Singh Ranjan K, Kumar Dipak
Internal Medicine, Anti-Retroviral Therapy Centre, District Hospital, Khagaria, IND.
Cureus. 2019 Nov 3;11(11):e6065. doi: 10.7759/cureus.6065.
In this article, we discuss the nontuberculous mycobacterial pulmonary disease in a 40-year-old HIV-seropositive female patient. The patient has a history of pulmonary tuberculosis, experienced two years ago. At the time, she was treated successfully with anti-tuberculous therapy. A chest x-ray (CXR) and computed tomography (CT) scan of the chest showed a thin-walled cavitary lesion in the right lung. In addition, the tree-in-bud sign, indicative of airway obstruction, was present on CT imaging. Fluorescence microscopy using auramine staining showed acid-fast bacilli (AFB) in sputum smears on more than two samples. Mycobacterium tuberculosis was not detected in the nucleic acid amplification test in the same sample. The AFB identified were mycobacteria other than tubercle bacilli, i.e., nontuberculous mycobacteria, that cause cavitary lung disease. Culture in liquid media and subsequent molecular analysis showed Mycobacterium avium complex (MAC). The patient is now being treated with a multidrug regimen of antibiotics and has improved, with documented sputum conversion.
在本文中，我们讨论了一名40岁HIV血清阳性女性患者的非结核分枝杆菌肺病。该患者有两年前患肺结核的病史。当时，她接受抗结核治疗后成功治愈。胸部X线（CXR）和胸部计算机断层扫描（CT）显示右肺有薄壁空洞性病变。此外，CT成像显示了提示气道阻塞的树芽征。使用金胺染色的荧光显微镜检查在两份以上痰涂片样本中发现了抗酸杆菌（AFB）。同一样本的核酸扩增试验未检测到结核分枝杆菌。所鉴定的AFB为非结核杆菌，即非结核分枝杆菌，可导致空洞性肺病。液体培养基培养及后续分子分析显示为鸟分枝杆菌复合群（MAC）。该患者目前正在接受多种抗生素联合治疗，病情已改善，痰菌转阴已得到证实。
