Fishman J E, Schwartz D S, Sais G J
Department of Radiology, University of Miami School of Medicine, Jackson Memorial Hospital, FL 33136, USA.
Radiology. 1997 Jul;204(1):171-5. doi: 10.1148/radiology.204.1.9205241.
To determine the chest radiographic findings and clinical manifestations of Mycobacterium kansasii pulmonary infection in patients with acquired immunodeficiency syndrome (AIDS).
Criteria for diagnosis included two or more positive cultures from respiratory sources, pulmonary symptoms or fever, and no other identifiable cause of pulmonary disease. Chest radiographs at initial examination and follow-up were evaluated for parenchymal opacities, cavitation, adenopathy, and pleural effusions. Medical records were reviewed for clinical signs and symptoms, CD4 cell count, presence of additional pathogens, and response to antimycobacterial therapy.
Of 96 patients, 16 (17%) satisfied all criteria for M kansasii pulmonary infection. The mean CD4 cell count was 24/mm3. Twelve patients (75%) demonstrated alveolar opacities, only three (19%) of which were cavitary. Interstitial opacities (6%) and pleural effusions (12%) were uncommon. Four (25%) patients had thoracic lymphadenopathy, which was the only positive radiographic finding in two patients. Fourteen patients were treated for M kansasii, and 10 (71%) showed clinical and radiographic improvement.
Patients with AIDS and pulmonary M kansasii frequently demonstrate focal alveolar opacities. Symptomatic patients with pulmonary nontuberculous mycobacteria should be presumptively treated for pulmonary M kansasii until final culture results are available.
确定获得性免疫缺陷综合征（AIDS）患者堪萨斯分枝杆菌肺部感染的胸部X线表现及临床表现。
诊断标准包括两份或更多份呼吸道来源的阳性培养物、肺部症状或发热，且无其他可识别的肺部疾病病因。对初次检查及随访时的胸部X线片进行评估，观察实质模糊影、空洞形成、淋巴结肿大及胸腔积液情况。查阅病历以了解临床体征和症状、CD4细胞计数、是否存在其他病原体以及抗分枝杆菌治疗的反应。
96例患者中，16例（17%）符合堪萨斯分枝杆菌肺部感染的所有标准。CD4细胞计数的平均值为24/mm³。12例患者（75%）出现肺泡模糊影，其中仅3例（19%）有空洞形成。间质模糊影（6%）和胸腔积液（12%）不常见。4例患者（25%）有胸部淋巴结肿大，其中2例患者的胸部X线检查仅发现此项阳性表现。14例患者接受了针对堪萨斯分枝杆菌的治疗，10例（71%）临床及X线表现有改善。
AIDS合并堪萨斯分枝杆菌肺部感染的患者常表现为局灶性肺泡模糊影。有症状的肺部非结核分枝杆菌感染患者在最终培养结果出来之前，应假定为堪萨斯分枝杆菌肺部感染并进行治疗。
