Ding Liang-Wen, Lai Chih-Cheng, Lee Li-Na, Hsueh Po-Ren
Division of Critical Care Medicine, Department of Emergency and Critical Care Medicine, Lotung Poh-Ai Hospital, Yi-Lan, Taiwan.
J Formos Med Assoc. 2006 May;105(5):370-6. doi: 10.1016/S0929-6646(09)60132-7.
BACKGROUND/PURPOSE: Abdominal nontuberculous mycobacterial infection is a rare condition. Continuous ambulatory peritoneal dialysis (CAPD)-associated peritonitis is the most common manifestation of infection due to nontuberculous mycobacteria (NTM). There are limited data on the clinical manifestations of nontuberculous mycobacterial infection. This study investigated the diagnostic features, clinical presentation, mycobacteriology, treatment and outcome of all abdominal NTM infections treated over a 7-year period at a major teaching hospital in Taiwan.
The medical records of all patients with a diagnosis of abdominal NTM infection from January 1997 through to December 2003 were retrospectively reviewed.
All 11 patients with abdominal NTM infections identified during the 7-year period were included. Among these patients, six were male and five were female, with a mean age of 64.5 years. The disease manifested as peritonitis (9 patients, 82%), splenic abscess (1, 9%), or perirenal abscess (1, 9%). Most patients (73%) had underlying malignancy, most often hepatoma (45%). Immunocompromised status (liver cirrhosis, malignancy, acquired immunodeficiency syndrome) was noted in 10 patients (91%). None of our patients who developed NTM peritonitis had received CAPD. The peritoneal fluid appearance varied considerably, with no particular predominance of clear, turbid, bloody, or chylous findings. Rapidly growing mycobacteria were the major etiology (46%) of abdominal NTM infection, and Mycobacterium abscessus played a major role (27%). Overall, eight patients died, and only one patient survived longer than 1 year. Seven patients (64%) died before diagnosis.
Abdominal NTM infection is frequently overlooked because of its rarity and nonspecific symptoms, with consequent delays in diagnosis and treatment. In immunocompromised patients with ascites from any cause (liver cirrhosis, malignant ascites, etc.), NTM peritonitis should be considered early in the differential diagnosis of symptoms including fever, abdominal pain and weight loss. The poor prognosis of abdominal NTM infection appears to be related to the severity of underlying conditions, most often malignancy.
背景/目的：腹部非结核分枝杆菌感染是一种罕见疾病。持续性非卧床腹膜透析（CAPD）相关腹膜炎是非结核分枝杆菌（NTM）感染最常见的表现形式。关于非结核分枝杆菌感染的临床表现的数据有限。本研究调查了台湾一家大型教学医院7年间所有接受治疗的腹部NTM感染的诊断特征、临床表现、分枝杆菌学、治疗及转归情况。
回顾性分析1997年1月至2003年12月期间所有诊断为腹部NTM感染患者的病历。
纳入了7年间确诊的所有11例腹部NTM感染患者。这些患者中，男性6例，女性5例，平均年龄64.5岁。疾病表现为腹膜炎（9例，82%）、脾脓肿（1例，9%）或肾周脓肿（1例，9%）。大多数患者（73%）有潜在恶性肿瘤，最常见的是肝癌（45%）。10例患者（91%）存在免疫功能低下状态（肝硬化、恶性肿瘤、获得性免疫缺陷综合征）。发生NTM腹膜炎的患者均未接受CAPD治疗。腹水外观差异很大，清亮、浑浊、血性或乳糜样表现均无明显优势。快速生长的分枝杆菌是腹部NTM感染的主要病因（46%），脓肿分枝杆菌起主要作用（27%）。总体而言，8例患者死亡，仅1例患者存活超过1年。7例患者（64%）在诊断前死亡。
由于腹部NTM感染罕见且症状不具特异性，常被忽视，导致诊断和治疗延迟。对于因任何原因（肝硬化、恶性腹水等）出现腹水的免疫功能低下患者，在对包括发热、腹痛和体重减轻等症状进行鉴别诊断时，应早期考虑NTM腹膜炎。腹部NTM感染预后不良似乎与潜在疾病的严重程度有关，最常见的是恶性肿瘤。
