Department of Respiratory Medicine, National Hospital Organization Osaka Toneyama Medical Center, 5-1-1 Toneyama Toyonaka, Osaka, Japan.
Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, Japan.
BMC Infect Dis. 2020 Nov 25;20(1):888. doi: 10.1186/s12879-020-05626-y.
Non-tuberculous mycobacterial pulmonary disease (NTM-PD) is becoming a significant health burden. Recent advances in analysis techniques have allowed the accurate identification of previously unknown NTM species. Here, we report a case of NTM-PD caused by a newly identified mycobacteria in an immunocompetent patient.
A 44-year-old woman was referred to our hospital due to the frequent aggravation of her chronic respiratory symptoms, with NTM-PD-compatible computed tomography findings. Unidentified mycobacterium was repeatedly isolated from respiratory specimens and we diagnosed her as NTM-PD of unidentified mycobacterium. Subsequent whole-genome analysis revealed that the unidentified mycobacterium was a novel mycobacterium genetically close to Mycolicibacterium mucogenicum. We started combination therapy with clarithromycin, moxifloxacin, amikacin, and imipenem/cilastatin, referring to drug sensitivity test results and observed its effect on M. mucogenicum infection. Her symptoms and radiological findings improved significantly.
We report a case of NTM-PD caused by a newly identified mycobacteria, Mycolicibacterium toneyamachuris, genetically close to M. mucogenicum. This pathogenic mycobacterium showed different characteristics from M. mucogenicum about clinical presentation and drug sensitivity. The clinical application of genomic sequencing will advance the identification and classification of pathogenic NTM species, and enhance our understanding of mycobacterial diseases.
非结核分枝杆菌肺病（NTM-PD）正成为一个重大的健康负担。分析技术的最新进展使得以前未知的 NTM 物种能够得到准确鉴定。在这里，我们报告了一例由免疫功能正常的患者体内新发现的分枝杆菌引起的 NTM-PD 病例。
一名 44 岁女性因慢性呼吸道症状频繁加重而被转至我院就诊，胸部 CT 检查符合 NTM-PD 表现。从呼吸道标本中反复分离出未鉴定分枝杆菌，因此诊断为未鉴定分枝杆菌 NTM-PD。随后的全基因组分析显示，未鉴定分枝杆菌是一种新型分枝杆菌，与粘质分枝杆菌亲缘关系较近。根据药敏试验结果，我们开始采用克拉霉素、莫西沙星、阿米卡星和亚胺培南/西司他丁联合治疗，并观察其对粘质分枝杆菌感染的疗效。她的症状和影像学表现明显改善。
我们报告了一例由新发现的分枝杆菌，即托尼分枝杆菌引起的 NTM-PD 病例，该分枝杆菌与粘质分枝杆菌亲缘关系较近。这种致病性分枝杆菌在临床表现和药敏方面与粘质分枝杆菌有不同的特征。基因组测序的临床应用将促进对致病性 NTM 物种的鉴定和分类，并加深我们对分枝杆菌病的认识。
