Coastal Ear, Nose and Throat, Neptune, New Jersey, USA.
Otolaryngol Head Neck Surg. 2012 Jun;146(6):1012-6. doi: 10.1177/0194599812437333. Epub 2012 Feb 2.
Atypical mycobacterium (AM) involvement in refractory chronic rhinosinusitis (CRS) is sought by some surgeons with customary acid-fast bacilli cultures (AFBC) in the operating room (OR). We evaluate our experience with AM in CRS by describing (1) associated risk factors, (2) species identified, and (3) frequency of positive cultures in clinic versus OR.
Case series with chart review.
Tertiary rhinology practice.
AFBC taken between 2005 and 2011 were identified from a microbiology laboratory database. Charts were reviewed for gender, age, medical history, risk factors for AM, pathogen types, and treatments, with statistical comparison using Pearson χ(2). The benefit of "targeted AFBC" for cases with high clinical suspicion was compared with "customary AFBC" in the OR.
Thirty-seven patients were identified with AM, of which 10 had one or more risk factors for AM including foreign body (n = 4), non-HIV immune dysfunction (n = 4), and previous chemoradiation (n = 4). Six different AM species were identified: most frequently Mycobacterium abscessus (57.1%), followed by Mycobacterium avium-intracellulare complex (14.3%) and Mycobacterium chelonae (14.3%). "Targeted AFBC" from the outpatient setting were positive in 10 of 190 (5.3%) patients, whereas 10 of 373 (2.6%) patients of "customary AFBC" in the OR were positive (P = .12). Macrolide therapy was employed in 23 of 37 (62%) patients with AM-associated CRS but was not prescribed in patients with positive "customary AFBC" alone.
AM-associated CRS is an uncommon condition that can occur in the absence of foreign body or overtly altered innate/adaptive immunity. Indications and efficacy of macrolide therapy, as well as the potential relationships between existence of AM in tap water, AM biofilms, and frequent use of nasal irrigations warrant further investigation in refractory CRS.
一些外科医生在手术室（OR）常规进行抗酸杆菌培养（AFBC），以寻找非典型分枝杆菌（AM）在难治性慢性鼻-鼻窦炎（CRS）中的作用。我们通过描述（1）相关的危险因素，（2）鉴定的物种，以及（3）临床与 OR 中阳性培养的频率，来评估我们在 CRS 中 AM 的经验。
病例系列和图表回顾。
三级鼻科实践。
从微生物学实验室数据库中确定了 2005 年至 2011 年之间进行的 AFBC。对图表进行了性别、年龄、病史、AM 危险因素、病原体类型和治疗方法的回顾，并使用 Pearson χ(2)进行了统计学比较。对具有高临床怀疑的病例进行“靶向 AFBC”与 OR 中的“常规 AFBC”进行了比较。
确定了 37 例 AM 患者，其中 10 例有一个或多个 AM 危险因素，包括异物（n=4）、非 HIV 免疫功能障碍（n=4）和先前的化疗和放疗（n=4）。鉴定了六种不同的 AM 物种：最常见的是脓肿分枝杆菌（57.1%），其次是鸟分枝杆菌-胞内分枝杆菌复合体（14.3%）和溃疡分枝杆菌（14.3%）。门诊环境下的“靶向 AFBC”在 190 例患者中的 10 例（5.3%）中呈阳性，而 OR 中 373 例患者中的 10 例（2.6%）的“常规 AFBC”呈阳性（P=0.12）。大环内酯类药物治疗用于 23 例 AM 相关 CRS 患者，但在仅阳性“常规 AFBC”的患者中未开具该药物。
AM 相关 CRS 是一种不常见的疾病，可在无异物或明显改变的固有/适应性免疫的情况下发生。大环内酯类药物治疗的适应证和疗效，以及 AM 在自来水中的存在、AM 生物膜和频繁使用鼻腔冲洗之间的潜在关系，都需要在难治性 CRS 中进一步研究。
