Distribution Characteristics of Drug Susceptibility Test Results of Tuberculosis and Non-Tuberculous Bacilli in Patients with Opportunistic Infections of AIDS

Objective: To understand the distribution of drug susceptibility test results of opportunistic infections of tuberculosis and non-tuberculous bacilli in AIDS patients. Methods: The AIDS patients who were hospitalized in our hospital from January 2016 to June 2019 were collected as the research objects, and patients with opportunistic tuberculosis and non-tuberculous bacilli from AIDS patients were screened for drug susceptibility tests, and the distribution characteristics of drug susceptibility were analyzed. Results: 179 strains of tuberculosis and non-tuberculous mycobacteria were isolated from the specimens of AIDS patients, including 135 cases of tuberculosis mycobacteria and 44 cases of non-tuberculous mycobacteria. In the results of the drug susceptibility test, most strains of Mycobacterium tuberculosis showed sensitivity to commonly used drugs, and a few strains showed resistance;most strains of non-tuberculous mycobacteria showed resistance, and a few strains showed sensitivity. Conclusion: AIDS opportunistic infection of Mycobacterium tuberculosis and non-tuberculous mycobacteria have significant differences in drug sensitivity test results. Timely detection and analysis are of great significance to the diagnosis and treatment of the disease.

Preliminary Study on Drug Susceptibility Profile and Resistance Mechanisms to Macrolides of Clinical Isolates of Non-tuberculous Mycobacteria from China

Objective Macrolide susceptibility and drug resistance mechanisms of clinical non-tuberculous mycobacteria（NTM） isolates were preliminarily investigated for more accurate diagnosis and treatment of the infection in China. Methods Four macrolides, including clarithromycin（CLAR）, azithromycin（AZM）, roxithromycin（ROX）, and erythromycin（ERY）, were used to test the drug susceptibility of 310 clinical NTM isolates from six provinces of China with the broth microdilution method. Two resistance mechanisms, 23 S r RNA and erm, were analyzed with nucleotide sequence analysis. Results Varied effectiveness of macrolides and species-specific resistance patterns were observed. Most Mycobacterium abscessus subsp. massiliense were susceptible and all M. fortuitum were highly resistant to macrolides. All the drugs, except for erythromycin, exhibited excellent activities against slow-growing mycobacteria, and drug resistance rates were below 22.2%. Only four highly resistant strains harbored 2,058/2,059 substitutions on rrl and none of other mutations were related to macrolide resistance. G2191 A and T2221 C on rrl were specific for the M. abscessus complex（MABC）. Seven sites, G2140 A, G2210 C, C2217 G, T2238 C, T2322 C, T2404 C, and A2406 G, were specifically carried by M. avium and M. intracellulare. Three sites, A2192 G, T2358 G, and A2636 G, were observed only in M. fortuitum and one site G2152 A was specific for M. gordonae. The genes erm（39） and erm（41） were detected in M. fortuitum and M. abscessus and inducible resistance was observed in relevant sequevar. Conclusion The susceptibility profile of macrolides against NTM was demonstrated. The well-known macrolide resistance mechanisms, 23 S r RNA and erm, failed to account for all resistant NTM isolates, and further studies are warranted to investigate macrolide resistance mechanisms in various NTM species.

Port site infection in laparoscopic surgery: A review of its management

Laparoscopic surgery(LS), also termed minimal access surgery, has brought a paradigm shift in the approach to modern surgical care. Early postoperative recovery, less pain, improved aesthesis and early return to work have led to its popularity both amongst surgeons and patients. Its application has progressed from cholecystectomies and appendectomies to various other fields including gastrointestinal surgery, urology, gynecology and oncosurgery. However, LS has its own package of complications. Port site infection(PSI), although infrequent, is one of the bothersome complications which undermine the benefits of minimal invasive surgery. Not only does it add to the morbidity of the patient but also spoils the reputation of the surgeon. Despite the advances in the field of antimicrobial agents, sterilization techniques, surgical techniques, operating room ventilation, PSIs still prevail. The emergence of rapid growing atypical mycobacteria with multidrug resistance, which are the causative organism in most of the cases, has further compounded the problem. PSIs are preventable if appropriate measures are taken preoperatively, intraoperatively and postoperatively. PSIs can often be treated non-surgically, with early identification and appropriate management. Macrolides, quinolones and aminoglycosides antibiotics do show promising activity against the atypical mycobacteria. This review article highlights the clinical burden, presentations and management of PSIs in LS as shared by various authors in the literature. We have given emphasis to atypical mycobacteria, which are emerging as a common etiological agent for PSIs in LS. Although the existing literature lacks consensus regarding PSI management, the complication can be best avoided by strictly abiding by the commandments of sterilization techniques of the laparoscopic instruments with appropriate sterilizing agent.

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.

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 Lwenstein-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.

非结核分枝杆菌病诊治六十年

人类发现非结核杆菌(nontuberculous mycobacteria,NTM)病已有60多年,对其诊治水平不断提高。20世纪90年代,通过随机对照多中心研究,发现大环内酯为核心的方案对鸟分枝杆菌复合群疾病有较好疗效。几乎同一时期,以分子生物学为基础的菌种鉴定取代了生化实验为基础的菌种鉴定,使医疗机构广泛开展NTM病的诊治成为可能。近年,该领域也出现较多进步,如实现了临床标本分枝杆菌的快速菌种鉴定,发现再感染是NTM病治疗失败的重要原因,以及发现阿米卡星脂质体用于鸟分枝杆菌复合群肺病的价值。基于结核病诊治的经验,未来的NTM诊治要不断探索核心药物敏感性快速诊断方法,实现短疗程的NTM病治疗新方案。

Routinely detected indicators in plasma have a predictive effect on the identification of HIV-infected patients with non-tuberculous mycobacterial and tuberculous infections

Background:It is difficult to quickly distinguish non-tuberculous mycobacterial(NTM)infection from tuberculosis(TB)infection in human immunodeficiency virus(HIV)-infected patients because of many similarities between these diseases.A simple and effective way to determine the differences using routine blood tests is necessary in developing countries.Methods:A retrospective cohort study was conducted to recruit HIV-infected patients with either NTM infection or TB infection diagnosed for the first time according to mycobacterial culture and microscopic identification from May 2010 to March 2016.These data included the analysis of blood cells,liver function,renal function,C-reactive protein(CRP),and erythrocyte sedimentation rate(ESR),and were compared between the HIV/TB and HIV/NTM groups.Results:A total of 240 patients were enrolled.The number of HIV/TB and HIV/NTM patients was 113 and 127,respectively.There were no significant differences in the CD4 T-cell count,age,sex,percentage of patients initiating antiretroviral therapy(ART)before the explicit diagnosis of TB or NTM infection.NTM infection was more likely to be restricted in the pulmonary while TB infection also involves extra-pulmonary sites.Both the leukocyte count(5.60×109/L)and the proportion of neutrophils in the leukocyte count(76.70%)in the HIV/TB group were significantly higher than those in the HIV/NTM group(4.40×10^(9)/L[P=0.0014]and 69.30%[P<0.001].The analysis of liver function markers indicated that the concentration of albumin but not ALT and AST was significantly lower in the HIV/TB group than in the HIV/NTM group(P<0.001).The creatinine and urea levels were not significantly different between the two groups.The ESR(84.00 mm/h)and the concentration of CRP(59.60 mg/L)were significantly higher in the HIV/TB group than in the HIV/NTM group(52.00 mm/h and 19.60 mg/L,respectively)(P<0.001).To distinguish TB infection from NTM infection,the best cut-off value was 69.5 mm/h for ESR,with a positive predictive value(PPV)of 0.740 and negative predictive value(NPV)of 0.721,and 48.8 mg/L for CRP,with a PPV of 0.676 and NPV of 0.697.Conclusion:The dissemination character as well as stronger immune response characterized by higher inflammation markers(e.g.WBC,ESR,CRP)can help distinguish TB from NTM infection in HIV-infected patients who need empirical therapy or diagnostic therapy immediately in low-income areas.

Thoracoscopic management for bronchiectasis with non-tuberculous mycobacterial infection

Background Non-tuberculous mycobacteria （NTM） have emerged as important opportunistic pathogens of the human being in recent years. Patients with pre-existing bronchiectasis are susceptible to NTM. However, information about its occurrence among bronchiectatic patients in Shenzhen, China is lacking and its impact on the course of bronchiectasis following surgical intervention is unknown. This preliminary study aimed to investigate the prevalence of NTM in bronchiectasis that required surgery in our center, evaluate the role of intraoperative routine screening for NTM, and summarize our initial experience in thoracoscopic management for bronchiectatic patients with NTM. Methods A retrospective analysis of clinical, microbiological data of our bronchiectatic patients with NTM over 5 years was made and 40 patients with bronchiectasis were studied to determine the role of intraoperative routine screening for NTM. Results The prevalence of NTM in this population of patients with bronchiectasis in our center was 6.7% （7/105）. The diagnostic yield of the 40 intraoperative specimens was 7.5% （3/40）. Of the 7 patients with bronchiectasis and NTM, 3 patients developed postoperative wound infections. All were cured with chemotherapy for 8-12 months along with vigorous surgical debridement. Another patient had a slow growth of mycobacteria involving double lungs and the right thoracic cavity and recovered after chemotherapy for nearly 14 months and tube drainage. The affected tissue was completely resected in the remaining 3 patients with no operative mortality and postoperative morbidity, and routine intraoperative screening for NTM was initiated in these patients. Conclusions NTM is not uncommon in bronchiectatic patients which deserves surgeons＇ utmost attention. Routine intraoperative screening for NTM identified otherwise unsuspected patients has shown favorable outcomes. Thoracoscopic management for bronchiectasis with NTM is technically feasible although its role remains to be defined.

某少数民族地区妊娠妇女阴道炎感染情况分析

目的通过分析某少数民族地区529例妊娠妇女阴道分泌物常规检查结果,探讨该少数民族地区妊娠妇女阴道炎感染情况及致病因素。方法对2022年4月—2023年3月松桃苗族自治县妇幼保健院进行初次产前检查的529例妊娠妇女阴道分泌物常规检查结果进行回顾性分析,并比较不同年龄段、不同孕期和不同季节性阴道炎感染情况。结果529例标本清洁度异常(Ⅲ度、Ⅳ度)有183例(占34.59%),其中有169例标本检出病原体,以霉菌最为常见(101例,占59.76%)。年龄40岁以上妇女病原体检出率为48.89%,远高于20岁以下和20~40岁年龄组人群;晚期妊娠妇女病原体检出率(35.09%)稍高于早期妊娠和中期妊娠;夏季病原体检出率(34.73%)高于其他季节。结论该少数民族地区妊娠妇女阴道炎感染情况不容乐观,40岁以上高龄妇女是感染的高危人群,霉菌是主要病原体,病原体检出情况与孕期以及季节性无明显相关性。

Misdiagnosis of tuberculosis and the clinical relevance of nontuberculous mycobacteria in Zambia

Objective:To determine the accuracy of TB diagnosis of TB in Zambia in the era of increasing HIV prevalence.Methods:Sputum of the clinically diagnosed TB cases was additionally subjected to liquid culture and molecular identification.This study distinguished between TB cases confirmed by positive Mycobacterium tuberculosis(M.tuberculosis) cultures and mycobacterial disease caused by non-tuberculous mycobacteria(NTM).Results:Only 49% of the 173 presumptively diagnosed TB cases was M.tuberculosis cultured,while in 13% (22) cases,a combination of M.tuberculosis and NTM was found.In 18% of the patients only NTM were cultured.In 28% ,no mycobacteria was cultivable.HIV positive status was correlated with the isolation of NTM(P【0.05).Conclusions:The diagnosis of tuberculosis based on symptoms, sputum smear and/or chest X-ray leads to significant numbers of false-positive TB cases in Zambia,most likely due to the increased prevalence of HIV.The role of NTM in tuberculosislike disease also seems relevant to the false diagnosis of TB in Zambia.

医院二次供水系统检出快速生长分枝杆菌的应对策略与实践探索

目的对医院二次供水系统快速生长分枝杆菌(rapidly growing mycobacteria,RGM)检出情况进行分析,探讨改进策略及实施效果。方法于2021年3月—4月对医院二次供水系统进行目标性监测,监测内容包括不同采样点的物表和水龙头放水30秒及10分钟后的水样RGM检出率。根据监测结果于2021年9月—11月采取改进措施。改进前、后各采集168份水样,其中放水30秒和10分钟各52份,手术室管路水64份。比较改进措施实施前后的水样和物表RGM检出率。结果改进前、后水龙头放水30秒水样的RGM检出率分别为44.2%和7.7%,改进前、后水龙头放水10分钟水样的RGM检出率分别为25.0%和0%,差异具有统计学意义(P<0.05);改进前后各采集96个物表进行培养,RGM的检出率由改进前的8.3%下降到0%,差异具有统计学意义(P<0.05),且改进前RGM阳性检出点均位于水龙头。结论水龙头是医院二次供水系统的重要感染源,加强水龙头周围清洁消毒等改进措施,可以使医院二次供水系统的RGM检出率得到有效控制,从而降低医院感染发生率。

脓肿分枝杆菌脓肿亚种肺病6个月治疗效果及影响因素分析

目的:评价应用不同药物联合治疗6个月对脓肿分枝杆菌脓肿亚种肺病的疗效并分析影响因素。方法:回顾性搜集2016年1月1日至2022年10月1日于首都医科大学附属北京胸科医院确诊的66例脓肿分枝杆菌脓肿亚种肺病患者作为研究对象。收集患者的临床资料,包括性别、年龄、体质量指数、临床症状、既往史、抗结核治疗史、实验室检查结果、影像学检查结果、药物治疗方案等。比较不同药物联合治疗6个月研究对象痰培养阴转情况,并分析影响治疗效果的因素。结果:经6个月治疗,66例研究对象中,有32例(48.5%)痰菌阴转,34例(51.5%)未阴转。单药治疗效果分析发现,使用阿奇霉素者6个月痰菌阴转率(57.4%,27/47)高于使用克拉霉素者(26.3%,5/19),差异有统计学意义(χ^(2)=5.250,P=0.022)。24例(36.4%,24/66)使用了亚胺培南,其中17例(70.8%,17/24)实现了6个月痰菌阴转,明显高于未使用者的痰菌阴转率(35.7%,15/42),差异有统计学意义(χ^(2)=7.542,P=0.006)。药物联合治疗效果分析发现,使用大环内酯类抗生素、阿米卡星、亚胺培南、利奈唑胺、氯法齐明联合治疗者,治疗6个月痰菌阴转率达到68.4%(13/19)。多因素分析发现,使用大环内酯类抗生素联合亚胺培南治疗的脓肿分枝杆菌脓肿亚种肺病患者更容易实现治疗6个月内的痰培养阴转[OR(95%CI)=0.229(0.077~0.676)]。结论:初始治疗阶段使用至少4周注射剂(阿米卡星和亚胺培南),继续治疗阶段使用大环内酯类抗生素联合阿米卡星、氯法齐明、利奈唑胺的联合治疗方案对脓肿分枝杆菌脓肿亚种肺病有良好疗效。

肺结核患者治疗中分离出非结核分枝杆菌与非结核分枝杆菌肺病的相关性

目的探索在肺结核患者治疗过程中,分离出非结核分枝杆菌(nontuberculous mycobacteria,NTM)时与NTM肺病的相关性。方法通过回顾性调查分析2016年4月至2022年6月在首都医科大学附属北京胸科医院成功检出NTM的28例肺结核患者资料,追踪记录患者病例资料中临床、影像和微生物学资料,评估患者合并NTM肺病的可能性。结果28例患者分离出的NTM均为脓肿分枝杆菌。17例患者痰培养和/或分子生物学仅成功检测出1次脓肿分枝杆菌,8例患者在痰中分离到脓肿分枝杆菌2次以上,3例患者支气管肺泡灌洗液中培养和/或分子生物学检测发现脓肿分枝杆菌1次。参照NTM肺病诊断标准和随访结果,所有患者均不符合NTM肺病诊断标准。结论在肺结核患者治疗过程中分离出的NTM菌株一般不致病。

耐药性肺结核患者NTM感染风险的预测模型构建与效能分析

目的分析耐药性肺结核患者非结核分枝杆菌(NTM)感染的特征及其危险因素,构建预测模型并评估模型的预测效能。方法纳入2020年3月—2022年5月十堰市太和医院呼吸内科收治耐药性肺结核患者230例,根据是否存在非结核分枝杆菌感染分为NTM组39例和无NTM组191例。比较2组患者临床资料;采用多因素Logistic回归方程分析耐药性肺结核患者发生NTM感染的危险因素。使用R软件建立发生NTM感染的列线图预测模型并进行内部验证。结果耐药性肺结核患者230例共发生非结核分枝杆菌感染39例(16.96%),无混合感染;排名前4位的NTM菌株分别为胞内分枝杆菌(33.33%)、脓肿分枝杆菌(23.08%)、戈登分枝杆菌(12.82%)、鸟分枝杆菌(10.26%);NTM组患者男性、年龄>40岁、农民、小学及以下文化程度、家庭收入<2万元/年、合并慢性阻塞性肺疾病(COPD)、恶性肿瘤及应用免疫抑制的比例均高于无NTM组(χ^(2)/P=5.487/0.019,5.529/0.018,8.129/<0.001,6.776/0.009,5.890/0.015,5.623/0.017,5.957/0.014,7.333/0.007);男性、年龄>40岁、农民、患有COPD、合并恶性肿瘤是耐药性肺结核患者发生NTM感染的危险因素[OR(95%CI)=10.205(2.068~50.361),36.324(8.128~162.328),7.640(1.941~30.072),13.832(3.938~48.588),18.796(2.786~126.802),P<0.01];列线图预测耐药性肺结核患者NTM感染的一致性指数(C-index)为0.904(95%CI 0.862~0.961)。结论NTM感染在耐药性肺结核患者中具有较高的检出率,感染人群以男性、农民及年龄>40岁的人群为主;通过构建的预测模型能够早期评估耐药性肺结核患者NTM感染情况,指导临床早期干预。

某综合性医院肺外非结核分枝杆菌病微生物学及临床特征分析

目的探讨肺外非结核分枝杆菌病(extrapulmonary nontuberculous mycobacterial disease,ENTM)的微生物学和临床特征。方法回顾性查找2017年1月至2021年12月复旦大学附属中山医院微生物实验室检出ENTM标本,纳入确诊ENTM病例33例,分析人口学、微生物学、临床表现、治疗和预后特征。结果33例ENTM患者中,年龄(49±16.3)岁,23例(69.7%)为女性,1/3为免疫抑制宿主。感染类型以皮肤软组织感染、骨关节感染和播散性感染最常见(57.6%、18.2%和15.6%),51.5%(17/33)为医疗保健相关感染。病原以快速生长型非结核分枝杆菌(RGM)中的脓肿分枝杆菌复合群(42.4%)最常见。患者平均接受(3.5±0.8)种药物联合治疗,疗程6.3(4.3,9.6)个月。多数病例痊愈(69.7%)或临床好转(18.2%)。与RGM相比,缓慢生长型非结核分枝杆菌(SGM)感染者年龄更大[(60.2±15.0)岁vs(42.6±14.0)岁,P<0.05]且更多为社区获得性感染(83.3%vs 28.6%,P<0.05)。结论ENTM中最常见皮肤软组织感染,脓肿分枝杆菌复合群感染最多。SGM感染者年龄更大且更常见社区获得性感染。ENTM的治疗较为困难且缺少统一标准,需要更多研究。

分枝杆菌液体培养与微孔板法分枝杆菌药敏试验对结核感染的检测效果分析

目的:分枝杆菌液体培养与微孔板法分枝杆菌药敏试验对结核感染的检测效果。方法:选取2022年5月—2023年5月贵阳市公共卫生救治中心收治的结核感染患者痰标本52例为观察对象,对所有标本均采取分枝杆菌液体培养与传统固体罗氏培养法,采用微孔板法完成分枝杆菌药敏试验,分析微孔板法药敏结果检测效能。结果:微孔板法药敏法对乙胺丁醇特异性高于传统比例法药敏法,差异有统计学意义(P=0.022);两种药敏试验方法对利福平、异烟肼及链霉素的敏感性、特异性、准确性,对乙胺丁醇的敏感性、准确性比较,差异无统计学意义(P>0.05)。结论:微孔板法分枝杆菌药敏试验可为多种药物进行药敏试验,为临床药物疗效提供重要参考依据,有助于结核病防控。

散发性皮肤非结核分枝杆菌感染37例回顾研究

目的:通过分析散发性皮肤非结核分枝杆菌(nontuberculous mycobacteria,NTM)感染的临床及病理特点,探讨皮肤NTM感染诊断方法的准确性及药物治疗原则。方法:回顾分析北京大学人民医院皮肤科门诊自2000年1月至2014年3月诊治的散发性皮肤NTM感染患者,病原学检查方法主要包括细菌培养鉴定及PCR扩增病损组织DNA分枝杆菌hsp65基因并鉴定。结果:共37例患者,30例为海分枝杆菌感染,6例为脓肿分枝杆菌感染,1例为龟分枝杆菌和偶发分枝杆菌感染,PCR法较细菌培养更为敏感;21例有外伤史,21例有养鱼史或海产相关工作史,1例有美容手术史。海分枝杆菌感染皮疹多表现为结节和浸润性斑块,沿淋巴管播散常见,脓肿分枝杆菌感染临床缺乏特异性,组织病理上常表现为感染性肉芽肿。海分枝杆菌感染患者多采用利福平、乙胺丁醇、克拉霉素二联或三联治疗,治愈率90.00%;6例脓肿分枝杆菌感染患者中4例治愈,1例死亡。结论:散发性皮肤NTM感染以海分枝杆菌感染最常见,外伤(包括美容或手术)及鱼类或海产接触为常见诱因;组织病理改变无致病菌特异性,确诊需有病原学诊断依据。海分枝杆菌感染的治疗可选用利福平、乙胺丁醇、克拉霉素中任两种联合治疗,脓肿分枝杆菌感染的治疗应依据药物敏感试验结果制定方案。

山东省非结核分枝杆菌感染的菌种分布研究

目的研究山东省13个哨点县2004—2007年非结核分枝杆菌临床分离率和菌种分布情况。方法对山东省13个哨点县2004—2007年送到汉光中心的2 625株分枝杆菌菌株,进行分枝杆菌菌群鉴定试验,鉴定为非结核分枝杆菌的菌株应用16SrDNA测序方法进行菌种鉴定。结果2 625株菌株分枝杆菌菌群鉴定39株为非结核分枝杆菌菌群,39株菌株16SrDNA序列分析结果有36株是非结核分枝杆菌,其中29株为胞内分枝杆菌株(80.6%),其余分别为堪萨斯分枝杆菌、偶然分枝杆菌各2株、戈登分枝杆菌、龟脓肿分枝杆菌复合物、瘰疬分枝杆菌各1株;结核分枝杆菌复合群2株;鼻疽诺卡氏菌1株。山东地区非结核分枝杆菌临床分离率占分枝杆菌培养阳性菌株的1.4%。结论山东地区流行的非结核分枝杆菌以慢生长分枝杆菌的胞内分枝杆菌为主。

关注非结核性分枝杆菌致皮肤和软组织的感染

目的对国内外有关非结核性分枝杆菌致皮肤软组织感染,在美容医学和整形外科中的发生病因学、诊断、菌种鉴别和防治原则进行综合分析。方法经计算机检索PubMed数据库、中国期刊全文数据库,检索1983年至2006年的相关文献并进行归纳。对美容医学和整形外科中发生非结核性分枝杆菌皮肤软组织感染的文献进行评述。结果在国内外的美容整形外科领域,如假体隆乳术、乳房缩小术、乳房提升术、脂肪抽吸术、面部提升术、重睑成形术、药物注射等,因非结核性分枝杆菌引起的局部感染有增加趋势,已引起人们的关注。结论非结核性分枝杆菌的皮肤软组织感染是可以治愈的。在临床中,只要做到早期诊断和早期处理,就能有效地控制感染的发生。