Effective prevention and therapy of MAC has the potential to contribute substantially to improved quality of life and duration of survival for HIV-infected persons. Pathophysiology
MAC is the most commonly found form of NTM.Immunodeficiency is not a requirement for MAI.MAC usually affects patients with abnormal lungs or bronchi. However, Jerome Reich and Richard Johnson describe a series of six patients with MAC infection of the right middle lobe or lingula who did not have any predisposing lung disorders.The right middle lobe and lingula of the lungs are served by bronchi that are oriented downward when a person is in the upright position. As a result, these areas of the lung may be more dependent upon vigorous voluntary expectoration (cough) for clearance of bacteria and secretions.Since the six patients in their retrospective case series were older females, Reich and Johnson proposed that patients without a vigorous cough may develop right middle lobe or left lingular infection with MAC. They proposed this syndrome be named Lady Windermere syndrome, after the character Lady Windermere in Oscar Wildes play Lady Windermeres Fan. However, little research has confirmed this speculative cause. Diagnosis
Diagnosis can be achieved through blood cultures or cultures of other bodily fluids such as sputum. Bone marrow culture can often yield an earlier diagnosis but is usually avoided as an initial diagnostic step because of its invasiveness. Many people will have anemia and neutropenia if the bone marrow is involved.
Diagnosis, therapy, and prophylaxis should follow recommendations similar to those for adolescents and adults. Society and culture
Terminology
"Lady Windermere syndrome" is one term to describe infection in the lungs due to MAC. It is named after a character in Oscar Wildes 1892 play Lady Windermeres Fan.In recent years, some have described the eponym as inappropriate, and some have noted that it would have been unlikely that Lady Windermere had the condition to which her name was assigned.The more commonly used term is nontuberculous mycobacteria (NTM) infection, or non-tuberculous mycobacterial infection (NMI). There is no evidence that a persons reluctance to spit has any causal role in NTM infection, the chief reason for the term having been applied to older women presenting with the condition.Lady Windermere syndrome is a type of mycobacterial lung infection. Literary reference
The original Chest article proposing the existence and pathophysiology of the Lady Windermere syndrome suggested the character Lady Windermere in Oscar Wildes Victorian-era play Lady Windermeres Fan is a good example of the fastidious behavior believed to cause the syndrome. The article states:
We offer the term, Lady Windermeres Syndrome, from the Victorian-era play, Lady Windermeres Fan, to convey the fastidious behavior hypothesized: "How do you do, Lord Darlington. No, I cant shake hands with you. My hands are all wet with the roses. "Victorian women presumably believed "ladies dont spit," and consequently might have been predisposed to develop lung infection.