The patient went back to her pulmonologist for a followup appointment after completing the medication treatment and was told by her pulmonologist that she was recovered. However, the patient continued to be symptomatic and expressed concern about her symptoms. The pulmonologist assured her that she was fine. Within the month, the patient began feeling weaker and experienced difficulty walking and sleeping. The patient then began coughing up blood and losing weight. She returned to the pulmonologist, who decided to do a lung bacterial culture. The culture came back positive for mycobacterium avium complex (MAC). He was referred to an infectious disease physician and treatment for the MAC commenced. In spite of multiple treatments, the patient ultimately required oxygen full time.
Question(s) For Expert Witness
Please describe your experience diagnosing and treating MAC?
What sort of symptoms would make you consider MAC?
What is the standard work up and diagnosis criteria for MAC?
Expert Witness Response E-001199
I have treated many cases of MAC and have several patients under my clinical care currently that are on active MAC regimens. I am currently a co-investigator on a clinical trial testing a nebulized antibiotic for MAC at my university. The classic symptoms of pulmonary MAC infection are cough, weight loss, fatigue, and intermittent low-grade fever. The standard workup includes chest CT and multiple sputum samples for AFB smear and culture. Alternatively, one bronchoscopic specimen can be used if pt is unable to produce sputum. Classic cases of pulmonary MAC involve nodular and bronchiectactic lung disease, often progressing to more cystic and cavitary disease. The presence of typical lung changes with repeated isolation of MAC from sputum samples is classic. Therapy is prolonged, often problematic, and not infrequently complicated by the emergence of drug resistance to the macrolide or rifamycin derivative (less commonly the ethambutol). In those cases, we'll send for drug resistance testing -- although it is expensive.
About the author
Wendy Ketner, M.D.
Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.
Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.
Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.
