Abdulfattah Omar, Salhan Divya, Kandel Saroj, Rahman Ebad Ur, Dahal Sumit, Alnafoosi Zainab, Schmidt Frances
Pulmonary and Critical Care Department, Interfaith Medical Center, Brooklyn, NY, USA.
Internal Medicine Department, Interfaith Medical Center, Brooklyn, NY, USA.
J Community Hosp Intern Med Perspect. 2017 Dec 14;7(6):372-377. doi: 10.1080/20009666.2017.1407211. eCollection 2017.
: () has low pathogenicity and usually requires either host immune impairment or structural lung disease to cause clinical disease. Fatal cavitary infection in a patient without immunosuppression is rarely presented. : A 62-year-old female with history of sarcoidosis and hypertension presented with cough, fever and dyspnea for one week. Chest imaging showed irregular opacification of upper lung zones. The sputum samples tested positive for acid-fast bacilli (AFB) and the subsequent testing identified . She was started on rifampin, isoniazid, pyrazinamide and ethambutol along with azithromycin, and was discharged with plans to continue the same. A follow up sputum test was negative for AFB. She was, however, readmitted ten months later with sepsis due to pneumonia. Chest imaging revealed worsening cavitary lung lesions. Despite starting her on intravenous antibiotics while continuing anti-tubercular therapy, she developed severe respiratory distress and had to be intubated. Her condition continued to deteriorate and she expired the following day. Fatal cavitary infections with M. xenopi have been reported in the absence of established optimal management. Well-designed studies with sufficient power are needed to establish new treatment guidelines.
（某病原体）致病性较低，通常需要宿主免疫功能受损或存在结构性肺部疾病才会引发临床疾病。在没有免疫抑制的患者中很少出现致命的空洞性感染。：一名62岁女性，有结节病和高血压病史，出现咳嗽、发热和呼吸困难一周。胸部影像学显示上肺区不规则混浊。痰标本抗酸杆菌（AFB）检测呈阳性，随后的检测确定了（具体病原体）。她开始接受利福平、异烟肼、吡嗪酰胺和乙胺丁醇治疗，同时加用阿奇霉素，出院时计划继续相同治疗方案。后续痰检AFB呈阴性。然而，十个月后她因肺炎并发败血症再次入院。胸部影像学显示空洞性肺部病变恶化。尽管在继续抗结核治疗的同时开始给予静脉抗生素治疗，但她仍出现严重呼吸窘迫，不得不插管。她的病情继续恶化，第二天死亡。在缺乏既定最佳治疗方案的情况下，已报告了偶发分枝杆菌致命的空洞性感染。需要进行有足够效力的精心设计研究来制定新的治疗指南。
