Latshang Tsogyal D, Lo Cascio Christian M, Russi Erich W
Klinik für Pneumologie, UniversitätsSpital Zürich, Zürich.
Ther Umsch. 2011 Jul;68(7):402-6. doi: 10.1024/0040-5930/a000184.
Nontuberculous mycobacterium (NTM) species are mycobacterial species other than those belonging to the Mycobacterium tuberculosis complex and M. leprae. NTM are generally free-living organisms that are ubiquitous in the environment. Pulmonary disease, especially in older persons with and without underlying lung disease, is caused primarily by M. avium complex (MAC) and M. kansasii. The symptoms and signs of MAC lung disease are variable and not specific, but include cough, malaise, weakness, dyspnoea, chest discomfort and occasionally hemoptoe. Two major clinical presentations include disease in those with underlying lung disease, primarily white, middle-aged or elderly men - often alcoholics and/or smokers with underlying chronic obstructive lung disease, patients in whom MAC develops in areas of prior bronchiectasis, and patients with cystic fibrosis; and those without known underlying lung disease, including non-smoking women over age 50 who have interstitial patterns on chest radiography. M. kansasii infections are endemic in cities with infected tap water. Symptoms of the M. kansasii lung disease resemble to tuberculosis. M. abszessus is the most pathogenic rapid growing Mycobacterium which causes pulmonary infection. The American Thoracic Society and Infectious Disease Society of America's diagnostic criteria for nontuberculous mycobacterial pulmonary infections include both imaging studies consistent with pulmonary disease and recurrent isolation of mycobacteria from sputum or isolated from at least one bronchial wash in a symptomatic patient. For treatment of MAC lung disease we recommend depending on severity and susceptibility testing a three to four drug treatment with a macrolide, rifampicin and ethambutol and for M. kansasii a treatment with Isoniazid, rifampicin and ethambutol. Surgical management only plays a role in rare and special cases. Treatment should be continued until sputum cultures are consecutively negative for at least one year.
非结核分枝杆菌（NTM）是指除结核分枝杆菌复合群和麻风分枝杆菌以外的分枝杆菌种类。NTM通常为自由生活的生物体，在环境中广泛存在。肺部疾病主要由鸟分枝杆菌复合群（MAC）和堪萨斯分枝杆菌引起，尤其在有或无基础肺部疾病的老年人中。MAC肺部疾病的症状和体征多样且不具特异性，包括咳嗽、不适、乏力、呼吸困难、胸部不适，偶尔咯血。两种主要临床表现包括：患有基础肺部疾病的患者，主要是白人中年或老年男性——通常是患有基础慢性阻塞性肺疾病的酗酒者和/或吸烟者、MAC在既往支气管扩张区域发病的患者以及囊性纤维化患者；以及无已知基础肺部疾病的患者，包括胸部X线有间质改变的50岁以上非吸烟女性。堪萨斯分枝杆菌感染在自来水受污染的城市呈地方性流行。堪萨斯分枝杆菌肺部疾病的症状类似于结核病。脓肿分枝杆菌是致病性最强的快速生长分枝杆菌，可引起肺部感染。美国胸科学会和美国感染病学会制定的非结核分枝杆菌肺部感染诊断标准包括与肺部疾病相符的影像学检查，以及在有症状的患者中反复从痰液中分离出分枝杆菌或至少从一次支气管灌洗中分离出分枝杆菌。对于MAC肺部疾病的治疗，我们建议根据病情严重程度和药敏试验结果，采用大环内酯类、利福平、乙胺丁醇三到四种药物联合治疗；对于堪萨斯分枝杆菌感染，采用异烟肼、利福平、乙胺丁醇治疗。手术治疗仅在罕见和特殊情况下起作用。治疗应持续至痰培养连续阴性至少一年。
