MAC bacteria should always be considered in a person with HIV infection presenting with diarrhea.The diagnosis requires consistent symptoms with two additional signs:
Chest X-ray or CT scan showing evidence of right middle lobe (or left lingular lobe) lung infection
Sputum culture or bronchoalveolar lavage culture demonstrating the infection is caused by MACDisseminated MAC is most readily diagnosed by one positive blood culture. Blood cultures should be performed in patients with symptoms, signs, or laboratory abnormalities compatible with mycobacterium infection. Blood cultures are not routinely recommended for asymptomatic persons, even for those who have CD4+ T-lymphocyte counts less than 100 cells/uL. HIV infection
MAC in patients with HIV disease is theorized to represent recent acquisition rather than latent infection reactivating (which is the case in many other opportunistic infections in immunocompromised patients).The risk of MAC is inversely related to the patients CD4 count and increases significantly when the CD4 count decreases below 50 cells/mm³. Other risk factors for acquisition of MAC infection include using an indoor swimming pool, consumption of raw or partially cooked fish or shellfish, bronchoscopy and treatment with granulocyte stimulating factor. Disseminated disease was previously the common presentation prior to the advent of highly active antiretroviral therapy (HAART). Today, in regions where HAART is the standard of care, localized disease presentation is more likely. This generally includes a focal lymphadenopathy/lymphadenitis. Prevention
People with AIDS are given macrolide antibiotics such as azithromycin for prophylactic treatment.People with HIV infection and less than 50 CD4 cells/uL should be administered prophylaxis against MAC.
Shortly after the Lady Windermere syndrome was proposed, a librarian wrote a letter to the editor of Chest challenging the use of Lady Windermere as the eponymous ancestor of the proposed syndrome. In the play, Lady Windermere is a vivacious young woman, married only two years, who never coughs or displays any other signs of illness. While her avoidance of shaking hands might be interpreted as "fastidiousness", two alternative explanations may be just as probable:

1) Lady Windermere actually is in the midst of arranging flowers and consequently cannot properly greet her guest:[LADY WINDERMERE is at table R., arranging roses in a blue bowl. ]2) Lady Windermere wishes to discourage the flirtatious advances of her would-be suitor Lord Darlington and cites her wet hands as an excuse to keep him from touching her:LADY WINDERMERE. Lord Darlington, you annoyed me last night at the Foreign Office. I am afraid you are going to annoy me again. . . .LORD DARLINGTON. [Takes chair and goes across L.C.] I am quite miserable, Lady Windermere. You must tell me what I did. [Sits down at table L.]LADY WINDERMERE. Well, you kept paying me elaborate compliments the whole evening. ]The scholars highlight the literary malapropism, but some in the medical community have adopted the term regardless, and peer-reviewed medical journals still sometimes mention the Lady Windermere syndrome, although it is increasingly viewed as a limiting and sexist term for a serious bacterial infection.