Ebert Deborah L, Olivier Kenneth N
Wilford Hall Medical Center, 759th MSGS/MCCP, 2200 Bergquist Drive, Lackland AFB, TX 78236, USA.
Clin Chest Med. 2002 Sep;23(3):655-63. doi: 10.1016/s0272-5231(02)00017-5.
Nontuberculous mycobacterial pulmonary infections are increasingly recognized in patients with CF. This may reflect the increasing longevity of this population with increased environmental exposure time, a higher clinical index of suspicion, and/or some as yet unidentified predisposing factor(s). The most common species of NTM in CF is MAC, followed by M abscessus. We recommend that adult patients with CF be screened for the presence of nontuberculous mycobacteria in pulmonary secretions on a regular basis, and that consideration be given to this diagnosis if a patient has an escalating pattern of exacerbations or admissions. Positive cultures are likely to indicate disease if they are multiple or if a patient has clinical evidence of pulmonary disease exacerbation (increased cough, increased purulence of secretions, systemic manifestations such as fever, weight loss) that is not responding to conventional antibiotic therapy. Cystic fibrosis patients who do not respond to treatment for the usual organisms should be carefully re-evaluated for the presence of NTM and treated with a macrolide-containing multidrug regimen directed against the identified NTM if diagnostic criteria are met. Novel treatments with cytokines and intermittent dosing of antibiotics are currently under investigation in non-CF populations and may have applicability to CF in the future.
非结核分枝杆菌肺部感染在囊性纤维化（CF）患者中越来越受到关注。这可能反映了该人群寿命延长，环境暴露时间增加，临床怀疑指数提高，和/或一些尚未明确的易感因素。CF患者中最常见的非结核分枝杆菌种类是鸟分枝杆菌复合群（MAC），其次是脓肿分枝杆菌。我们建议成年CF患者定期筛查肺部分泌物中是否存在非结核分枝杆菌，如果患者病情加重或住院次数不断增加，应考虑这一诊断。如果培养结果为多次阳性，或者患者有肺部疾病加重的临床证据（咳嗽加剧、分泌物脓性增加、发热、体重减轻等全身表现）且对传统抗生素治疗无反应，则培养阳性可能提示患有疾病。对常见病原体治疗无反应的囊性纤维化患者应仔细重新评估是否存在非结核分枝杆菌，如果符合诊断标准，应使用针对已鉴定的非结核分枝杆菌的含大环内酯类药物的多药方案进行治疗。目前在非CF人群中正在研究细胞因子和间歇性使用抗生素的新疗法，未来可能适用于CF。
