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
[phone]

Episode Transcript

Speaker 1 (00:00):
Welcome to the Dr Mark J Pamer podcast, a doctor
who uses his heart to treat yourlungs.
Here's your host, Dr Mark JPamer.

Speaker 2 (00:14):
Curious about the mysteries of lung health, dive
into an exclusive interview witha leading penologist for Port
St Lucie, where we unravel thecomplexity of microbacteria
avian complex MAC.
Welcome back everyone.
Garfield Bullen, co-host, slashproducer, back in the studio
with Dr Mark Pamer.

(00:34):
Dr Pamer, how you doing.
I'm great, garfield, let's getthis going.
So what is microbacteria aviancomplex?

Speaker 3 (00:43):
Awesome question.
I get asked this questionmultiple 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 bacteriaclasses.
Two of them are kind of justregular old bacteria.
We call them gram positives,gram negatives.
The third one's calledmycoplasma.
And the fourth one is this onewe're going to call

(01:05):
mycobacterium.
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 howthey stain the bacteria and
really whether it turns pink,blue, whether it's got a slime
layer or not.
That's your usual bacteria thatwe're taking antibiotics for.

(01:28):
That third one I talked about,mycoplasma.
They're tiny little bacteria.
They get inside of the cells.
They've got some stuff incommon with fungus.
Mycoplasma pneumonia is afamous one that causes walking
pneumonia in college kids.
Chlamydophthora pneumonia thoseare the mycoplasmas Not as

(01:53):
relevant to most of us as adults, certainly don't cause a big
burden of disease.
But then there's this fourthone, mycobacterium.
And myco M-Y-C-O refers tofungus.
So mycobacterium are some kindof a fusion and evolution where
you've got bacteria that havereally adopted fungal properties
on their cell wall and that hasmade them extremely resistant
to destruction.

(02:14):
They can live for a long, longtime.
They're resistant to whiteblood cells taking over.
They're resistant to death.
They're like an Abrams tank, Imean, you just can't kill the
thing.
And so that makes them quitethe potent adversary to the
immune system.
They're everywhere, they're inthe dirt, they're in the water,
but you know, most of us aren'tgetting infected with it.

(02:35):
So the most famous member ofthat class if you will the
Hitler, the one that's, you know, the most famous throughout
history that's mycobacteriumtuberculosis.
Everybody's heard of that oneTB, and that one's been
devastating throughout history.
But there's some other membersin the family that are less
well-known but still cause a lotof disease.
And then there's multiple inthe family that don't really do

(02:58):
anything.
They don't affect humans.
The one that we're going to talkabout today is called
Mycobacterium Avium Complex, mac, m-a-c.
There's several members of thatcommunity in MAC.
Mycobacterium Avium is a famousone.
Mycobacterium Intracellular isanother one.
You've got Mycobacterium AviumIntracellular M-A-I.

(03:19):
There's other members in there.
We're not going to go throughall eight of them, but MAC is
the group Now.
Mac's everywhere.
As I said, it's in your showerwater.
It's in freestanding water.
It could be in your hot tub.
It's in the dirt when you gogardening.
I mean, it's everywhere, youcan't get away from it.

(03:40):
But the reality is we're allnot walking around with Mac, any
more than we're all walkingaround with strep throat or
anything else.
Something happens and somepeople get infected and others
don't.
So the people really kind ofget infected with MAC.
It may just be bad luck, butthere's something you know,
there's an indictment there ofthe immune system where this
pathogen has been allowed to be,you know, engulfed by the cells

(04:01):
, and now it's set up shop andit's created, perhaps an
infection.
That may or may not be relevant.
So people may get some littlelung nodules that are picked up
just, you know, as ahappenstance, and we'll follow
it from there.
Or they may present becausethey've got cough.
It may be a very, very advancedstage where they've had
significant lung destructionwith what we call bronchiectasis

(04:24):
, all kinds of nodules, theycoughing up sputum.
That would be a much moreadvanced stage, but we may find
it very, very early.
We may find it completelyasymptomatic.
Not everybody that has thisneeds to be treated, that's for
sure.
Now, mac is not necessarilydifficult to kill, but it takes
a long time to kill it.

(04:45):
It usually requires at leastthree antibiotics.
It's at risk of becominginfectious if you mess around
with it and you're going tostart stop on the antibiotics.
Even once you start to treat itwith a significant regimen of
usually three antibioticsrifampin, azithromycin,
ethambutol.
That's the most common regimen.

(05:06):
Even once you've cleared theairway of growing this, you
still need to stay on therapyfor another year.
There's still a chance thatthis thing will come back or may
not go away.
There's a national center out inDenver, national Jewish, who is
world famous.
They're the world leader in MACand mycobacterial diseases and
many people travel there andthey've got state-of-the-art

(05:29):
testing and diagnosis andtreatment.
That's certainly where I sendmy more refractory patients.
But the diagnosis is you know,cough up sputum, got to grow.
It takes six weeks usually togrow it and then I have a
discussion with patients on thetreatment of it.
Some patients want to gettreated, some people don't even
need treatment, some we justwatch it, but some really do

(05:51):
need treatment and from therethat's a prolonged course.
So one of the things that'sinteresting about Mac is I think
most of us tend to see the samegeneral person showing up with
MAC over and over.
Not always, but the majority ofpeople, I think, in the offices
showing up tend to be women.

(06:11):
They tend to be thin to mediumbuild and the MAC usually is in
the mid zones of the lungs, theright middle lobe and what we
call the lingula Over here.
If you thought of it as theleft middle lobe, that would
sort of be accurate, even thoughit's a pocket off of the left
middle lobe.
That would sort of be accurateeven though it's a pocket off of
the left upper lobe.
But this mid zone in thin womenor medium-sized women dry cough
bronchiectasis that's what wecall it these enlarged airways

(06:36):
with what we call a tree-in-budnodularity in those mid zones is
many, many times this atypicalmycobacterium that's growing in
there.
So it's interesting that it'sthe same physical appearance of
people that keep getting thesame infection that hopefully
will work itself out in thegenetic understanding in the

(06:57):
years to come.

Speaker 2 (06:59):
Are there like some symptoms that's commonly known?
I know it could be multiplethings, but what are some signs
that people should look for thatthey may have this particular
bacteria?

Speaker 3 (07:13):
Great question.
Generally it's a dry cough.
It could be completelyasymptomatic and a person got a
chest x-ray or a CAT scan forwhatever reason.
Maybe they were a smoker and itwas a CT lung screen or
something happened.
They got a CAT scan and therewere.
Maybe they were a smoker and itwas a CT lung screen or
something happened.
They got a CAT scan and therewere some little nodules that
showed up.
That may be it and they mightbe completely asymptomatic.
But it might be a dry cough.

(07:34):
In a more advanced stage itmight be a wet cough with
production of sputum and at thispoint the airways have become
enlarged, thickened, they'remaking a lot of mucus.
In a, the airways have becomeenlarged, thickened, they're
making a lot of mucus.
In a much more advanced stage,with a lot of mucus production,

(07:55):
they may be losing weight andeven have shortness of breath
and other problems, but for themost part it's usually chronic
cough for the majority of people.

Speaker 2 (08:02):
So if you get any of these symptoms, you need to get
yourself in front of a goodpenologist.
Dr Pamer love it.
You have a good rest of the day.
We'll see you in the nextepisode.
Thank you, garfield.

Speaker 1 (08:17):
Thanks for listening to the Dr Mark J Pamer podcast.
To learn more about the doctorwho uses his heart to treat your
lungs, go to markpamerdocom orcall 772-785-5864.
Once again, that's 772-785-5864.