痰标本分离非结核分支杆菌44例报告

目的探讨痰标本鉴定非结核分支杆菌(NTM)的意义.方法对本院1997年9月～1999年3月255份痰标本鉴定的44株NTM与相对应的37份临床资料对照分析.结果NTM检出率17.3%,NTM对抗结核药总耐药率79.5%.37例NTM检出者抗结核治疗病灶吸收好转率83.3%,24例痰菌阴转率83.3%,反复痰鉴定为NTM者病程长,耐多种抗结核药.结论NTM感染及引发的疾病必须引起医学检验与临床的重视.痰标本一次鉴定的NTM大部分为寄生菌,实验室有必要进一步开展NTM的菌种鉴定技术.连续痰鉴定为NTM者为NTM肺病高度可疑者.诊断多耐药肺结核,必须除外NTM肺病.     

非结核分支杆菌肺病的外科治疗

目的　探讨非结核分支杆菌 (NTM)肺病手术治疗的适应证、手术方式及其效果。方法　 37例NTM肺病患者接受 38次肺切除术。术前 30例进行了化疗 ,平均用药 8个月 (1～ 4 6个月 )。手术方式包括 :胸膜全肺切除 2例 ,肺叶切除 33例 ,段切除 1例 ,楔形切除 1例。常规包埋支气管残端。术后有 33例给予化疗 ,用药基本同术前 ,平均用药 10个月 (1～ 37个月 )。结果　无手术死亡及手术并发症病例。术后痰菌阴转率 97%。平均随访时间 (35± 15 )个月 (1～ 5 5个月 ) ,1例楔形切除的病例于术后 2年复发。结论　对于空洞型病变 ,持续痰菌阳性 ,不能耐受化疗 ,或合并曲菌感染及咯血的NTM肺病患者应考虑手术治疗。肺叶切除为首选手术方式。     

非结核分支杆菌病临床研究现状

非结核分支杆菌病系由结核分支杆菌和麻风分支杆菌以外的非结核分支杆菌(non -tuberculousmycobecteria,NTM)引起的疾病。分支杆菌菌种报道迄今已达150种以上 ,其中有37种已见致病病例报道。非结核分支杆菌病多继发于慢性肺病 ,如支气管扩张、矽肺和肺结核 ,是人类免疫缺陷病毒 (HIV)感染、获得性免疫缺陷综合征(AIDS)的常见并发症 ,也可以是因消毒不严而引发的院内感染。本病曾称为非典型分支杆菌病等外 ,我国对该病的研究起步较迟。1987年我国制定了非典型分支杆菌病诊断标准及其处理措施。随后 ,1993年在黄山市召开的非典型抗酸菌会…     

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     

PCR-SSCP方法用于痰标本中结核分支杆菌耐药基因的检测

目的探讨采用直接检测结核病人痰标本中rpoB基因和KatG基因突变。评价该方法检测结核分支杆菌对利福平（RFP）和异烟肼（INH）耐药性。方法用PCR-SSCP技术分析，对35例耐INH（或含耐异烟肼）、63例耐RFP（或含耐RFP）的肺结核病人痰标本和20例非结核性肺部疾病组痰标本进行rpoB和KatG基因突变的检测。结果以结核分支杆菌H37RV为对照，63例耐RFP痰标本中57例PCR扩增阳性，其中46例SSCP图谱与H37Rv标准株有差异。rpoB突变率为65．2％。35例耐INH肺结核病人痰标本有20例扩增阳性。15例SSCP图谱与H37Rv标准株有差异，突变率为42．8％。20例非结核病人痰标本rpoB基因和KatG基因扩增均为阴性。结论PCR-SSCP技术有望成为结核分支杆菌耐药性检测的重要方法之一。     

结核分支杆菌临床分离株rpoB基因突变的研究

目的：了解我院结核分支杆菌耐RFP临床分离rpoB基因的突变特点。方法：利用PCR和测序试验,分析了50株结核分支杆菌临床分离株及H37Rv标准株的rpoB基因,包括核心区域的81个碱基在内的184bp的基因片段,结果：20株敏感株未发现rpoB基因的突变,30株耐药株中,28株（93.3%）出现rpoB基因的突变,突变位置集中在rpoB基因核心区域内的27个氨基酸内,531,526两个密码子的突变率为60.7%（17／28）,未发现缺失或插入突变。高浓度耐药（R250）突变位置主要在531位氨基酸,占52.4%（11／21）,低浓度耐药（R50）突变位置主要在526位氨基酸,占57.1%(4/7)。结论：rpoB基因核心序列的检测,可作为利福平耐药的指标,对临床用药有指导意义。     

胸腺瘤并发非结核分支杆菌肺病1例并文献复习

胸腺瘤是一种常见疾病,非结核分支杆菌肺病是一种少见疾病,而胸腺瘤并发非结核分支杆菌肺病国内外文献未见报道,国外文献有1例胸腺瘤并发肺结核的报道,现将1例胸腺瘤并发非结核分支杆菌肺病报道如下,结合文献以提高对这两个疾病的认识。     

340株痰结核分支杆菌耐药结果分析

目的探讨340例肺结核病人痰培养阳性菌株对常规抗结核药物的耐药性。并对耐INH、RFP、SM及耐HR者进行敏感药物的选择。方法应用Baetec或改良罗氏法，采用绝对浓度法进行结核分支杆菌药物耐受性测定。结果耐药顺位次序为RFP45．9％、SM45．3％、INH34．4％、EMB18．6％、PAST．4％、HR23．8％。结论我市属于高耐药区域．以耐RFP、SM、INH居前三位，耐HR率亦很高。DIP、OFLX、PCM对耐HR菌株敏感。     

结核分支杆菌的实验诊断新技术

结核分支杆菌引起的感染和死亡 ,随着抗结核药物的开发和应用曾一度得到有效的控制 ,但从 2 0世纪 80年代以来 ,结核病出现疫情回潮现象。其主要原因是耐多药结核病(ｍｕｌｔｉｄｒｕｇｒｅｓｉｓｔａｎｃｅｔｕｂｅｒｃｌｅｂａｃｉｌｌｕｓ ,ＭＤＲ ＴＢ)的流行、人类免疫缺陷病毒 (ｈｕｍａｎｉｍｍｕｎｏｄｅｆｉｃｉｅｎｃｙｖｉｒｕｓ ,ＨＩＶ)感染、器官移植、免疫抑制剂使用等所致免疫损害宿主 (ＩＣＨ)增多和高龄人口中机体免疫力低下等因素 ,使结核分支杆菌感染难以控制 ,发展为难治倾向。要想从根本上控制结核病的流行 ,诊断是所…     

结核分支杆菌的实验室诊断简述

近年来结核病发病率逐步上升,这与结核分支杆菌(MTB)的多耐药菌株的出现密切相关.临床上也出现了许多典型的非致病性分支杆菌.因此,国内外学者正面临着开发快速鉴定MTB的方法.笔者主要简述有关MTB的实验室诊断方法. 1 常规方法 常规检查MTB的方法主要有齐-尼二氏涂片抗酸染色显微镜检查和经固体培养基如Lowenstein-Jensen或液体培养基如Middlebrook的细菌培养检查法.抗酸染色检查法灵敏度低,只有抗酸菌浓度大于104/ml时才可检出.     

Clinical significance of a single isolation of pathogenic nontuberculous mycobacteria from sputum specimens

A single sputum culture positive for nontuberculous mycobacteria (NTM) could be an early sign of NTM lung disease. We found that 14% of patients with a single sputum culture positive for pathogenic NTM were diagnosed with NTM lung disease during the median follow-up period of 16 months.     

Isolation of nontuberculous mycobacteria from patients with pneumoconiosis

This study aimed to confirm the isolation of nontuberculous mycobacteria (NTM) from patients with pneumoconiosis. Monthly sputum examinations in 155 patients were performed from April 1998 to December 2002. When NTM were isolated, species were identified and the frequency of isolation was reviewed. We then identified the patients who satisfied the bacteriologic criteria for the diagnosis of nontuberculous mycobacterial pulmonary disease (NTM pulmonary disease) recommended by the American Thoracic Society (ATS). Symptoms and findings on computed tomography (CT) scans were evaluated. NTM were isolated from 60 patients (39%): common etiologic species defined by the ATS, i.e., Mycobacterium avium, M. intracellulare, M. abscessus, and M. kansasii, were identified in 21 patients; unusual etiologic species, i.e., M. fortuitum, M. simiae, and M. szulgai, were identified in 11 patients; and undefined species, which appeared to be nonpathogenic, were identified in 41 patients. The bacteriologic criteria were satisfied in 8 patients. NTM species isolated in conformity with the bacteriologic criteria were: M. avium in 4 patients, M. intracellulare in 2, a combination of M. intracellulare and M. kansasii in 1, and M. gordonae in 1 patient. Two patients, from whom M. avium were repeatedly isolated, satisfied the ATS diagnostic criteria for NTM pulmonary disease. It is important to note that NTM, including both pathogenic species and nonpathogenic species, were isolated from patients with pneumoconiosis.     

Inactivation of nontuberculous mycobacteria by gaseous ozone treatment

Nontuberculous mycobacteria (NTM) are environmental bacteria resistant to many common disinfectants and ultraviolet radiation. Inhalation of aerosols generated from NTM-containing water and soil causes NTM lung disease, especially in people with underlying lung diseases and decreased immunity. To prevent healthcare-acquired NTM infections, it is important to eradicate NTM living in hospital environments. Therefore, we evaluated the efficacy of gaseous ozone for the inactivation of NTM, namely Mycobacterium (M.) avium, M. intracellulare, M. kansasii, M. abscessus subsp. abscessus and M. abscessus subsp. massiliense. Gaseous ozone treatment at 1 ppm for 3 h reduced the bacterial number of all strains by more than 97%. Gaseous ozone treatment could be a practical, effective and convenient disinfection method for NTM living in hospital environments.     

Molecular identification of nontuberculous mycobacteria isolates in a Brazilian mycobacteria reference laboratory

This study utilized the hsp65 polymerase chain reaction restriction analysis (PRA) method in the identification of nontuberculous mycobacteria (NTMs) isolated in a Brazilian mycobacteria laboratory. NTM isolates from clinical specimens collected from 192 patients were characterized using the hsp65 PRA method and analyzed using both 16S rRNA and hsp65 gene sequencing. Only 30% of the NTM strains were correctly identified through PRA, though the suggested inclusion of an additional restriction enzyme could increase the resolution to roughly 90%. A total of 17 NTM strains were not identified to species level and may represent a new taxonomic entity classified as belonging to the Mycobacterium simiae complex. This study demonstrates the applicability of hsp65 PRA in the identification of several NTM strains in a reference laboratory, though the results suggest that some modifications to the original PRA method could increase its resolution substantially.     

非结核分枝杆菌肺病的临床与MSCT表现

目的 探讨非结核分枝杆菌（NTM）肺病的临床表现与MSCT特征。方法 回顾性分析经临床和实验室检查确诊的102例NTM肺病和102例肺结核患者的病历资料与MSCT资料,两组间一般资料、CT征象的比较采用t/χ²检验。结果 NTM肺病患者临床表现与肺结核类似,主要表现为咳嗽、咳痰、咯血和活动后气促,两组间差异无统计学意义（P均>0.05）。NTM肺病常合并慢性肺部疾病,如肺结核病史、慢性阻塞性肺疾病、肺心病,与肺结核组比较,两组间差异均有统计学意义（P均<0.05）。NTM肺病MSCT主要表现为小叶中心结节（89/102,87.25%）、支气管扩张（67/102,65.69%）、斑片状实变灶（64/102,62.75%）,其次为纤维条索灶、薄壁空洞及胸膜增厚,其中小叶中心结节、支气管扩张、薄壁空洞的发生率高于肺结核组（χ²=3.995、22.675、12.823,P均<0.05）,支气管扩张以右中叶和/或左舌叶明显。结论 NTM肺病常合并慢性肺部疾病,CT表现有一定特征性,尤其表现为右中叶和/或左舌叶支气管扩张伴周围小叶中心结节、薄壁空洞,具有以上CT特征且经正规抗结核效果不佳时,应考虑NTM肺病的可能。     

绍兴地区非结核分枝杆菌肺部感染情况分析

目的了解绍兴地区由非结核分枝杆菌(NTM)所引起的肺部感染情况及细菌耐药状况,为临床合理用药提供参考。方法收集2017年7月-2018年7月分离自绍兴文理学院附属医院及各县区医院临床样本的NTM,并分析患者临床资料。采用对硝基苯甲酸培养基和噻吩-2-羧酸肼培养基对菌株进行初步鉴定,并用基因芯片技术进一步进行分型。采用比例法进行药物敏感性试验。结果 2 768例样本中共分离出NTM 243株,检出率为8.77%。NTM感染患者中男性占77.37%,<60岁者占65.43%,约70.00%的患者同时患有其他肺部疾病。243株NTM主要为胞内分枝杆菌(62.14%),其次为鸟分枝杆菌(19.75%)。分离出的NTM对一线抗菌药物的耐药率均较高,对异烟肼和链霉素的耐药率近100.00%;对二线抗菌药物的耐药率低于一线抗菌药物。结论 NTM感染引起的肺部疾病好发于患有其他肺部疾病的患者,胞内分枝杆菌是临床主要的NTM,快速、准确地进行菌种鉴定有助于临床对患者进行早期诊断和治疗。     

Evaluation of a membrane array for detection of Mycobacterium tuberculosis complex and nontuberculous mycobacteria in positive liquid cultures

Molecular identification of mycobacteria in positive Mycobacteria Growth Indicator Tube (MGIT) cultures can accelerate mycobacterial diagnosis. A membrane hybridization array (Blue Point) was evaluated for this purpose in 284 positive MGIT cultures. Discrepant results were resolved by testing with the GenoType Mycobacterium kit, TBc ID test, sequencing of the 16S rRNA gene and internal transcribed spacer. Total recovery from culture and the array (if confirmed) was considered 100%. The sensitivity, specificity, positive, and negative predictive values of the array for detection of Mycobacterium tuberculosis complex were 99.4%, 100%, 100%, and 99.2%, respectively, while the corresponding values of culture were 95.1%, 100%, 100%, and 93.8%, respectively, with significant differences in sensitivity and negative predictive value being found between the 2 methods. The recoveries of nontuberculous mycobacteria and mixed cultures of the array were also significantly higher than those of culture. The array can be adopted in routine mycobacteriology laboratory.     

Patients with nontuberculous mycobacteria: comparison of updated and previous diagnostic criteria for lung disease

We classified patients with respiratory nontuberculous mycobacteria (NTM) isolates using updated (2007) and previous (1997) American Thoracic Society/Infectious Diseases Society of America criteria for NTM lung disease. We found that a greater proportion of such patients have disease using updated criteria due to improved sensitivity of the microbiologic component of the disease definition.     

Clinical characteristics of extrapulmonary nontuberculous mycobacteria infections in comparison with pulmonary infections: A single-center,retrospective study in Japan

IntroductionThe prevalence of nontuberculous mycobacteria (NTM) infections is increasing worldwide. Although NTM can affect extrapulmonary organs, studies on the clinical characteristics of extrapulmonary NTM are rare.MethodsWe retrospectively analyzed patients who were newly diagnosed with NTM infections at Hiroshima University Hospital between 2001 and 2021 to investigate species distribution, infected sites, and risk factors of extrapulmonary NTM compared to pulmonary NTM.ResultsOf the 261 NTM infections, 9.6% and 90.4% had extrapulmonary and pulmonary NTM, respectively. The mean ages of patients with extrapulmonary and pulmonary NTM were 53.4 and 69.3 years, 64.0% and 42.8% were male, 36.0% and 9.3% received corticosteroids, 20.0% and 0% had acquired immune deficiency syndrome (AIDS), and 56.0% and 16.1% had any immunosuppressive conditions, respectively. Younger age, corticosteroid use, and AIDS were associated with extrapulmonary NTM. In pulmonary NTM, Mycobacterium avium complex (MAC) accounted for 86.4% of NTM species, followed by M. abscessus complex (4.2%), whereas in extrapulmonary NTM, M. abscessus complex, MAC, M. chelonae, and M. fortuitum accounted for 36.0%, 28.0%, 12.0%, and 8.0%, respectively. Compared to pulmonary NTM, extrapulmonary NTM were significantly more likely to be rapid-growing mycobacteria (RGM) (56.0% vs. 5.5%). The most common sites of infection were the skin and soft tissues (44.0%), followed by the blood (20.0%), tenosynovium, and lymph nodes (12.0%).ConclusionYounger age and immunosuppressive conditions are associated with extrapulmonary NTM, with a higher prevalence of RGM in extrapulmonary NTM than in pulmonary NTM. These results provide a better understanding of extrapulmonary NTM.