全身播散性卡介苗病多次合并机会性感染1例附文献复习

目的探讨全身播散性卡介苗病多次合并机会性感染的临床及病原学特征,为诊断和治疗提供依据。方法分析本例自发病以来的系列临床及实验室、影像学等相关资料,结合文献总结其临床特点。结果经BECTEC960培养并菌型鉴定为牛分枝杆菌,复经间歇区寡核苷酸（SPOLIGOTYPING）和PCR对临床分离株与结核分枝杆菌标准株（H37RV）、牛结核分枝杆菌（M.bovis）标准株和卡介苗株作比对,证实为卡介苗株。同时经细胞免疫、体液免疫检测,提示患儿机体免疫功能低下。虽经反复治疗,终未获预期疗效。结论免疫功能低下是全身播散性卡介苗病多次合并机会性感染的成因,预后不佳,应引起警惕。     

肺结核诊断的研究进展

肺结核是结核病中的主要类型,是由于结核分枝杆菌感染入侵到人体肺组织,并引起了肺组织相应的病理损伤以及出现相应的临床症状.肺结核临床分为原发性肺结核、血行播散性肺结核和继发性肺结核. 肺结核诊断的金标准仍然是痰培养结核分枝杆菌阳性,但在临床实践中,约有2/3的肺结核患者,痰抗酸染色和痰结核分枝杆菌培养为阴性.因此,对于痰菌阴性的肺结核诊断主要依据包括临床症状、体征、胸部影像以及辅助检查的结果来进行综合诊断.     

12例非结核分枝杆菌肺病患者的护理

正非结核分枝杆菌(nontuberculous mycobacteria,NTM)是分枝杆菌属内除结核分枝杆菌复合群和麻风分枝杆菌以外的其他分枝杆菌。迄今为止,共发现154种NTM和13个亚种,大部分是腐物寄生菌,只有少部分对人体致病。NTM可以侵犯人体肺脏、淋巴结、骨骼、关节、皮肤和软组织等组织器官,并可引起全身播散性疾病,以NTM肺病多见[1]。近年来,NTM病呈     

影像学检查病案精选（二）

全身播散性结核病,是由肺、淋巴结、肠、肾、骨等结核病灶破溃入血管,经血液循环至脏器或组织的重型结核感染。好发于脑及腑膜、脊髓及脊膜、肺及胸膜、肠及腹膜等部位,多见于青少年。病理上,受累脏器或组织分布大量结核结节、炎性反应、纤维蛋白性渗出与粘连等改变,临床上,发病早期全身结核毒性症状明显,并可伴有罹疾脏器体征及实验室检验阳性反应。     

播散性放线菌病合并结核分枝杆菌感染一例

播散性放线菌病临床上不常见,同时合并结核分枝杆菌感染的更为罕见[1-2].现报道1例继发于流产术后年轻女性播散性放线菌病合并结核分枝杆菌感染的病例,经过积极的脓液引流、抗放线菌联合四联(异烟肼+利福平+乙胺丁醇+吡嗪酰胺)抗结核治疗痊愈.     

非结核分枝杆菌肺病患者生活质量调查及影响因素分析

非结核性分枝杆菌病是指人类感染非结核分枝杆菌(nontuberculous mycolbactefia NTM),并引起相关组织器官病变的一种疾病。NTM可以起全身组织器官感染而致病,但90％可侵犯肺,引起NTM肺病[1]。随着社会对结核病防治力度的加大和人们健康观念的提高,我国结核病发病率每年呈下降趋势,而非结核分枝杆菌病则有增多的趋势。NTM肺病的临床症状和体征与肺结核极为相似,全身中毒症状等较肺结核轻,有发热、咳血、咳嗽、咳痰,肺部空洞等症状。大多数NTM对常用的抗分枝杆菌药物均耐药,治疗效果差,病程长。我们对2009年6月~2012年12月住院治疗的108例NTM肺病患者进行了问卷调查,以研究NTM肺病患者的生活质量及其影响因素,以期患者能得到更好的医疗照护及社会支持,现将调查结果报告如下。     

海分枝杆菌引起骨髓增生异常综合征患者血流感染1例

正海分枝杆菌自然栖息于水中,对人类为条件致病菌~([1])。通过接触海水、淡水、水产品等途径引起皮肤和软组织感染,是非结核分枝杆菌感染所致皮肤和软组织感染的主要致病菌。海分枝杆菌感染很少引起系统播散,但在免疫缺陷的患者可侵犯黏膜下组织、骨骼、关节等深部组织~([2])。2017年7月从骨髓增生异常综合征患者的血液中分离出一株海分枝杆菌,现报道如下。1临床资料1.1基本资料患者,女性,46岁,20年前诊断为再     

脓肿分枝杆菌血源播散1例

正非结核分枝杆菌(NTM)是除结核分枝杆菌及麻风分枝杆菌外其他一大类分枝杆菌的总称。Runyon分类法依据NTM在生长速度及色素产生的差别,将其分为4组[1],即光产色菌、暗产色菌、不产色菌和快速生长分枝杆菌(RGM),其中脓肿分枝杆菌(M.abscess)属于第Ⅳ组为快速生长分枝杆菌,培养3-5天即有肉眼可见的菌落。NTM可感染肺、黏膜、淋巴结,侵犯血液后称为播散性NTM病,     

儿童非结核分支杆菌脑膜炎1例误诊分析

<正>非结核性分枝杆菌(NTM)是指在分枝杆菌属中,除了结核分枝杆菌复合群(人型、牛型、非洲型和田鼠型结核分枝杆菌)和麻风分枝杆菌以外的分枝杆菌。非结核分支杆菌脑膜炎是由NTM引起。由于非结核分支杆菌与结核分支杆菌同为分支杆菌属,故非结核分支杆菌脑膜炎与结核分支杆菌脑膜炎的临床症状、X线胸片特点极为相似,单纯靠胸片和痰液结核分枝杆菌抗酸染色涂片是无法区分的。临床上往往在没有进行抗酸杆菌菌型鉴定的情     

皮肤和软组织感染非结核分枝杆菌的分布和耐药性分析

目的 分析皮肤和软组织感染患者非结核分枝杆菌的分布特点及耐药性。方法 收集2017年2月至2019年2月期间在我院门诊及住院治疗的皮肤和软组织感染患者感染部位分泌物并进行鉴定,分析非结核分枝杆菌的分布;通过药敏试验检测非结核分枝杆菌对5种抗生素的敏感性。结果 1152例皮肤与软组织感染患者样本中共检出983株分枝杆菌(85.33%)。其中人型结核分枝杆菌614株(62.46%),牛型结核分枝杆菌307株(31.23%),非结核分枝杆菌62株(6.31%);62株非结核分枝杆菌中包括偶发分枝杆菌18株(29.03%)、龟分枝杆菌8株(12.90%)、溃疡分枝杆菌5株(8.07%)、海分枝杆菌7株(11.29%)、脓肿分枝杆菌10株(16.13%)和快速生长分枝杆菌14株(22.58%);药敏试验结果显示,偶发分枝杆菌、龟分枝杆菌、溃疡分枝杆菌、海分枝杆菌、脓肿分枝杆菌和快速生长分枝杆菌对INH、SM、RFP和PAS的耐药率均在90%以上,对KM的耐药率在80%-95%之间。结论 非结核分枝杆菌在皮肤和软组织感染患者中以偶发分枝杆菌、脓肿分枝杆菌和快速生长分枝杆菌最为常见,且非结核分枝杆菌对多种抗生素均有较高的耐药性。     

Mutation in the signal-transducing chain of the interferon-gamma receptor and susceptibility to mycobacterial infection.

IFN-gamma is critical in the immune response to mycobacterial infections, and deficits in IFN-gamma production and response have been associated with disseminated nontuberculous mycobacterial infections. Mutations in the IFN-gamma receptor ligand-binding chain (IFNgammaR1) have been shown to confer susceptibility to severe infection with nontuberculous mycobacteria. However, mutations in the IFN-gamma receptor signal-transducing chain (IFNgammaR2) have not been described. We describe a child with disseminated Mycobacterium fortuitum and M. avium complex infections and absent IFN-gamma signaling due to a mutation in the extracellular domain of IFNgammaR2. In vitro cytokine production by patient PBMCs showed 75% less PHA-induced IFN-gamma production than in normal cells, while patient PHA-induced TNF-alpha production was normal. The normal augmentation of TNF-alpha production when IFN-gamma was added to endotoxin was absent from patient cells. Expression of IFNgammaR1 was normal, but there was no phosphorylation of Stat1 in response to IFN-gamma stimulation. DNA sequence analysis of the gene for IFNgammaR2 showed a homozygous dinucleotide deletion at nucleotides 278 and 279, resulting in a premature stop codon in the protein extracellular domain. This novel gene defect associated with disseminated nontuberculous mycobacterial infection emphasizes the critical role that IFN-gamma plays in host defense against mycobacteria.     

Activities of azithromycin and clarithromycin against nontuberculous mycobacteria in beige mice.

The comparative activities of azithromycin (AZI) and clarithromycin (CLA) were evaluated against nontuberculous mycobacteria in a murine model of disseminated infection. Four-week-old beige mice (C57BL/6J bgj/bgj) were infected intravenously with approximately 10(7) viable Mycobacterium kansasii, M. xenopi, M. simiae, or M. malmoense. Treatment with AZI at 200 mg/kg, CLA at 200 mg/kg, ethambutol at 125 mg/kg, rifampin at 20 mg/kg, or clofazimine at 20 mg/kg of body weight was started 7 days postinfection, and the treatments were administered 5 days per week for 4 weeks. Control groups were sacrificed at the start and end of the treatments. Spleens and lungs were homogenized, and viable cell counts were determined by serial dilution and plating onto 7H10 agar. AZI and CLA had activities comparable to or better than that of rifampin, ethamutol, or clofazimine against these nontuberculous mycobacteria in the beige mouse test system. AZI at 200 mg/kg was more active than CLA at 200 mg/kg against organisms in the spleens for M. xenopi and M. malmoense. The activities of AZI and CLA were comparable against organisms in the spleens for M. kansasii and M. simiae. The activities of these two agents were comparable against organisms in the lungs for all four nontuberculous mycobacterial species. AZI or CLA in combination with other agents may be useful for the therapy of nontuberculous mycobacterial infections in humans.     

Subcutaneous injection of interferon gamma therapy could be useful for anti–IFN-γ autoantibody associated disseminated nontuberculous mycobacterial infection

One of the human natural defense systems protects against nontuberculous mycobacterial (NTM) infection by IFN-γ producing T lymphocyte cells. Most disseminated NTM infections usually occur in severe immune-compromised patients, such as HIV infection or after organ transplant patients. However, there have been several reports of non-compromised patients with disseminated NTM infection, including antibiotic resistance cases and the presence of a neutralizing antibody against IFN-γ. We elucidated the anti–IFN–γ neutralizing antibody in a 65 year-old Japanese man whose legs were paralyzed because of multiple abscesses in vertebral bodies. Although his vertebral bodies were released due to an operation and antibiotics were administered, this treatment efficacy was poor. Patient's plasma demanded not only IFN-γ expression in peripheral blood mononuclear cells (PBMC) obtained from healthy controls, but also recombinant human IFN-γ expression. Furthermore, IFN-γ receptor expression was increased, compared to the healthy control. Finally, anti–IFN–γ antibody was detected in his plasma. These results suggested that anti–IFN–γ antibody induced an incurable NTM infection. IFN-γ was subcutaneously administrated with antibiotics, and then the abscesses diminished and his general condition was successfully improved. This therapy might be useful against severe NTM infections.     

Nontuberculous mycobacterial infection in a patient with myelofibrosis: case report and concise review

A 70‐year‐old patient having massive refractory ascites in the course of idiopathic myelofibrosis was diagnosed of peritoneal extramedullary hematopoiesis and developed an overwhelming nontuberculous mycobacterial infection. The case describes this unusual infection and highlights the need for additional studies to confirm the etiology of ascites in primary myelofibrosis.     

Super acute-onset disseminated BCG infection: A case report

Intravesical Bacillus Calmette-Guérin (BCG) instillation is an established immunotherapy for superficial bladder cancer. Herein, we describe a case of disseminated BCG infection that developed immediately after the first BCG injection. A 76-year-old man diagnosed with non-invasive bladder cancer underwent intravesical BCG instillation; he developed high fever and systemic arthralgia later that night. General examination did not reveal any infectious sources, and a combination therapy of isoniazid, rifabutin, and ethambutol was initiated after collecting his blood, urine, bone marrow, and liver biopsy samples for mycobacterial cultures. Three weeks later, Mycobacterium bovis was detected in the urine and bone marrow samples, and pathological investigation of liver biopsy revealed multiple small epithelial granulomas with focal multinucleated giant cells, leading to a diagnosis of disseminated BCG infection. The patient recovered after long-term antimycobacterial therapy without remarkable sequelae. Most cases of disseminated BCG infection occur after several doses of BCG injections, and its onset reportedly varies among cases, ranging from a few days to several months. The present case was notable as disease onset was observed only a few hours after the first BCG injection. Although rare, development of disseminated BCG infection should be considered as a differential diagnosis in patients at any time after intravesical BCG instillation therapy.     

Nontuberculous mycobacterial infections in cancer patients in a medical center in Taiwan, 2005-2008

Data on the nontuberculous mycobacterial (NTM) species that cause infection and the characteristics of disease caused by these pathogens in cancer patients are limited, so we perform this study to investigate the species distribution of NTM isolates from various clinical specimens and to elucidate the epidemiologic trends in NTM isolates and diseases among cancer patients. From 2005 through 2008, cancer patients with NTM infections as defined by the American Thoracic Society/Infectious Diseases Society of America criteria were identified at the National Taiwan University Hospital. The medical records of all patients were reviewed. During the study period, a total of 219 cancer patients with NTM infections were identified. Among them, 133 (60.7%) patients were older than 65 years, most of whom were men. Lung cancer was the most common type of cancer, followed by hematologic cancer and gastrointestinal tract cancer. Pulmonary NTM infection was the most common type of infection in 205 (93.6%) patients, followed by skin and soft tissue infections (n = 7, 3.2%), disseminated infections (n = 4, 1.8%), and genitourinary tract infection (n = 3, 1.4%). Disseminated infections occurred exclusively in patients with hematologic cancer. Mycobacterium avium complex (MAC) caused the majority of pulmonary NTM infections in cancer patients; in contrast, M. abscessus was the most common causative pathogen of extrapulmonary NTM diseases, followed by MAC. In conclusion, physicians need to be aware of the possibility of co-existing pulmonary NTM infection in patients with lung cancer. In addition, disseminated NTM infection should be considered in patients with hematologic cancer.     

Acquired predisposition to mycobacterial disease due to autoantibodies to IFN-gamma

Genetic defects in the IFN-gamma response pathway cause unique susceptibility to intracellular pathogens, particularly mycobacteria, but are rare and do not explain mycobacterial disease in the majority of affected patients. We postulated that acquired defects in macrophage activation by IFN-gamma may cause a similar immunological phenotype and thus explain the occurrence of disseminated intracellular infections in some patients without identifiable immune deficiency. Macrophage activation in response to IFN-gamma and IFN-gamma production were studied in whole blood and PBMCs of 3 patients with severe, unexplained nontuberculous mycobacterial infection. In all 3 patients, IFN-gamma was undetectable following mitogen stimulation of whole blood, but significant quantities were detectable in the supernatants of PBMCs when stimulated in the absence of the patients' own plasma. The patients' plasma inhibited the ability of IFN-gamma to increase production of TNF-alpha by both autologous and normal donor PBMCs, and recovery of exogenous IFN-gamma from the patients' plasma was greatly reduced. Using affinity chromatography, surface-enhanced laser desorption/ionization mass spectrometry, and sequencing, we isolated an IFN-gamma-neutralizing factor from the patients' plasma and showed it to be an autoantibody against IFN-gamma. The purified anti-IFN-gamma antibody was shown to be functional first in blocking the upregulation of TNF-alpha production in response to endotoxin; second in blocking induction of IFN-gamma-inducible genes (according to results of high-density cDNA microarrays); and third in inhibiting upregulation of HLA class II expression on PBMCs. Acquired defects in the IFN-gamma pathway may explain unusual susceptibility to intracellular pathogens in other patients without underlying, genetically determined immunological defects.     

Crossprotection against nontuberculous mycobacterial infections by Mycobacterium tuberculosis memory immune T lymphocytes

Adoptive immunization of T cell-deficient recipient mice with M. tuberculosis-specific memory immune T lymphocytes conferred upon these animals the ability to express significantly enhanced resistance both to the homologous infection, and to three strains of nontuberculous mycobacteria. These results support the hypothesis, therefore, that antigenic determinants possessed by the four mycobacterial strains that are relevant to the generation of protective cellular immunity are identical or closely crossreactive.