中国首例脓毒分枝杆菌感染肺病报告

The first case of pulmonary infection with Mycobacterium septium in China

目的分析脓毒分枝杆菌感染肺病的临床和细菌学特征,探讨其鉴别诊断方法。方法分析脓毒分枝杆菌感染肺病患者的临床表现极其相关实验室检查结果。对其临床分离株采用L-J,TCH/PNB鉴别培养基和多位点PCR初步鉴别,rpoB/hsp65基因PCR-测序鉴定出菌种。结果该患者痰涂片和培养检测为阳性。L-J,TCH/PNB鉴别培养基和多位点PCR鉴别为非结核分枝杆菌。rpoB/hsp65基因PCR-测序,经BLAST比对,与脓毒分枝杆菌(ATCC 700731)同源性均为99%。药物敏感性检测证实本病例分离到的菌株对大多数药物(包括四种一线抗结核药物)耐药,而对阿米卡星、环丙沙星、氧氟沙星、左氧氟沙星、卡那霉素和新诺明等药物敏感。结论在中国首次鉴定、确诊脓毒分枝杆菌感染肺病。

Objective To analyze the clinical and bacteriological characteristics of pulmonary infection of Mycobacterium septium and discuss the differential diagnosis of pulmonary M. spetium infection. Methods The analysis was conducted on the clinical manifestations and laboratory detection results of a patient with pulmonary M. spetium infection. The identification of isolated strain was conducted with L-J, TCH/PNB differential medin, and multi-locus PCR, and the sequencing of rpoB/hsp65 gene of the strain was performed with PCR. Results The sputum smear and culture results were all positive for the patient. The identification result indicated that the strain was non-tuberculosis Mycobacterium （NTM）. The rpoB/hsp65 gene of the strain shared 99% homology with M. spetium （ATCC 700731 ）. The drug susceptibility test showed that the strain was resistant to most antibiotics, but sensitive to amikacin, ciprofloxacin, ofloxacin, levofloxacin, kanamycin and sulfamethoxazole. Conclusion This was the first case of pulmonary M. spetium infection diagnosed in China.