: 8:02

So if you get any of these symptoms, you need to get yourself in front of a good penologist. Dr Pamer love it. You have a good rest of the day. We'll see you in the next episode. Thank you, garfield.

Speaker 1: 8:17

Thanks for listening to the Dr Mark J Pamer podcast. To learn more about the doctor who uses his heart to treat your lungs, go to markpamerdocom or call 772-785-5864. Once again, that's 772-785-5864.