Hjelt K, Højlyng N, Howitz P, Illum N, Munk E, Valerius N H, Fursted K, Hansen K N, Heltberg I, Koch C
Danish Cystic Fibrosis Centre, Department of Paediatrics, Rigshospitalet, University of Copenhagen.
Scand J Infect Dis. 1994;26(5):569-76. doi: 10.3109/00365549409011815.
The purpose of this study was to estimate the frequency of and evaluate the clinical impact of pulmonary mycobacterial infections among cystic fibrosis (CF) patients. 185 CF patients aged 2.2-38.5 years were screened by sputum samples and by intracutaneous skin tests against tuberculin and sensitins produced from Mycobacterium chelonae subsp. abscessus, M. avium, M. intracellulare and M. scrofulaceum (the MAIS complex). The skin tests towards the sensitins in BCG-vaccinated patients (n = 60) were significantly influenced by the vaccination. 26 of the remaining 125 non-vaccinated patients had > or = 1 positive skin test (95% confidence limits 15-29%). The majority reacted against the MAIS complex. However, the reactions were similar to those of healthy siblings and an age-matched control group. Moreover, the lung function, growth and HbA1c were similar among skin test positive and negative patients. Three patients had repeated positive sputum cultures, the point prevalence being 1.6% (M. intracellulare, n = 2 and M. chelonae subsp. abscessus, n = 1). During the subsequent 4 years, 4 additional patients with M. chelonae subsp. abscessus were identified. Based on clinical observations, 5 of the infected patients were considered asymptomatic, while 2 might have been symptomatic. In 1 patient, M. chelonae subsp. abscessus disappeared spontaneously. Despite intensive treatment with new antibiotics against Mycobacteria Other Than Tuberculosis (MOTT) in 4 patients, the mycobacteria were not eradicated. In conclusion, MOTT infection was rare and the clinical impact difficult to prove. Treatment should focus on clinical improvement in the individual patient suspected of suffering from significant symptomatic infection. Eradication of the bacteria should not be expected.
本研究的目的是评估囊性纤维化（CF）患者肺部分枝杆菌感染的发生率，并评估其临床影响。对185例年龄在2.2至38.5岁之间的CF患者进行了筛查，采用痰液样本以及针对结核菌素和由龟分枝杆菌脓肿亚种、鸟分枝杆菌、胞内分枝杆菌和瘰疬分枝杆菌（MAIS复合体）产生的致敏素的皮内皮肤试验。卡介苗接种患者（n = 60）对致敏素的皮肤试验受到疫苗接种的显著影响。其余125例未接种疫苗的患者中，26例有≥1次皮肤试验呈阳性（95%置信区间15 - 29%）。大多数患者对MAIS复合体有反应。然而，这些反应与健康同胞和年龄匹配的对照组相似。此外，皮肤试验阳性和阴性患者的肺功能、生长情况和糖化血红蛋白相似。3例患者痰培养反复阳性，时点患病率为1.6%（胞内分枝杆菌，n = 2；龟分枝杆菌脓肿亚种，n = 1）。在随后的4年中，又发现了4例龟分枝杆菌脓肿亚种感染患者。根据临床观察，5例感染患者被认为无症状，而2例可能有症状。1例患者的龟分枝杆菌脓肿亚种自发消失。尽管对4例患者使用了针对非结核分枝杆菌（MOTT）的新型抗生素进行强化治疗，但分枝杆菌未被根除。总之，MOTT感染罕见，其临床影响难以证实。治疗应侧重于疑似有明显症状性感染的个体患者的临床改善。不应期望根除细菌。
