Division of Otolaryngology-Head and Neck Surgery, University of California-Los Angeles, School of Medicine, Los Angeles, California 90095-1624, USA.
Am J Rhinol Allergy. 2011 Nov-Dec;25(6):421-4. doi: 10.2500/ajra.2011.25.3677.
The purpose of this study was to identify the incidence of atypical Mycobacterium identified by routine sinus cultures and review the recent literature on management.
A retrospective case series was performed in a tertiary academic hospital. A retrospective case series of all patients treated with atypical Mycobacterium rhinosinusitis from 2005 to 2010 was performed. Cases were identified from a prospective database of 676 endoscopically guided sinus cultures.
Eight patients with atypical Mycobacterium sinusitis were identified. There were five women and three men. Median age was 63 years (range, 55-71 years). All patients had prior endoscopic sinus surgery a median of 14 months (range, 0.8-162 months) before a positive culture result. Species identified included Mycobacterium chelonae, Mycobacterium fortuitum, Mycobacterium abscessus, and Mycobacterium avium complex. Chief presenting symptoms were postnasal discharge (88%), followed by decreased smell and taste (63%), and facial pain/pressure (38%). Patients were treated based on sensitivity results with long-term oral antibiotics for at least 2 months based on improvements on endoscopy. Median follow-up for patients in this study after treatment was 1.3 years (range, 0.6-4.6 years).
In this study, atypical mycobacteria were identified in <1% of sinus cultures. Prolonged, culture-directed antibiotic therapy remains the mainstay of treatment when there is clinical evidence of infection. Previous endoscopic sinus surgery may represent a risk factor for colonization and subsequent infection. Further research is necessary to determine the optimal treatment duration and management to prevent disease relapse.
本研究旨在确定常规鼻窦培养物中鉴定出的非典型分枝杆菌的发生率,并回顾最近关于其治疗的文献。
在一家三级学术医院进行了回顾性病例系列研究。对 2005 年至 2010 年期间接受非典型分枝杆菌鼻-鼻窦炎治疗的所有患者进行了回顾性病例系列研究。病例是从 676 例经内镜引导的鼻窦培养前瞻性数据库中确定的。
鉴定出 8 例非典型分枝杆菌鼻窦炎患者。女性 5 例,男性 3 例。中位年龄为 63 岁(范围,55-71 岁)。所有患者在阳性培养结果前均有中位时间为 14 个月(范围,0.8-162 个月)的内镜鼻窦手术史。鉴定出的物种包括龟分枝杆菌、脓肿分枝杆菌、偶然分枝杆菌和鸟分枝杆菌复合体。主要表现为后鼻漏(88%),其次为嗅觉和味觉减退(63%)和面部疼痛/压痛(38%)。根据敏感性结果,患者接受了长期口服抗生素治疗,至少 2 个月,基于内镜改善。本研究中患者治疗后的中位随访时间为 1.3 年(范围,0.6-4.6 年)。
在这项研究中,鼻窦培养物中不到 1%鉴定出非典型分枝杆菌。当有临床感染证据时,延长、基于培养的抗生素治疗仍然是治疗的主要方法。先前的内镜鼻窦手术可能是定植和随后感染的危险因素。需要进一步研究以确定最佳治疗持续时间和管理方法,以防止疾病复发。