Department of Community Medicine for Respirology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan.
Division of Internal Medicine, Japan Agricultural Cooperatives Kochi Hospital, Kochi, Japan.
J Med Invest. 2021;68(3.4):220-227. doi: 10.2152/jmi.68.220.
The incidence rate of pulmonary nontuberculous mycobacterial disease (PNTMD) in Japan is the highest among major industrialized nations. Although the typical clinical course and radiological manifestations of PNTMD are different from those of pulmonary tuberculosis (TB), confusion about these mycobacterial diseases leads to a diagnostic pitfall. Diagnostic challenges include the coexistence of Mycobacterium tuberculosis (MTB) and nontuberculous mycobacteria (NTM), false positives for NTM in MTB nucleic acid amplification tests, microbial substitution, and abnormal radiological manifestations caused by NTM. Features of extrapulmonary NTM diseases, such as pleurisy, vertebral osteomyelitis, and disseminated disease, are different from the corresponding tuberculous diseases. Moreover, the immunological background of the patient (status of human immunodeficiency virus infection with or without antiviral therapy, continuation or discontinuation of immunosuppressive therapy, use of immune checkpoint inhibitor, pregnancy and delivery, etc.) influences the pathophysiology of mycobacterial diseases. This review describes the varying clinical presentations of NTM disease with emphasis on the differences from TB. J. Med. Invest. 68 : 220-227, August, 2021.
日本的非结核分枝杆菌肺病（Nontuberculous Mycobacterial Disease，NTDM）发病率在主要工业化国家中最高。尽管 NTDM 的典型临床过程和影像学表现与肺结核（TB）不同，但对这些分枝杆菌病的混淆导致了诊断陷阱。诊断挑战包括结核分枝杆菌（Mycobacterium tuberculosis，MTB）和非结核分枝杆菌（Nontuberculous mycobacteria，NTM）共存、MTB 核酸扩增试验中 NTM 的假阳性、微生物替代以及 NTM 引起的异常影像学表现。肺外 NTM 病的特征，如胸膜炎、脊椎骨骨髓炎和播散性疾病，与相应的结核病不同。此外，患者的免疫背景（人类免疫缺陷病毒感染状态，有无抗病毒治疗，免疫抑制治疗的持续或中断，免疫检查点抑制剂的使用，妊娠和分娩等）影响分枝杆菌病的病理生理学。本综述描述了 NTM 病的不同临床表现，并强调了与 TB 的差异。J. Med. Invest. 68 : 220-227, August, 2021.
