Naito Maiko, Maekura Toshiya, Kurahara Yu, Tahara Masahiro, Ikegami Naoya, Kimura Yohei, Sonobe Shoko, Kobayashi Takehiko, Minomo Shojiro, Tsuji Taisuke, Tsuyuguchi Kazunari, Hayashi Seiji, Suzuki Katsuhiro
Department of Internal Medicine, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan.
Department of Infectious Diseases, Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Japan.
Intern Med. 2018 Jan 1;57(1):13-16. doi: 10.2169/internalmedicine.9119-17. Epub 2017 Oct 16.
Objective The incidence of pulmonary nontuberculous mycobacterial (NTM) infections has increased in recent decades. Nevertheless, NTM pleurisy is still a rare disease. The objective of the present study was to elucidate the clinical features and outcomes of NTM pleurisy. Methods A retrospective study was undertaken of consecutive patients whose pleural effusion culture yielded NTM, from 2002 to 2016 at a respiratory hospital in Japan. The clinical features, treatment, and outcomes of these patients were analyzed. Result The 12 patients with NTM pleurisy were predominantly male, with a median age of 69 years (range, 48-93 years). They included eight patients with a history of smoking and six patients with immunosuppressive comorbidities such as malignancy, diabetes mellitus, and conditions requiring steroid administration. Fibrocavitary disease was the most common radiographic feature of these patients, and Mycobacterium avium complex was the most common pathogen. Pneumothorax was complicated in 11 patients. Surgery was performed on seven patients, in addition to thoracic drainage for the treatment of pleurisy and pneumothorax. Three patients died of respiratory failure. Conclusion Pneumothorax is a frequent complication of NTM pleurisy, often making the condition difficult to treat. Surgery at an appropriate time should therefore considered for refractory cases.
目的 近几十年来，肺部非结核分枝杆菌（NTM）感染的发病率有所上升。然而，NTM胸膜炎仍然是一种罕见疾病。本研究的目的是阐明NTM胸膜炎的临床特征和转归。方法 对2002年至2016年期间在日本一家呼吸医院连续收治的胸腔积液培养出NTM的患者进行回顾性研究。分析这些患者的临床特征、治疗方法和转归。结果 12例NTM胸膜炎患者以男性为主，中位年龄为69岁（范围48 - 93岁）。其中8例有吸烟史，6例有免疫抑制合并症，如恶性肿瘤、糖尿病以及需要使用类固醇治疗的疾病。纤维空洞性病变是这些患者最常见的影像学特征，鸟分枝杆菌复合群是最常见的病原体。11例患者并发气胸。除了进行胸腔引流治疗胸膜炎和气胸外，7例患者接受了手术治疗。3例患者死于呼吸衰竭。结论 气胸是NTM胸膜炎的常见并发症，常使病情难以治疗。因此，对于难治性病例应考虑在适当的时候进行手术。
