Chai J J, Liu T, Sun H L, Xu J, Zhu H D, Cai B Q
Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2021 Aug 12;44(8):705-710. doi: 10.3760/cma.j.cn112147-20201229-01201.
To summarize the clinical characteristics and species distribution of nontuberculous mycobacteria(NTM). We conducted a retrospectively chart review of 453 adult patients with 532 positive cultures with NTM diagnosed and treated in Peking Union Medical College Hospital from January 2014 to December 2018. The information including clinical findings, imaging and etiological data were obtained from clinical examination system. Among these 453 patients, 75 cases met the diagnostic criteria for NTM, with detailed clinical data, culture results and radiological images. Of these patients, 38 were males and 37 were females, with an average age of (50.8±16.2) years. Clinical manifestations, imaging features, NTM species and treatment were analyzed. Among 75 NTM patients, 43 cases (57.3%, 43/75) were infected with Mycobacterium avium Complex (MAC)/intracellular, 18 cases (24.0%, 18/75) with Mycobacterium turtle/abscess, and 7 cases (9.3%, 7/75) with Mycobacterium kansasii. Comorbidities existed in 64.0% patients (48/75). The top two common comorbidities were previous tuberculosis (25.3%, 19/75) infection and clinical bronchiectasis (18.7%, 14/75). After the respiratory disease (82.7%, 62/75), we identified bloodstream as the most frequent manifestation of NTM infection (25.3%, 19/75). MAC was often associated with infection in respiratory system and bloodstream, while rapidly growing mycobacteria (RGM) was more commonly detected in lymph nodes and skin and soft tissues. Cough/expectoration (77.4%, 48/62) was the most common clinical symptom of NTM disease, followed by fever and dyspnea. The frequent imaging findings were nodules (41.9%, 26/62), bronchiectasis (37.1%, 23/62), and fibrous cavities (24.2%, 15/62). In disseminated NTM disease, 94.7% (18/19) patients had underlying diseases and 89.5% (17/19) patients had long-term immunosuppression. The most common NTM species was Mycobacterium avium/intracellular in our series. The predominant infected organ was the respiratory system. Previous tuberculosis history likely increased the risk of infection.
总结非结核分枝杆菌(NTM)的临床特征及菌种分布。我们对2014年1月至2018年12月在北京协和医院诊断并治疗的453例成年NTM培养阳性患者进行了回顾性病历审查。临床检查系统获取了包括临床表现、影像学和病因学数据等信息。在这453例患者中,75例符合NTM诊断标准,具备详细的临床资料、培养结果及影像学图像。这些患者中,男性38例,女性37例,平均年龄为(50.8±16.2)岁。分析了临床表现、影像学特征、NTM菌种及治疗情况。75例NTM患者中,43例(57.3%,43/75)感染鸟分枝杆菌复合群(MAC)/胞内分枝杆菌,18例(24.0%,18/75)感染龟分枝杆菌/脓肿分枝杆菌,7例(9.3%,7/75)感染堪萨斯分枝杆菌。64.0%的患者(48/75)存在合并症。最常见的两种合并症是既往结核感染(25.3%,19/75)和临床支气管扩张(18.7%,14/75)。在呼吸系统疾病之后(82.7%,62/75),我们发现血流感染是NTM感染最常见的表现(25.3%,19/75)。MAC常与呼吸系统和血流感染相关,而快速生长分枝杆菌(RGM)在淋巴结及皮肤和软组织中更常见。咳嗽/咳痰(77.4%,48/62)是NTM病最常见的临床症状,其次是发热和呼吸困难。常见的影像学表现为结节(41.9%,26/62)、支气管扩张(37.1%,23/62)和纤维空洞(24.2%,15/62)。在播散性NTM病中,94.7%(18/19)的患者有基础疾病,89.5%(17/19)的患者有长期免疫抑制。在我们的研究系列中,最常见的NTM菌种是鸟分枝杆菌/胞内分枝杆菌。主要感染器官是呼吸系统。既往结核病史可能增加感染风险。