Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
PLoS One. 2018 Apr 4;13(4):e0195390. doi: 10.1371/journal.pone.0195390. eCollection 2018.
The objective of this study is to describe the clinical significance of Mycobacterium simiae at a major tertiary care center in Lebanon.
This is a retrospective study of patients with positive cultures for M. simiae isolated between 2004 and 2016 at the American University of Beirut Medical Center.
This study included 103 M. simiae isolates recovered from 51 patients. Their mean age was 62.7 years. The majority were males and smokers. Specimens were mostly from respiratory sources (97%). Common comorbidities included chronic lung disease (such as chronic obstructive pulmonary disease), solid tumor, systemic disease, and diabetes mellitus. Productive cough and dyspnea were the most common symptoms. Frequent radiographic findings were infiltrates and nodules on chest X-ray and nodules, infiltrates, and bronchiectasis on chest computed tomography scan. Among 18 tested isolates, 5.8% were resistant to clarithromycin, 11.7% to amikacin, and 70-100% to other antimicrobials. Out of 13 patients receiving early treatment, 5 noted improvement, one had recurrence of symptoms, two received alternative diagnosis, and five died. Two of those deaths were related to M. simiae. Common treatment regimens included clarithromycin in different combinations with trimethoprim-sulfamethoxazole, moxifloxacin, and amikacin. Moreover, clofazimine was used in only two patients whose isolates were resistant to all but one agent. Duration of treatment ranged from 6-24 months.
In Lebanon, M. simiae is increasingly encountered with true infection rates of at least 47%. Furthermore, the prevalence of multidrug resistance among the Lebanese M. simiae isolates is very high limiting the treatment options.
本研究旨在描述黎巴嫩一家主要三级保健中心的猿分枝杆菌的临床意义。
这是一项回顾性研究，纳入了 2004 年至 2016 年间在贝鲁特美国大学医学中心分离的阳性培养为 M. simiae 的患者。
本研究包括从 51 例患者中分离出的 103 株 M. simiae 分离株。他们的平均年龄为 62.7 岁。大多数是男性和吸烟者。标本主要来自呼吸道（97%）。常见的合并症包括慢性肺部疾病（如慢性阻塞性肺疾病）、实体瘤、系统性疾病和糖尿病。最常见的症状是有痰咳嗽和呼吸困难。常见的放射学表现是胸片浸润和结节以及胸部 CT 扫描的结节、浸润和支气管扩张。在 18 株测试的分离株中，5.8%对克拉霉素耐药，11.7%对阿米卡星耐药，对其他抗菌药物的耐药率为 70-100%。在接受早期治疗的 13 例患者中，5 例症状改善，1 例症状复发，2 例接受替代诊断，5 例死亡。其中 2 例死亡与 M. simiae 有关。常见的治疗方案包括不同组合的克拉霉素联合甲氧苄啶-磺胺甲噁唑、莫西沙星和阿米卡星。此外，只有两名分离株对所有药物均耐药的患者使用氯法齐明。治疗时间从 6-24 个月不等。
在黎巴嫩，M. simiae 的发病率至少为 47%，且不断增加。此外，黎巴嫩 M. simiae 分离株的多药耐药率非常高，这限制了治疗选择。
