Nagano Hiroaki
Department of Respiratory Medicine Okinawa Chubu Hospital Okinawa Japan.
Respirol Case Rep. 2019 Apr 17;7(5):e00428. doi: 10.1002/rcr2.428. eCollection 2019 Jul.
Non-tuberculous mycobacteria (NTM) cause several infectious diseases in humans. This study reports on infection in an immunosuppressed 61-year-old male with a background of emphysema. His chief complaint was haemoptysis. Chest computed tomography showed a large, thin-walled cavitary lesion in the upper right lobe. Although NTM were identified in two separate expectorated sputum samples, DNA-DNA hybridization (DDH) failed to identify the species. was finally identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Following antimicrobial agent susceptibility tests, treatment with clarithromycin, levofloxacin, and ethambutol commenced. Six months post-treatment, acid-fast sputum culture was negative and repeat imaging demonstrated improvement of the radiographic abnormalities. This study aimed to assess the utility of MALDI-TOF MS for successful identification of rare NTM species that are not identifiable by DDH. It is the first report of from Okinawa, which is the only prefecture in Japan categorized as subtropical.
非结核分枝杆菌（NTM）可引发人类多种感染性疾病。本研究报告了一名患有肺气肿的61岁免疫抑制男性的感染情况。他的主要症状是咯血。胸部计算机断层扫描显示右上叶有一个大的薄壁空洞性病变。尽管在两份独立咳出的痰液样本中发现了NTM，但DNA-DNA杂交（DDH）未能鉴定出该菌种。最终使用基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF MS）鉴定出了该菌种。在进行抗菌药物敏感性试验后，开始使用克拉霉素、左氧氟沙星和乙胺丁醇进行治疗。治疗六个月后，痰抗酸杆菌培养呈阴性，重复成像显示影像学异常有所改善。本研究旨在评估MALDI-TOF MS在成功鉴定无法通过DDH鉴定的罕见NTM菌种方面的效用。这是来自冲绳的该菌种的首例报告，冲绳是日本唯一被归类为亚热带的县。
