马赛分枝杆菌肺病一例并文献复习

Pulmonary infection with Mycobacterium massiliense： a case report and review of the literature

目的分析马赛分枝杆菌肺病的临床特征，探讨其鉴别诊断方法。方法分析患者的临床表现及实验室检测结果，对其临床分离菌株进行细菌学检查和分子生物学鉴定，采用PCR扩增rpoB和hsp65基因片段和双向DNA测序，并与美国国立生物技术信息中心（NCBI）数据库比对进行菌种鉴定。结果患者女，72岁，体质瘦弱，因反复出现呼吸道症状而入院，既往多次治疗无效。该病例的临床分离菌株经细菌学检查和分子生物学鉴定确定为马赛分枝杆菌，rpoB和hsp65基因片段测序结果与NCBI数据库马赛分枝杆菌相应片段的同源性分别为100％和99％，结合临床表现确诊为马赛分枝杆菌肺病。药敏试验结果显示该菌株对多种药物耐药，根据药敏试验结果和患者的身体条件确定治疗方案，采用静脉滴注头孢西丁和口服阿米卡星治疗有效。结论马赛分枝杆菌肺病多发于免疫功能低下人群，其临床和影像学表现与结核病相似，通过实验室细菌学检测和菌种鉴定，可以对二者进行鉴别。

Objective To analyze the clinical features and differential diagnosis of pulmonary infection with Mycobacterium massiliense （M. massiliense ）. Methods The clinical manifestations and laboratory test results of our patient were analyzed and the strain isolated from the patient was tested by bacteriological and molecular methods. The partial gene fragments of rpoB and hsp65 were amplified by PCR, sequenced and compared with GeneBank database in NCBI for identification of Mycobacterium species. Results The patient was a 72 year old female, who had been admitted to hospital several times because of recurrent respiratory symptoms which had failed to improve upon treatment. This time, pulmonary infection with M. massiliense was confirmed by clinical manifestation and laboratory results. M. massilence isolated from the sputum of our patient was confirmed by bacteriological and molecular methods. The results of specific segments of rpoB and hsp65 tested by PCR and sequence analysis, and compared with that of mycobaeterium in NCBI, showed that the DNA homology was 100% and 99% respectively. The resuhs of drug sensitivity test showed that this strain was resistant to multiple drugs. According to the results of drug susceptibility tests and the condition of the patient, therapy with cefoxitin sodium and amikacin was used and the drugs were effective. Conclusions The clinical manifestations and the chest imaging of pulmonary infection with M. massiliens were similar to those of Mycobacterium tuberculosis, which can be differentiated by laboratory tests.