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非结核分枝杆菌肺病、破坏性耐多药肺结核以及非结核分枝杆菌肺病与肺结核合并症的临床及影像学特征比较

A Comparison of Clinical and Radiographic Signs of Nontuberculous Mycobacterial Pulmonary Disease, Destructive Drug-Resistant Pulmonary Tuberculosis and a Combination of Nontuberculous Mycobacterium Pulmonary Disease and Pulmonary Tuberculosis.

作者信息

Giller Dmitrii, Scherbakova Galina, Enilenis Inga, Martel Ivan, Kesaev Oleg, Koroev Vadim, Popova Anna, Ilyukhin Alexandr, Basangova Valeria, Smerdin Sergey, Mayusupov Shokirjon, Saenko Sergey, Frolova Olga, Vinarskaya Veronika, Severova Lyudmila

机构信息

Department of Phthisiopulmonology and Thoracic Surgery Named after M.I. Perelman, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 119991, Russia.

State Budgetary Healthcare Institution of the Moscow Region "Moscow Regional Clinical Anti-Tuberculosis Dispensary", Sukmanikha Village, Shchelkovsky District, Moscow 170555, Russia.

出版信息

Pathogens. 2023 Jun 29;12(7):887. doi: 10.3390/pathogens12070887.

Abstract

A misdiagnosis of isolated pulmonary tuberculosis (pTB) is highly likely when a patient has nontuberculous mycobacterial pulmonary disease (NTMPD) or a combination of nontuberculous mycobacterium pulmonary disease and pulmonary tuberculosis. Frequently, bacterial excretion is absent or only Mycobacteria tuberculosis (MBT) is found. This often results in an incorrect diagnosis and subsequent misinformed treatment regimes. In order to determine possible clinical and radiographic differences between patients with NTMPD (Group 1), destructive drug-resistant pulmonary tuberculosis (Group 3) and a combination of NTMPD and pTB (Group 2) we compare clinical and radiographic signs for these three patient groups. When comparing with Group 3 (2.5%), Groups 1 (25%) and 2 (17.4%) have a substantially higher incidence of pulmonary haemorrhages. Thus, upon clinically observing the combination of pTB and NTMPD, there are no pathognomonic clinical and radiographic detected symptoms. However, the presence of an indolent course, hemoptysis and bronchiectasis in the presence of acid-fast bacteria (or identified MBT) in the sputum makes it possible to suspect not simple pTB, but a combination of pTB and NTMPD. To clarify this necessitated in-depth bacteriological examination.

摘要

当患者患有非结核分枝杆菌肺病(NTMPD)或非结核分枝杆菌肺病与肺结核的组合时,孤立性肺结核(pTB)的误诊可能性很高。通常,细菌排泄物不存在或仅发现结核分枝杆菌(MBT)。这往往导致错误的诊断和随后错误的治疗方案。为了确定NTMPD患者(第1组)、耐药性破坏性肺结核患者(第3组)以及NTMPD与pTB组合患者(第2组)之间可能存在的临床和影像学差异,我们比较了这三组患者的临床和影像学体征。与第3组(2.5%)相比,第1组(25%)和第2组(17.4%)的肺出血发生率显著更高。因此,在临床观察pTB与NTMPD的组合时,未检测到具有诊断意义的临床和影像学症状。然而,在痰中存在抗酸杆菌(或已鉴定的MBT)的情况下,病程缓慢、咯血和支气管扩张的存在使得有可能怀疑不是单纯的pTB,而是pTB与NTMPD的组合。为了澄清这一点,有必要进行深入的细菌学检查。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/50ec/10384069/e22da34ca90b/pathogens-12-00887-g001.jpg

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