摘要
目的探讨脓肿分枝杆菌致病特点,提高临床医生对该病的认识及诊治水平。方法回顾性分析昆明市第三人民医院2018年6月9日收治的1例脓肿分枝杆菌致患者多系统播散性感染的临床资料、诊治经过及随访、转归情况,并进行经验总结。结果本例患者于2017年7月因"发热、咳嗽1月余"就诊于澜沧县人民医院,以肺部感染治疗2周无效后转至普洱县人民医院,再以"肺结核"诊断性抗结核药品治疗至2017年12月,咳嗽及发热症状较前有缓解。但12月20日患者因发热、咳嗽突然加重并伴胸闷而入住普洱市人民医院,以肺结核并发肺部感染继续行抗结核和抗感染治疗。1个月后因效果不佳而转诊至昆明医科大学某附属医院,诊治后的病情仍无改善,于2018年2月14日回原住地,在当地医院门诊间断进行抗感染及对症治疗。5月8日患者因病情再次加重且伴右侧颈部淋巴结肿大,就诊于云南省某肿瘤医院,淋巴结手术标本病理检查未检出恶性细胞,考虑"耐药性肺结核可能",于6月9日转至我院。经我院血培养、淋巴结脓液培养、肺泡灌洗液分枝杆菌22项分子诊断检测鉴定为"脓肿分枝杆菌",给予"利奈唑胺、莫西沙星、氯法齐明、阿米卡星、克拉霉素"联合治疗40d好转出院,且随访预后良好。结论当疑似结核病患者反复抗酸杆菌检测阻性且诊断性抗结核治疗效果差,除考虑耐药结核病外,还应积极行新型分子生物学检测排除NTM病,以提高疾病诊断率和治愈率。
Objective To investigate the pathogenic characteristics of Mycobacterium abscess,helping clinicians to improve the awareness of the disease and the level of diagnosis and treatment. Methods The clinical data,diagnosis and treatment,as well as follow-up and prognosis of a multisystemic disseminated infection in a patient caused by Mycobacterium abscess admitted to the Third People’s Hospital of Kunming on June 9,2018 were reviewed. Results The patient visited the People’s Hospital of Lancang County in July 2017 with the chief complaint of fever and cough for more than one month.Then,the patient was transferred to the People’s Hospital of Pu’er County because of two-week ineffective anti-pulmonary infection treatment for,and was treated with"tuberculosis"diagnostic anti-tuberculosis drugs until December,2017.The symptoms of cough and fever were relieved.However,on December 20 th,2017,the patient was admitted to the Pu’er City People’s Hospital because that fever and cough suddenly worsened with chest tighness,and continued to be treated with anti-tuberculosis and anti-infective treatment based on the diagnosis of pulmonary tuberculosis complicated with pulmonary infection.One month later,the patient was transferred to an affiliated hospital of Kunming Medical University due to poor effect,however,the condition did not improve after treatment.On February 14,2018,the patient returned to the original residence,and received intermittent anti-infection and symptomatic treatment in the outpatient clinic of the local hospital.On May 8,the patient was admitted to a tumor hospital in Yunnan Province due to the aggravation of the condition and the swollen right cervical lymph node.No malignant cells were detected in the pathological examination of the lymph node specimen,therefore,the possibility of"drug-resistant tuberculosis"was considered.On June 9,the patient was transferred to our hospital.After blood culture,lymph node pus culture,and 22 molecular diagnostic tests for mycobacterium in alveolar lavage fluid,Mycobacterium abscess was identified.After40-day combination therapy of linezolid,moxifloxacin,clofazimine,amikacin and clarithromycin,the condition was improved.The patient discharged from our hospital,and the follow-up showed a good prognosis. Conclusion If repeatedly positive in acid-fast bacilli test was found in patients with suspected tuberculosis,and the effect of diagnostic anti-tuberculosis treatment was poor,in addition to considering the possibility of drug-resistant tuberculosis,new molecular biology tests should be activety performed to exclude NTM disease,to improve the diagnostic rate and cure rate.
作者
张开义
吕正煊
刘永莉
张乐
朱江春
喻明丽
ZHANG Kai-yi;LYU Zheng-xuan;LIU Yong-li;ZHANG Le;ZHU Jiang-chun;YU Ming-li(Department of Interventional Tuberculosis,the Third People’s Hospital of Kunming,Kunming 650041,China)
出处
《中国防痨杂志》
CAS
CSCD
2021年第1期66-71,共6页
Chinese Journal of Antituberculosis
基金
云南省重症医学科(感染性疾病)临床重点专科建设项目(云卫医发[2017]15号)
重症感染性疾病机械通气技术中心项目[2019-SW(技)-19]。
关键词
分枝杆菌感染
非典型性
分枝杆菌
龟亚科
疾病特征
诊断技术和方法
药物疗法
联合
结果与过程评价(卫生保健)
Mycobacterium infections,atypical
Mycobacterium chelonae,Disease characteristics
Diagnostic techniques and procedures
Drug therapy,combination
Outcome and process assessment(health care)
