Jacobson K, Garcia R, Libshitz H, Whimbey E, Rolston K, Abi-Said D, Raad I
Department of Medical Specialties, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Eur J Clin Microbiol Infect Dis. 1998 Sep;17(9):615-21. doi: 10.1007/BF01708343.
The role of rapidly growing mycobacteria in the pathogenesis of pulmonary disease is being increasingly recognized; however, the clinical significance of these mycobacteria in patients with underlying malignancy has not been well studied. Over a 6-year period, 37 cancer patients with rapidly growing mycobacteria isolated from respiratory specimens were identified at our center. Mycobacterium chelonae group was isolated in 24 cases and Mycobacterium fortuitum in 13 cases. Of the 24 cases with cultures yielding Mycobacterium chelonae group, eight met the study criteria for infection and were determined to be clinically significant, whereas only one of the Mycobacterium fortuitum isolates was determined to represent infection. An average of two antimicrobial agents were used for treatment, most commonly clarithromycin, ciprofloxacin, and trimethoprim/sulfamethoxazole. Although the isolation of rapidly growing mycobacteria represents colonization in most cases, these bacteria, especially the Mycobacterium chelonae group, may cause pulmonary disease in cancer patients. The clinical and radiological findings are usually non-specific in this population, and patients with respiratory cultures yielding rapidly growing mycobacteria should be assessed carefully to distinguish infection from colonization. Effective therapy can be provided with oral regimens that include at least two antibiotics to which the organism is susceptible.
快速生长分枝杆菌在肺部疾病发病机制中的作用日益受到认可；然而，这些分枝杆菌在潜在恶性肿瘤患者中的临床意义尚未得到充分研究。在6年期间，我们中心共识别出37例从呼吸道标本中分离出快速生长分枝杆菌的癌症患者。其中，24例分离出龟分枝杆菌组，13例分离出偶然分枝杆菌。在24例培养出龟分枝杆菌组的病例中，8例符合感染研究标准并被判定具有临床意义，而偶然分枝杆菌分离株中只有1例被判定为感染。平均使用两种抗菌药物进行治疗，最常用的是克拉霉素、环丙沙星和甲氧苄啶/磺胺甲恶唑。尽管在大多数情况下，快速生长分枝杆菌的分离代表定植，但这些细菌，尤其是龟分枝杆菌组，可能会导致癌症患者发生肺部疾病。该人群的临床和影像学表现通常不具有特异性，对于呼吸道培养出快速生长分枝杆菌的患者，应仔细评估以区分感染和定植。可通过口服包含至少两种该菌敏感抗生素的方案提供有效治疗。
