A definition of the Mycobacterium avium complex for taxonomical and clinical purposes, a review

Nontuberculous mycobacteria, particularly the Mycobacterium avium complex (MAC) bacteria, are increasingly recognized as opportunistic pathogens of humans. As a result, studies on antibiotic treatment and taxonomy of the MAC are intensifying, but an updated definition of what constitutes the MAC, either for taxonomical studies or for clinical purposes, is lacking. On the basis of literature review and phylogenetic analyses, we propose to define the MAC as a grouping of slow-growing mycobacteria that show corresponding values in at least two of the following targets against either M. avium ATCC 25291(T) or Mycobacterium intracellulare ATCC 13950(T) : >99.4% sequence identity for the full 16S rRNA gene, >98.7% for the partial (5') 16S rRNA gene, >97.3% for hsp65 and >94.4% for rpoB region V. A >97.5% value in concatenated analyses of >2500 bp that includes 16S rRNA, hsp65 and rpoB gene sequence data or >= 85% average nucleotide identity to M. avium ATCC 25291(T) or M. intracellulare ATCC 13950(T) on basis of whole genome sequencing data is recommended. This molecular definition is based on the distances observed between the classical members of the MAC, M. avium and M. intracellulare. Applying this definition, the complex currently consists of 12 validly published species: Mycobacterium avium, Mycobacterium intracellulare, Mycobacterium chimaera, Mycobacterium colombiense, Mycobacterium arosiense, Mycobacterium vulneris, Mycobacterium bouchedurhonense, Mycobacterium timonense, Mycobacterium marseillense, Mycobacterium yongonense, Mycobacterium paraintracellulare and Mycobacterium lepraemurium.