Pulmonary sequestration infected with nontuberculous mycobacteria:a report of two cases and literature review

We report two cases of pulmonary sequestration infected with nontuberculous mycobacteria(NTM): Mycobacterium avium and Mycobacterium abscessus.Chest computed tomography showed pneumonic consolidation in the right lower lobe,which received a systemic blood supply from the descending aorta in both patients.Video-assisted thoracoscopic surgeries were successfully performed and pathologica]examinations revealed multiple caseating granulomas.A review of the literature revealed only seven previous case reports of pulmonary sequestration infected with NTM,and no case with Mycobacterium abscessus has been reported.

Molecular Epidemiology of Nontuberculous Mycobacteria in a German CF Center and Clinical Course of NTM Positive Patients

Goal of this study was to analyse the clinical course of cystic fibrosis (CF) patients with nontuberculous mycobacteria (NTM) in their respiratory secretions and to investigate the molecular epidemiology of the most prevalent NTM species by multilocus sequence analysis (MLSA). The respiratory specimen and the clinical parameters forced expiratory volume in one second (FEV1), body-mass-index (BMI), erythrocyte sedimentation rate (ESR) 1 h and immunoglobulin G (IgG) of 357 CF patients, 0 - 52.4 years, mean FEV1 2009 81.5% pred were analysed between 1998 and 2010. In 13 patients NTM were detected. 12 of 13 patients carried M. abscessus, for one patient the NTM species was not characterized. 4 patients carried a second NTM species (M. avium, M. chelonae (2x), M. intracellulare). 6 patients exhibited a significant decline in FEV1, however changes in BMI, IgG and ESR were discordant. Molecular genotyping of M. abscessus isolates revealed a unique MLSA pattern in 6 patients. 2 patients harboured identical strains, and one patient a closely related strain. Whether the presence of identical strains is attributed to the acquisition of NTM clones from common environmental sources or to patient-to-patient transmission cannot be definitely clarified. Although cross-in- fection of the three patients with identical/closely related strains in the present cohort is highly unlikely, we recommend strict hygiene measures for all CF patients harbouring NTM.

Clinical and Laboratory Characteristics of Patients with Nontuberculous Mycobacterium Bloodstream Infection in a Tertiary Referral Hospital in Beijing, China

Background： Nontuberculous Mycobacterium （NTM） bloodstream infection （BSI） is relatively rare. We aimed in this study to evaluate the clinical characteristics, laboratory evaluation, and outcomes of patients with NTM BSI. Methods： We retrospectively reviewed the clinical records of inpatients with NTM BSI at our institution between January 2008 and January 2015 and recorded clinical parameters including age, gender, underlying disease, clinical manifestation, organs involved with NTM disease, species of NTM, laboratory data, treatment and outcome of these patients. We also reviewed the reported cases and case series ofNTM BSI by searching PubMed, EMBASE, and Wanfang databases. Data of normal distribution were expressed by mean ~ standard deviation （SD）. Data of nonnormal distribution were expressed by median and interquartile range （IQR）. Results： Among the ten patients with NTM BSI, the median age was 51 years （IQR 29-57 years） and three patients were males. Eight patients were immunocompromised, with underlying diseases including human immunodeficiency virus （HIV） infection （one patient）, rheumatic diseases （two patients）, breast cancer （one patient）, myelodysplastic syndrome （two patients）, and aplastic anemia （two patients）. Other organ（s） involved were lung （two patients）, endocardium （two patients）, brain, spinal cord, and soft tissue （one each patient）. The median lymphocyte was 0.66 x 109/L （IQR 0.24-1 .93 × 10^9/L）. The median cluster of differentiation 4 （CD4） cell count was 179/ mm^3 （IQR 82-19/mm^3）. Five patients died （three with hematological diseases, one with breast cancer, and one with rheumatic disease）, three recovered, and two were lost to follow-up. Conclusions： We reported all cases in our hospital diagnosed with bloodstream NTM infection that was rarely reported. In this group of patients, patients usually had a high fever and could have multiple organ involvements. All patients with poor prognosis had underlying diseases.

Epidemiology and Clinical Features of Mycobacterium avium Complex Pulmonary Disease in a Brazilian Amazon Cohort

The incidence of Mycobacterium avium complex pulmonary disease (MACPD) has been globally increasing. The present study aims to provide a comprehensive analysis of clinical characteristics and treatment response among patients in the Amazon region of Brazil and conduct a retrospective cohort study at a prominent referral hospital in the State of Par, Brazil, from 2012 to 2020. The M. avium group represented 58.9% of cases, followed by M. intracellulare (35.7%), M. colombiense (3.6%), and M. chimaera (1.8%). The majority of patients (73.2%) were female and with an average age of 63 years. Primary clinical manifestations included persistent cough and sputum production. The Charlson comorbidity index (CCI) averaged 2.47, with 36.3% of patients having a CCI score equal to higher than 3. Notably, over 70% of patients had received treatment for pulmonary tuberculosis before initiating treatment for MAC infection. The fibrocavitary radiologic form was the most prevalent (55.4%), frequently exhibiting a bilateral distribution (53.6%). Antimicrobial susceptibility revealed a significant prevalence of MAC resistance to drugs in the therapeutic regimen. Despite this, most of the patients experienced clinical improvement (50%). In conclusion, this study highlights a higher prevalence of MAC infections among middle-aged women, with a history of pulmonary tuberculosis treatment and presenting the fibrocavitary radiological form was predominant.

CUTANEOUS MYCOBACTERIUM MARINUM INFECTION DIAGNOSED BY PCR-RFLP ANALYSIS

Objective To identify Mycobacterium marinum （M. marinum ） inducing misdiagnosis and treatment failure. Methods The lesional specimen of patient with cutaneous M. marinum were cultivated on L6wenstein-Jensen medium. The isolate was identified by biochemical tests and polymerase chain reaction （PCR）-restriction fragment length polymorphism （RFLP） analysis of the hsp65 gene. Results Smooth and non- pigmented colonies were noted after incubation at 32 ℃ for 2 weeks. The isolate was acid-fast bacilli and confirmed as M. marinum by biochemical tests and PCR-RFLP. Conclusion For a correct diagnosis of cutaneous M. marinum infection, it is crucial for clinicians to have a high index of suspicion, obtain the history of exposure and trauma and understand growth characteristics of the organism. Compared with conventional biochemical techniques, PCR-RFLP analysis is a more rapid, accurate and reliable method for mycobacterial identification to species level.

Comparing the Genotype and Drug Susceptibilities between Mycobacterium avium and Mycobacterium intracellulare in China

Objective Mycobacterium avium （M. avium） and Mycobacterium intracellulare （M. intracellulare） are the major causative agents of nontuberculous mycobacteria （NTM）-related pulmonary infections. However, little is known about the differences in drug susceptibility profiles between these two species. Methods A total of 393 NTM isolates were collected from Shanghai Pulmonary Disease Hospital. Sequencing of partial genes was performed to identify the strains at species level. The minimum inhibitory concentration （MIC） was used to evaluate the drug susceptibility against 20 antimicrobial agents. Variable number of tandem repeat （VNTR） typing was conducted to genotype these two species. Results A total of 173 （44.0%） M. avium complex （MAC） isolates were identified, including 41 （10.4%） M. avium isolates and 132 （33.6%） M. intracellulare isolates. Clarithromycin and amikacin were the two most effective agents against MAC isolates. The Hunter-Gaston Discriminatory Index （HGDI） values for VNTR typing of M. avium and M. intracellulare isolates were 0.993 and 0.995, respectively. Levofloxacin resistance was more common among the unclustered strains than among the clustered strains of M. intracellulare. Conclusion M. intrecellulare was the most common NTM species in China. Clarithromycin and amikacin had high antimicrobial activities against MAC. VNTR typing of MAC isolates revealed a high discriminatory power. Levofloxacin resistance was associated with unclustered strains of M. intracellulare.

Drug resistance and pathogenic spectrum of patients coinfected with nontuberculous mycobacteria and human-immunodeficiency virus in Chengdu, China

Background:Human-immunodeficiency virus (HIV) infection is increasing worldwide and nontuberculous mycobacteria (NTM) is an established microbiologic cause of pulmonary disease,lymphadenitis,and disseminated disease in cases of advanced immune suppression.Data on patients coinfected with HIV and NTM are limited.Thus,this study aimed to analyze the clinical characteristics,drug resistance,and pathogen spectrum of patients coinfected with both HIV and NTM in the Chengdu area of China.Methods:Data of 59 patients coinfected with both HIV and NTM collected from the Public Health Clinical Center of Chengdu,between January 2014 and December 2018,were analyzed.NTM drug sensitivity testing was performed using the microporous plate ratio method.Data were analyzed using SPSS 19.0,and the change in drug resistance rate was analyzed using the chi-square (x2) test.Results:Seven species/complex of NTM were identified from patients coinfected with HIV and NTM in this study,with Mycobacterium avium-intracellulare complex (52.5%) and M.kansasii (27.1%) as the predominant species.Male patients were more affected 50/59 (84.7%);the mean age of the 59 cases was 45 years.The clinical characteristics mainly included anemia (86.4%),cough and expectoration (79.7%).The baseline CD4 count was <50 cells/μL (84.7%).Patients were mainly in advanced acquired immunodeficiency syndrome (AIDS) stage.Chest imaging mainly showed patchy shadows (42.4%) and nodules (32.2%),with various degrees of AIDS-defining diseases.The drug resistance of NTM was severe,and the rate of isoniazid resistance (100.0%) was the highest,followed by rifampicin (94.9%),streptomycin (94.9%),ofloxacin (93.2%),and others.Ethambutol (52.5%) and clarithromycin (33.9%) were relatively low.No significant difference was found in the drug resistance rate of NTM strain against nine antituberculosis drugs in 5 years (P > 0.05).Condusions:The immune level of patients coinfected with HIV and NTM is low in advanced AIDS stage;more male are affected in patients who are mainly infected with MAC and M.kansasii and with serious drug resistance,The drug resistance rate of ethambutol and clarithromycin is relatively low.

Prevalence and Antimicrobial Susceptibility of Mycobacterium abscessus in a General Hospital, China

Objective To gain greater insight into the prevalence drug resistant profiles of M. abscessus from a general hospital in Beijing, China. Methods Partial gene sequencing of 16 S, hsp65, and rpo B were used to distinguish the species of NTM isolates. All strains identified as M. abscessus were further enrolled in the drug susceptibility testing by using broth microdilution method. Results We found that M. avium complex was the most frequent NTM organism, accounting for 54.1%（33/61） of all isolates. Behind MAC, the second most common organisms were M. abscessus（22 out of 61, 36.1%）. Average rates of resistance were 4.5% for AMK, 9.1% for LZD, and 13.6% for CLA, respectively. In contrast, resistance to LEV（17/22, 77.3%）, IMI（9/22, 40.9%）, and SMX（10/22, 45.5%） was noted in more than 40% of M. abscessus isolates. DNA sequencing revealed that all the CLA-resistant isolates harbored nucleotide substitutions in position 2058（1/3, 33.3%） or 2059（2/3, 66.7%） of 23 S r RNA. Conclusion In conclusion, our data demonstrated that M. intracellulare and M. abscessus were the most common NTM species in the general hospital of Beijing. CLA, AMK, LZD showed promising activity, where as LEV, IMI, and SMX exhibited poor activity against M. abscessus in vitro.

Bilateral nontuberculous mycobacterial keratitis after laser in situ keratomileusis

Laser in situ keratomileusis （LASIK） is currently the most popular keratorefractive procedure performed worldwide with generally excellent outcomes. However, infectious keratitis after LASIK is a devastating, vision-threatening complication. The common pathogens were bacteria and fungi. Nontuberculous mycobacterium （NTM） accounted for a substantial proportion of these pathogens. Most NTM infections （86% of cases） were involved in unilateral cornea. In this study, we report six patients with bilateral NTM keratitis following LASIK.

Lumbar infection caused by Mycobacterium paragordonae:A case report

Mycobacterium paragordonae(M.paragordonae),a slow-growing,acid-resistant mycobacterial species,was first isolated from the sputum of a lung infection patient in South Korea in 2014.Infections caused by M.paragordonae are rare.CASE SUMMARY Herein,we report the case of a 53-year-old patient who presented with fever and low back pain.Lumbar nuclear magnetic resonance imaging revealed the destruction of the lumbar vertebra with peripheral abscess formation.After antiinfective and diagnostic anti-tuberculosis treatment,the patient had no further fever,but the back pain was not relieved.Postoperatively,the necrotic material was sent for pathological examination,and all tests related to tuberculosis were negative,but pus culture suggested nontuberculous mycobacteria.The necrotic tissue specimens were subjected to metagenomic next-generation sequencing,which indicated the presence of M.paragordonae.Finally,the infecting pathogen was identified,and the treatment plan was adjusted.The patient was in good condition during the follow-up period.CONCLUSION M.paragordonae,a rare nontuberculous mycobacterium,can also cause spinal infections.In the clinic,it is necessary to identify nontuberculous mycobacteria for spinal infections similar to Mycobacterium tuberculosis.

Subcutaneous infection caused by Mycobacterium abscessus following cosmetic injections of botulinum toxin:A case report

BACKGROUND In recent years,the cosmetic intervention related infections caused by nontuberculous mycobacteria(NTM)are increasing as the informal cosmetic treatments are performed.However,many dermatologists are inexperienced in the diagnosis and management of similar cases.Here we report a case of subcutaneous infection caused by Mycobacterium abscessus(M.abscessus)following cosmetic injections of botulinum toxin.CASE SUMMARY A 53-year-old woman presented with multiple abscesses and nodules on her forehead and both temporal sites for half a month after cosmetic injections of botulinum toxin.Her lesions did not show any alleviation after 2-wk prescription of antibiotics.Laboratory examinations indicated that she had no sign of immunodeficiency and the whole body of computed tomography did not find any systemic infection or diseases.The pathology of skin tissue showed inflammatory cell infiltration with the negative results of Periodic acid Schiff(PAS)and Acidfast staining and the culture yielded no microbiome.Afterwards,the puncture on abscess was performed and M.abscessus was successfully isolated.The pathogen was identified by acid-fast staining and DNA sequencing.The patient was treated with the strategy of clarithromycin,ofloxacin,and amikacin according to the result of drug sensitivity test and got complete remission of the lesions.CONCLUSION The case presents the whole process of diagnosis and management of NTM infection after cosmetic intervention and highlights the diagnostic thoughts.In a word,the mycobacterium infection should be aware in patients after cosmetic performance.

Mycobacterium abscessus infection after facial injection of argireline:A case report

BACKGROUND The incidence of infection with Mycobacterium abscessus(M.abscessus)has increased in recent years.This increase is partly associated with invasive cosmetic procedures.CASE SUMMARY The purpose of this case summary is to increase clinicians'awareness of M.abscessus infection and reduce mycobacterial infection caused by cosmetic procedures.We report the case of a 45-year-old woman who received acetyl hexapeptide-8(argireline)injections in the forehead and temples,and erythema,nodules,and abscesses appeared at the injection sites after one week.The pus specimens were examined by microbiological culture and confirmed to be positive for M.abscessus.Clarithromycin 500 mg twice daily and moxifloxacin 400 mg once daily were administered for 5 mo and the lesions gradually subsided.CONCLUSION We report here for the first time a case of infection with M.abscessus after argireline injection.This condition is easily misdiagnosed as a common bacterial infection.Microbiological examinations are helpful for diagnosis and standardized cosmetic procedures can prevent infection with M.abscessus.

Susceptibility Testing of <i>Mycobacterium frederiksbergense</i>Strains Isolated from Alfalfa Plants against Antibacterial Compounds

Mycobacteria constitute vast population of bacteria that are found in animals, plants and outer environments. Tuberculosis mycobacteria are a group that causes very dangerous diseases for human and animals. Nontuberculous mycobacteria are mainly environmental and are pathogenic in certain circumstances. There are reports of finding mycobacteria in plant tissues, which can be effective to survey in case of different infectious disease issues. In a previous study, we found mycobacteria strains in alfalfa vascular tissues and identified them to species level using 16S rRNA gene sequence analysis, causing some symptoms in plant tissues and aerial parts. As these rapidly growing mycobacteria (RGM) have the potential to cause opportunistic infections in human tissues, one of the most important issues for dealing with these agents is to find the best and most effective drug to treat them. Here, we conducted some assays to investigate the MIC of 7 antibiotics and two antibacterial agents against eight Mycobacterium frederiksbergense alfalfa isolated strains, in order to find the susceptible and resistant ones. We performed susceptibility testing based on broth microdilution method using Mueller hinton broth as the medium used. Results were different among the strains and different resistant and susceptible reactions were observed among different strains against each drug tested, but ethambutol resulted in similar high MIC for all of them. This variability could be attributed to many factors, such as plant tissue composition and developmental stage from which the strains have been isolated, existence and nature of drug targets and other factors such as test conditions and environmental causes. These results can bring us some insights into design and develop new drugs for treating these kinds of organisms, based on the variations in susceptibility reactions and the plant composition effect on them.

Anti-programmed death 1 antibody in the treatment of coexistent Mycobacterium fortuitum and lung cancer: A case report

BACKGROUND Nontuberculous mycobacterium(NTM) refers to all mycobacteria except Mycobacterium tuberculosis and Mycobacterium leprae, also known as environmental Mycobacterium. The patients with lung cancer and NTM are somewhat special;the two diseases are inevitably influenced by each other. It brings difficulties and challenges to the choice of treatment. Recently, cancer immunotherapy has been considered one of the pillars for the treatment of lung cancer. However, the clinical experience in the application of immune checkpoint inhibitors is scarce for lung cancer patients with pulmonary tuberculosis, and lung cancer with NTM is even more rare. Although it ameliorates lung cancer, immunotherapy with immune checkpoint inhibitors presents complications of infectious diseases, including tuberculosis and NTM.CASE SUMMARY A 61-year-old male patient visited a doctor in May 2019. His admitting diagnoses were:(1) Cancer of the left lung with a pathological diagnosis of poorly differentiated non-small cell carcinoma, likely poorly differentiated adenocarcinoma, clinical stage Ⅲb(T3N3M0);and(2) Mycobacterium fortuitum(M. fortuitum) infection. We chose to proceed with pembrolizumab treatment. After two treatment cycles, a chest computed tomography scan showed a new irregular subpleural mass in the anterior segment of the left upper lobe of the lung, a reduction in the mediastinal enlarged lymph node, and no other obvious changes. Next, an ultrasound-guided biopsy of the new tumor was performed. Pathological examination showed that a large number of carbon particles were deposited in the alveolar tissue with histiocyte reaction and multinucleated giant cell formation. The tuberculosis(TB) specialist suggested that anti-TB therapy be combined with continued antitumor treatment. The patient continued to be treated with pembrolizumab. After 14 cycles, the lesion shrunk by 79%, there was no recurrence of M. fortuitum infection, and there were no intolerable adverse reactions.CONCLUSION We have observed that in cases of lung cancer complicated with M. fortuitum infection, opportunistic pathogen infection recurrence can be overcome, and immunotherapy is most beneficial when TB doctors and oncologists cooperate to closely observe dynamic changes in M. fortuitum and lung cancer. Treatment should be maintained with low dosage anti-TB drugs after general anti-TB chemotherapy for 1 year;this may prevent opportunistic pathogen infection recurrence during immunotherapy.

切取活检法在皮肤非结核分枝杆菌检测中的应用

目的:明确规范应用切取活检法对提高皮肤NTM病原体检出率的意义。方法:对2021-2024年采用切取活检法进行感染皮肤组织取材临床诊断为非结核分枝杆菌感染的9例患者资料进行回顾性分析,分析内容包括皮肤组织抗酸涂片、组织病理抗酸染色及细菌培养。结果:9例患者中,皮损脓液或皮下组织直接抗酸涂片阳性8例,组织培养6例培养出分枝杆菌,培养阳性率75%,病理抗酸涂片阳性1例。结论:切取活检法可用于皮肤非结核分枝杆菌感染的病原学取材,且取脓液和皮下坏死组织培养阳性检出率更高。

贵阳市2018-2021年83株临床分离非结核分枝杆菌的菌种分布及流行情况

目的了解贵阳市临床分离的非结核分枝杆菌(NTM)菌种分布及流行情况。方法收集2018-2021年鉴定为NTM感染的菌株83株,经罗氏培养基分离培养后采用16S rRNA基因测序方法进行菌种鉴定;应用Excel 2016与SPSS 26.0软件对数据进行整理分析,利用非参数检验与卡方检验对NTM菌种来源、菌种分布、感染患者性别及年龄等特征进行分析。结果83株菌株样本来源主要以痰液为主,感染疾病前3的分别为结核感染(38.55%)、肺部感染(30.12%)及肺部阴影(6.02%);分离培养及16SrRNA测序鉴定出17种NTM,主要以脓肿分枝杆菌(44.58%)为主、其次为鸟分枝杆菌(8.43%);发现三重分枝杆菌、外来分枝杆菌、败素分枝杆菌等6株不同于贵州省以往报道过的NTM。感染NTM患者男女比例为1.5∶1,感染高峰年龄段为45~<60岁,不同年龄NTM感染患者菌种分布差异有统计学意义(χ^(2)=133.926,P<0.05);女性患者脓肿分枝杆菌的感染率大于男性,差异有统计学意义(χ^(2)=8.053,P<0.05)。结论2018-2021年贵阳市NTM感染主要为中老年人群、男性居多;NTM感染菌株以脓肿分枝杆菌为主,女性感染率高于男性,发现6株不同于之前报道的新NTM菌株。

肺戈登分枝杆菌感染1例

临床上戈登分枝杆菌致病较为罕见。本文介绍暨南大学附属第一医院1例肺戈登分枝杆菌感染患者。通过分析流行病学史、临床表现、影像学特点、肺穿刺活检及行支气管肺泡灌洗,诊断为非结核分枝杆菌肺病(NTM-PD)。予以抗非结核分枝杆菌治疗后随访,复查CT图像显示病灶未再进展,证实诊断。

Diagnostic Value of Targeted Next-generation Sequencing in Pulmonary Mycobacterial Infections

Objective This study aimed to explore the diagnostic value of novel technique-targeted next-generation sequencing(tNGS)of bronchoalveolar lavage fluid(BALF)in pulmonary mycobacterial infections.Methods This retrospective study was conducted on patients who underwent bronchoscopy and tNGS,smear microscopy,and mycobacterial culture of BALF.Patients with positive Mycobacterium tuberculosis(MTB)culture or GeneXpert results were classified into the tuberculosis case group.Those diagnosed with nontuberculous mycobacteria(NTM)-pulmonary disease(NTM-PD)composed the case group of NTM-PD patients.The control group comprised patients without tuberculosis or NTM-PD.Sensitivity,specificity,and receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance.Results For tuberculosis patients with positive mycobacterial culture results,the areas under the ROC curves(AUCs)for tNGS,GeneXpert,and smear microscopy were 0.975(95%CI:0.935,1.000),0.925(95%CI:0.859,0.991),and 0.675(95%CI:0.563,0.787),respectively.For tuberculosis patients with positive GeneXpert results,the AUCs of tNGS,culture,and smear microscopy were 0.970(95%CI:0.931,1.000),0.850(95%CI:0.770,0.930),and 0.680(95%CI:0.579,0.781),respectively.For NTM-PD,the AUCs of tNGS,culture,and smear-positive but GeneXpert-negative results were 0.987(95%CI:0.967,1.000),0.750(95%CI:0.622,0.878),and 0.615(95%CI:0.479,0.752),respectively.The sensitivity and specificity of tNGS in NTM-PD patients were 100%and 97.5%,respectively.Conclusion tNGS demonstrated superior diagnostic efficacy in mycobacterial infection,indicating its potential for clinical application.

非结核分枝杆菌肺病患者的临床特征及治疗转归相关因素分析

目的分析台州市非结核分枝杆菌肺病(nontuberculous mycobacterial pulmonary disease,NTM-PD)患者的临床特征及治疗转归相关因素,为NTM-PD的管理和诊治提供参考依据。方法回顾性分析于2016年1月至2021年12月在浙江省台州医院确诊的167例NTM-PD患者的临床特征。比较分析83例鸟分枝杆菌复合群肺病(Mycobacterium avium complex pulmonary disease,MAC-PD)患者治愈组和失败组在临床特征上的差异。结果167例NTM-PD患者中检测到的主要为MAC-PD,占94.6%,其中88例得到治疗,治愈率47.7%。与治愈组比较,失败组患者在体质量指数(body mass index,BMI)≤18.5kg/m^(2)、抗酸涂片阳性、合并结核病史、有纤维空洞和未规范治疗等方面差异有统计学意义(P<0.05)。结论台州市NTM-PD患者以MAC-PD最为常见,BMI≤18.5kg/m^(2)、抗酸涂片阳性、合并结核病史、有纤维空洞和未规范治疗的MAC-PD患者的治疗难度更大。

副戈登分枝杆菌性角膜炎1例

43岁女性,主诉左眼反复红痛4年余,伴视物模糊2年余。患者起病时,以左眼反复晨起时红痛流泪为特点,结合既往有左眼角膜划伤外伤诱因以及近视激光矫正手术史,考虑左眼复发性角膜上皮糜烂。此后患者出现左眼中央灰白色病灶,边界不清,角膜基质雾状水肿,但病原学检测均为阴性,经验性的抗细菌及抗真菌治疗后好转。之后患者感染新型冠状病毒后症状反复,又呈现出病毒性角膜炎的特征,诊断性治疗好转后又出现了角膜表面坏死灶和卫星灶的表现。后收入院行左眼角膜清创活检术,术中取坏死组织送宏基因组检测,最终明确副戈登分枝杆菌感染,术后予以阿米卡星及加替沙星局部抗感染治疗后病情得到控制。讨论体会:副戈登分枝杆菌性角膜炎的临床表现有一定伪装性,对于有近视激光手术史的不典型角膜炎表现时需警惕非结核分枝杆菌感染。常规病原检查难以明确病因时可借助宏基因组检测来及早诊断。对于非结核分枝杆菌性角膜炎,敏感抗生素局部治疗应足量、足疗程、防毒副作用,必要时采用角膜瓣切除开放创面。