Montaigne E, Petit F X, Gourdier A L, Urban T, Gagnadoux F
Lunam université, 49933 Angers, France.
Rev Mal Respir. 2012 Jan;29(1):79-83. doi: 10.1016/j.rmr.2011.07.006. Epub 2011 Dec 14.
Atypical mycobacteria and Aspergillus are opportunistic organisms responsible for severe pulmonary diseases whose development is encouraged by the presence of chronic obstructive pulmonary disease (COPD) and related immunosuppression.
We report the cases of two patients, both alcoholics with emphysematous COPD, who developed chronic pulmonary aspergillosis following atypical mycobacterial infection. Patient 1 developed chronic necrotising aspergillosis several months after the diagnosis of infection with Mycobacterium avium. Patient 2 developed an aspergilloma several weeks after the diagnosis of infection with Mycobacterium xenopi. The association of these two pathologies presents diagnostic and therapeutic problems that are discussed.
The development of Aspergillus pulmonary disease may complicate atypical mycobacterial infections and explain a poor response to treatment. Our two case reports suggest that a systematic search should be made for pulmonary aspergillosis during the follow-up of patients with atypical mycobacterial infection.
非典型分枝杆菌和曲霉菌是导致严重肺部疾病的机会性病原体,慢性阻塞性肺疾病(COPD)及相关免疫抑制会促使这类疾病的发展。
我们报告了两名患者的病例,这两名患者均为患有肺气肿型COPD的酗酒者,他们在非典型分枝杆菌感染后患上了慢性肺曲霉病。患者1在诊断出鸟分枝杆菌感染数月后发展为慢性坏死性曲霉病。患者2在诊断出偶发分枝杆菌感染数周后发展为曲菌球。本文讨论了这两种病症并存时在诊断和治疗方面出现的问题。
肺曲霉病的发展可能会使非典型分枝杆菌感染复杂化,并解释了治疗反应不佳的原因。我们的两个病例报告表明,在对非典型分枝杆菌感染患者进行随访时,应系统地筛查肺曲霉病。