Center for Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Tokyo,
Center for Respiratory Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan.
Respiration. 2018;96(6):507-513. doi: 10.1159/000490548. Epub 2018 Oct 4.
While nontuberculous mycobacterial (NTM) pleuritis rarely complicates pulmonary NTM infection, high mortality has been reported in case reports and small studies.
The purpose of this study was to clarify the clinical features and treatment outcomes of pulmonary NTM infection cases accompanied by NTM pleuritis.
Medical records of 1,044 patients with pulmonary NTM disease were retrospectively reviewed to select patients complicated by NTM-proven pleuritis. We investigated clinical characteristics, pathogens, pleural effusion examinations, radiographic findings, treatments, and clinical course of the NTM pleuritis patients.
Among 1,044 cases with pulmonary NTM, NTM pleuritis occurred in 15 cases (1.4%). The mean age was 69 years with a performance status of mostly 2 or better (80.0%), and 6 cases (40.0%) were complicated by pneumothorax. Subpleural cavities were radiologically detected in 11 cases (73.3%), and extrapulmonary air-fluid level was detected in 14 cases (93.3%). Eleven patients were treated with combinations of 2-4 antimycobacterial drugs, including clarithromycin, and 2 patients were treated with isoniazid, rifampicin, and ethambutol. Chest tube drainage was performed in 11 cases, and surgical approach was added in 6 cases. The pleural effusion of 2 patients treated with only antimycobacterial medications gradually deteriorated. Two patients died from NTM pleuritis, and 1 patient died from pneumonitis during a mean of 1.8 years of follow-up.
Comorbid NTM pleuritis was difficult to treat by medical therapy alone and resulted in a poor prognosis. In addition to antimycobacterial agents, chest tube drainage and surgical procedures in the early stages should be considered to treat NTM pleuritis.
非结核分枝杆菌（NTM）性胸膜炎很少并发肺部 NTM 感染，但已有病例报告和小样本研究显示其死亡率较高。
本研究旨在阐明并发 NTM 性胸膜炎的肺部 NTM 感染患者的临床特征和治疗结局。
回顾性分析了 1044 例肺部 NTM 疾病患者的病历，以选择并发 NTM 性胸膜炎的患者。我们调查了 NTM 性胸膜炎患者的临床特征、病原体、胸腔积液检查、影像学表现、治疗方法和临床病程。
在 1044 例肺部 NTM 患者中，15 例（1.4%）并发 NTM 性胸膜炎。患者平均年龄为 69 岁，体力状态多为 2 级或更好（80.0%），6 例（40.0%）并发气胸。11 例（73.3%）患者存在肋胸膜下腔，14 例（93.3%）患者存在肺外空气-液平。11 例患者接受了 2-4 种抗分枝杆菌药物（包括克拉霉素）的联合治疗，2 例患者接受了异烟肼、利福平、乙胺丁醇的治疗。11 例患者进行了胸腔引流，6 例患者增加了手术治疗。仅接受抗分枝杆菌药物治疗的 2 例患者的胸腔积液逐渐恶化。2 例患者死于 NTM 性胸膜炎，1 例患者在平均 1.8 年的随访期间死于肺炎。
并发 NTM 性胸膜炎仅通过药物治疗难以治愈，预后较差。除抗分枝杆菌药物外，早期还应考虑胸腔引流和手术治疗以治疗 NTM 性胸膜炎。
