Wallace R J, Brown B A, Onyi G O
Department of Microbiology, University of Texas Health Center, Tyler 75710.
J Infect Dis. 1992 Aug;166(2):405-12. doi: 10.1093/infdis/166.2.405.
Little is known of clinical disease due to Mycobacterium chelonae chelonae. One hundred skin, soft tissue, or bone isolates of this rapidly growing mycobacterium were identified over 10 years. Clinical disease included disseminated cutaneous infection (53%); localized cellulitis, abscess, or osteomyelitis (35%); and catheter infections (12%). Underlying conditions with disseminated infection included organ transplantation, rheumatoid arthritis, and autoimmune disorders; 92% involved corticosteroid use. Trauma and medical procedures were risk factors for localized infections. Corticosteroids and chronic renal failure were risk factors for catheter infections. Overall, 62% of patients were receiving corticosteroids and 72% were immunosuppressed. MICs of six oral antimicrobials were obtained for 180 isolates by broth microdilution. Up to 20% of isolates were susceptible to doxycycline, ciprofloxacin, ofloxacin, and sulfamethoxazole. In contrast, 100% were susceptible to clarithromycin (MICs less than or equal to 1 microgram/mL). Disease due to M. chelonae chelonae usually occurs in the setting of corticosteroid therapy and is often disseminated; the organisms require high MICs of oral antimicrobials other than clarithromycin.
关于龟分枝杆菌引起的临床疾病，人们了解甚少。在10年期间共鉴定出100株这种快速生长分枝杆菌的皮肤、软组织或骨分离株。临床疾病包括播散性皮肤感染（53%）；局限性蜂窝织炎、脓肿或骨髓炎（35%）；以及导管感染（12%）。播散性感染的基础疾病包括器官移植、类风湿性关节炎和自身免疫性疾病；92%的病例使用了皮质类固醇。创伤和医疗操作是局限性感染的危险因素。皮质类固醇和慢性肾衰竭是导管感染的危险因素。总体而言，62%的患者正在接受皮质类固醇治疗，72%的患者存在免疫抑制。通过肉汤微量稀释法对180株分离株进行了六种口服抗菌药物的最低抑菌浓度（MIC）检测。高达20%的分离株对强力霉素、环丙沙星、氧氟沙星和磺胺甲恶唑敏感。相比之下，100%的分离株对克拉霉素敏感（MIC小于或等于1微克/毫升）。龟分枝杆菌引起的疾病通常发生在皮质类固醇治疗的情况下，且常为播散性；除克拉霉素外，该菌对其他口服抗菌药物的MIC要求较高。
