Tuberculosis And The Hiv / Aid Epidemic

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Throughout history humans have been plagued with mycobacterial diseases, most notably, Tuberculosis and Leprosy, caused by Mycobacterium tuberculosis and Mycobacterium leprae, respectively. [1] However, with the advent of antimicrobial cocktails and public health measures, the incidence of these diseases saw a sharp decline. [1-2] Conversely, with the increase of pulmonary diseases due to smoking, immunosuppressive drug therapies, and the HIV/AID epidemic, the incidence of diseases caused by non-Tuberculosis Mycobacteria (NTM) began to increase. [2] These NTMs are ubiquitous in nature and can be found nearly everywhere (e.g., soil, domestic and wild animals, tap water, surface water, milk, and food.) [3-4] Currently, just
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[4-5] Though these species are extremely related there relevance to certain disease manifestation is dissimilar. In order to resolve these species modern techniques must be implemented. Probes have been designed to target and amplify uniquely identifiable regions on the genomes of these two species. [5] By using Polymerase chain reactions (PCR) the ratio of M. avium and M. intracelluare can be ascertained for each manifestation of disease. Other members of Mycobacteria can be isolated and identified in the MAC including M. chimaera and M. colombiense. [2]
Research shows that M. avium is more predominant in highly disseminated, systemic manifestations whereas M. intracelluare is more predominate in pulmonary, localized manifestations. The importance of this ratio has not yet been discovered; however, the true significance may be important to future research and treatments. [8]
ECOLOGY. MAC organisms, much like many of the other NTMs, are found in an extraordinary number of different ecological niches. M. avium and M. intracelluare, as stated above, can be isolated from the environment in soils, water, and on animals. MAC organisms can also be transient flora of healthy humans. [3]

TRANSMISSION. Because the reservoir for MAC is environmental, the potential exposure to it is high. [3] Subcutaneous testing of M. intracelluare antigen revealed high levels of exposure especially in the costal regions of the
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