Shitrit David, Baum Gerry L, Priess Rachel, Lavy Anita, Shitrit Ariella Bar-Gil, Raz Meir, Shlomi Dekel, Daniele Bendayan, Kramer Mordechai R
Pulmonary Institute, Rabin Medical Center, Beilinson Campus, Petah Tiqwa 49100, Israel.
Chest. 2006 Mar;129(3):771-6. doi: 10.1378/chest.129.3.771.
Mycobacterium kansasii infection is one of the most common causes of nontuberculous mycobacterial lung disease in world. However, little is known about its background characteristics or drug sensitivity in nonendemic areas.
We assessed the clinical features, radiologic findings, and drug sensitivity associated with M kansasii infection in Israel.
Patients with a culture-positive diagnosis of M kansasii infection between April 1999 and April 2004 were identified from a clinic database of tuberculosis centers. Mycobacterial cultures were performed with standard methods. Data on patient background and clinical features were collected from the medical files.
Mean age (+/- SD) of the 56 patients was 58 +/- 18 years, and 64% were men; 59% had associated lung disease. Fifteen percent were receiving immunosuppressive medications. None had HIV infection. Systemic comorbid diseases were noted in 27%. The most common clinical presentations were chest pain, cough, hemoptysis, fever, and night sweats. Cavitation was noted only in 54%. Older patients had more noncavitary disease than younger patients (p = 0.01, r = 0.35). Lower-lobe predominance was very rare (4%). None of the patients presented with pleural effusion or lymphadenopathy. Only seven patients (11%) underwent bronchoscopy for diagnosis. M kansasii isolates showed the highest sensitivity to rifampin, ethambutol, clarithromycin, and ofloxacin, and the highest resistance to ciprofloxacin and capreomycin. The mean duration of treatment was 21 +/- 7.2 months. There were no disease-related deaths.
M kansasii disease in Israel has no association with HIV, more systemic comorbid diseases and associated lung disease, and fewer cavitations. Following appropriate treatment, patients with M kansasii disease have an excellent prognosis.
堪萨斯分枝杆菌感染是全球非结核分枝杆菌肺病最常见的病因之一。然而，在非流行地区，对其背景特征和药物敏感性了解甚少。
我们评估了以色列与堪萨斯分枝杆菌感染相关的临床特征、影像学表现及药物敏感性。
从结核病中心的临床数据库中识别出1999年4月至2004年4月间培养确诊为堪萨斯分枝杆菌感染的患者。采用标准方法进行分枝杆菌培养。从病历中收集患者背景和临床特征数据。
56例患者的平均年龄（±标准差）为58±18岁，64%为男性；59%伴有肺部疾病。15%正在接受免疫抑制治疗。无人感染HIV。27%有全身性合并症。最常见的临床表现为胸痛、咳嗽、咯血、发热和盗汗。仅54%有肺空洞形成。老年患者的非空洞性疾病比年轻患者更多（p = 0.01，r = 0.35）。下叶优势极为罕见（4%）。无患者出现胸腔积液或淋巴结病。仅7例患者（11%）接受支气管镜检查以明确诊断。堪萨斯分枝杆菌分离株对利福平、乙胺丁醇、克拉霉素和氧氟沙星敏感性最高，对环丙沙星和卷曲霉素耐药性最高。平均治疗时长为21±7.2个月。无疾病相关死亡病例。
以色列的堪萨斯分枝杆菌病与HIV无关，有更多的全身性合并症和相关肺部疾病，肺空洞形成较少。经过适当治疗，堪萨斯分枝杆菌病患者预后良好。
