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.
Prophylaxis should be continued for the patients lifetime unless multiple drug therapy for MAC becomes necessary because of the development of MAC disease.Clinicians must weigh the potential benefits of MAC prophylaxis against the potential for toxicities and drug interactions, the cost, the potential to produce resistance in a community with a high rate of tuberculosis, and the possibility that the addition of another drug to the medical regimen may adversely affect patients compliance with treatment. Because of these concerns, therefore, in some situations rifabutin prophylaxis should not be administered.Before prophylaxis is administered, patients should be assessed to ensure that they do not have the active disease due to MAC, M. tuberculosis, or any other mycobacterial species. This assessment may include a chest radiograph and tuberculin skin test.Rifabutin, by mouth daily, is recommended for the peoples lifetime unless disseminated MAC develops, which would then require multiple drug therapy. Although other drugs, such as azithromycin and clarithromycin, have laboratory and clinical activity against MAC, none has been shown in a prospective, controlled trial to be effective and safe for prophylaxis. Thus, in the absence of data, no other regimen can be recommended at this time. The 300-mg dose of rifabutin has been well tolerated. Adverse effects included neutropenia, thrombocytopenia, rash, and gastrointestinal disturbances. Treatment
Postinfection treatment involves a combination of antituberculosis antibiotics, including rifampicin, rifabutin, ciprofloxacin, amikacin, ethambutol, streptomycin, clarithromycin or azithromycin.NTM infections are usually treated with a three-drug regimen of either clarithromycin or azithromycin, plus rifampicin and ethambutol.