慕尼黑分枝杆菌引起术后伤口感染1例附文献复习

A case of wound infection caused by Mycobacterium monacense with literature review

目的报道1例由慕尼黑分枝杆菌引起术后伤口感染病例。方法对1例慕尼黑分枝杆菌引起术后感染患者的临床表现、实验室检查结果、治疗及预后进行分析,并以"Mycobacterium monacense"和"慕尼黑分枝杆菌"为关键词,检索Pubmed和维普数据库2006-2019年关于慕尼黑分枝杆菌引起感染的文献,筛选并总结分析患者的临床资料及该菌的药敏结果。结果该例55岁男性患者以神经鞘瘤术后3个月,颈背部红肿流脓7d为主要表现,CT检查显示颈椎术后,后颈部软组织内广泛感染。伤口分泌物结核培养出分枝杆菌,经测序提示为慕尼黑分枝杆菌,结核T淋巴细胞酶联免疫斑点试验(T-SPOT.TB)有反应性,经规则治疗后痊愈,考虑慕尼黑分枝杆菌所致术后伤口感染。通过文献复习并结合本例患者,目前全世界共有7篇文章10个病例报道,其中男性3例,女性4例,3例性别不明,年龄11~82岁,主要临床表现为呼吸系统感染5例、外伤史2例和皮肤反复感染1例;标本类型:6例呼吸道标本,3例组织标本,1例脑脊液标本;2例有明确的诊疗过程,其余未提及;规律用药后,预后良好。结论从手术感染部位分离出慕尼黑分枝杆菌,快速分子生物学进行菌种鉴定,手术切除感染部位及抗菌药物的联合运用可提高疾病治愈率,预后良好。

Objective A case of wound infection caused by Mycobacterium monacense was reported.Methods The clinical manifestations,laboratory test results,treatment and prognosis of a patient with postoperative infection caused by Mycobacterium monacense were analyzed based on the key words " Mycobacterium monacense",the PubMed and VIP databases were searched in 2006-2019.The literatures about Mycobacterium monacense infection were screened and analyzed.The clinical data and drug sensitivity results of the patients were summarized and analyzed.Results The main manifestation of this 55 year old male patient was 3 months after the operation of schwannoma and 7 dafter the operation.CT examination showed that there was widespread infection in the soft tissue of the back neck after the operation.Mycobacterium was cultured from the wound secretion tuberculosis,which was confirmed to be Mycobacterium monacense by sequencing,TSPOT.TB was reactive.Healed after regular treatment,and Mycobacterium monacense induced wound infection was considered.Through literature review and combined with this case,there were 7 articles and 10 case reports in the world at present,included 3 males,4 females,3 cases of unknown gender,age 11-82 years old,the main clinical manifestations were respiratory system infection in 5 cases,trauma history in 2 cases and repeated skin infection in 1 case;specimen type:6 respiratory specimens,3 tissue specimens,1 cerebrospinal fluid specimen;2 cases had definite diagnosis and treatment process,the rest were not mentioned;after regular medication,the prognosis was good.Conclusion Mycobacterium monacense is isolated from the site of surgical infection.Rapid molecular biology is used to identify the species.Surgical resection of the site of infection and the combination of antibiotics can improve the cure rate of the disease and have a good prognosis.