Clin Lab. 2024 Oct 1;70(10). doi: 10.7754/Clin.Lab.2024.240531.
Tuberculous pleurisy (TP) is one of the most common types of extrapulmonary tuberculosis, often secondary to tuberculosis (TB). Clinical and imaging manifestations of non-tuberculous mycobacterial pulmonary diseases (NTM-PD) are usually similar to those of tuberculosis. Because of their similarity and the high incidence of tuberculosis, non-tuberculous mycobacterial infections are often overlooked for a long time. Especially in people without immunodeficiency.
Mycobacterium tuberculosis (MTB) in pleural effusion was found by metagenomic next-generation sequencing (mNGS). During anti-tuberculosis treatment, mNGS of lung tissue by ultrasound-guided percutaneous lung puncture revealed that this patient had combined NTM-PD.
Mycobacterium chelonae (M. chelonae) was detected by mNGS, and after anti-NTM treatment, the patient's chest CT showed that the inflammation was absorbed more than before, and the patient's symptoms improved.
When TB is poorly treated with standardized anti-tuberculosis therapy, comorbid non-tuberculous mycobacterial infections may be considered, and mNGS may complement traditional pathogenetic testing.
结核性胸膜炎（TP）是最常见的肺外结核类型之一，常继发于结核病（TB）。非结核分枝杆菌肺病（NTM-PD）的临床和影像学表现通常与结核病相似。由于它们的相似性和结核病的高发，分枝杆菌感染往往长期被忽视。特别是在没有免疫缺陷的人群中。
通过宏基因组下一代测序（mNGS）发现胸腔积液中的结核分枝杆菌（MTB）。在抗结核治疗过程中，超声引导经皮肺穿刺的肺组织 mNGS 显示该患者合并 NTM-PD。
mNGS 检测到嗜肺军团菌（M. chelonae），经抗非结核分枝杆菌治疗后，患者的胸部 CT 显示炎症较前吸收，患者症状改善。
当 TB 经标准化抗结核治疗效果不佳时，应考虑合并非结核分枝杆菌感染，并可通过 mNGS 补充传统的病原体检测。
