Hu X L, Wang S Q
Department of Occupational Disease, The Affiliated Weihai Second Municipal Hospital of Qingdao University, Weihai 264200, China.
Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2024 Mar 20;42(3):210-212. doi: 10.3760/cma.j.cn121094-20230303-00066.
Non-tuberculosis mycobacterium (NTM) refers to a general term for a large group of mycobacteria, excluding the mycobacterium tuberculosis and mycobacterium leprae, which is an opportunistic pathogen. NTM pulmonary disease and pulmonary tuberculosis have very similar clinical and imaging manifestations. Ordinary sputum tests can not distinguish between mycobacterium tuberculosis and NTM accurately, and it needs to be differentiated through detection methods such as mycobacterium culture medium, high-performance liquid chromatography, and molecular biology. During the diagnosis of occupational pneumoconiosis, a sandblasting and polishing worker's lung CT showed dynamic changes in infiltrating shadows and cavities in the right lung. A sputum drug sensitivity test showed NTM infection, but the patient refused treatment. After 20 months, the CT examination of the lung showed further enlargement of infiltrating shadows and cavities, and NTM bacterial identification showed intracellular mycobacterial infection. Amikacin, moxifloxacin, azithromycin, and ethambutol combined antibacterial treatment were given. Currently, the patient is still under treatment.
非结核分枝杆菌（NTM）是指一大类分枝杆菌的统称，不包括结核分枝杆菌和麻风分枝杆菌，它是一种机会性病原体。NTM肺病与肺结核有非常相似的临床和影像学表现。普通痰液检测无法准确区分结核分枝杆菌和NTM，需要通过分枝杆菌培养基、高效液相色谱和分子生物学等检测方法进行鉴别。在职业性尘肺病诊断过程中，一名喷砂和抛光工人的肺部CT显示右肺浸润影和空洞有动态变化。痰液药敏试验显示NTM感染，但患者拒绝治疗。20个月后，肺部CT检查显示浸润影和空洞进一步增大，NTM细菌鉴定显示为细胞内分枝杆菌感染。给予阿米卡星、莫西沙星、阿奇霉素和乙胺丁醇联合抗菌治疗。目前，该患者仍在治疗中。
