Becker S L, Schlotthauer U, Schäfers H-J, Bals R, Trudzinski F C
Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes, Homburg, Deutschland.
Schweizerisches Tropen- und Public Health-Institut, Basel, Schweiz.
Pneumologie. 2019 Aug;73(8):474-481. doi: 10.1055/a-0872-8809. Epub 2019 May 10.
The recognition, correct diagnosis and adequate clinical management of infections caused by atypical mycobacteria are challenging tasks in clinical practice. Invasive infections caused by , a member of the complex, have been increasingly reported over the past few years. Most infections occurred in patients who had undergone open-chest cardiothoracic surgery. Epidemiological and molecular studies showed that transmission of occurred through intraoperative aerosols derived from contaminated heater-cooler units, i. e. devices that are used to enable the extracardiac circuit in cardiothoracic surgery. Thus far, approximately 120 patient cases have been reported worldwide. The latency between exposure and onset of clinical symptoms may comprise several years. Clinical manifestations of infections include not only endocarditis and implant-associated infections, but also non-cardiac entities such as sarcoidosis-like symptoms, vertebral osteomyelitis and chorioretinitis. The pathogen can be detected in blood culture vials and in surgically obtained specimens from affected tissues, if specific microbiological tests for detection of mycobacteria are employed. There are no simple-to-use screening tests and a high clinical index of suspicion is thus mandatory in patients with previous exposure and compatible signs and symptoms. The successful treatment of infections requires the removal of infected devices and prolonged combination therapy with antimycobacterial drugs. This review summarises the clinical relevance, epidemiology, symptomatology, diagnosis and treatment of infections caused by , with a specific focus on pneumological aspects.
在临床实践中，识别、正确诊断和妥善临床处理非结核分枝杆菌引起的感染是具有挑战性的任务。过去几年中，分枝杆菌复合体成员引起的侵袭性感染报告日益增多。大多数感染发生在接受开胸心胸外科手术的患者中。流行病学和分子研究表明，分枝杆菌通过受污染的热交换器产生的术中气溶胶传播，即心胸外科手术中用于建立心外循环的设备。迄今为止，全球已报告约120例患者病例。接触与临床症状出现之间的潜伏期可能长达数年。分枝杆菌感染的临床表现不仅包括心内膜炎和植入物相关感染，还包括非心脏病变，如类肉瘤样症状、脊椎骨髓炎和脉络膜视网膜炎。如果采用检测分枝杆菌的特定微生物学检测方法，可在血培养瓶和受影响组织的手术标本中检测到病原体。目前没有简单易用的筛查检测方法，因此对于有既往接触史且有相应体征和症状的患者，必须保持高度的临床怀疑指数。成功治疗分枝杆菌感染需要移除感染设备，并使用抗分枝杆菌药物进行长期联合治疗。本综述总结了分枝杆菌感染的临床相关性、流行病学、症状学、诊断和治疗，特别关注肺部方面。
