■非结核分枝杆菌(NTM)介导的感染在具有神经炎症性表现的病例中很重要。我们旨在在美国国立卫生研究院(NIH)临床中心描述具有神经系统表现的NTM病例,并回顾相关文献。
■在1995年1月至2020年12月期间,发现了6例病例。对人口统计记录进行了审查,临床,和放射学特征。MEDLINE搜索发现了以前报告的病例。数据被提取,然后进行统计分析,比较两组[生长缓慢的分枝杆菌(SGM)与那些具有快速增长的分枝杆菌(RGM)]并评估生存率的预测因子。评估NIH病例的临床和放射学特征。对文献中的病例进行了回顾,以确定SGM和RGM病例之间的差异,并确定生存率的预测因子。
■确定了来自NIH的6例(年龄41±13,男性83%)。5例由SGM[鸟分枝杆菌复合体(MAC)n=4;嗜血分枝杆菌n=1]引起,1例由RGM(脓肿分枝杆菌)引起。仅在SGM病例中发现了潜在的免疫疾病[遗传(n=2),HIV(n=1),结节病(n=1),和抗干扰素γ抗体(n=1)]。所有病例均采用组织分析进行诊断。文献回顾发现125例(SGMn=85,RGMn=38,未识别n=2)的81例报告。26例(21%)未报告免疫紊乱。在SGM案例中,最常见的基础疾病是HIV感染(n=55,65%),癫痫发作和局灶性病变更为常见。在RGM案例中,最常见的潜在疾病是神经外科介入或植入物(55%),头痛和脑膜症状很常见。基于组织的诊断更多用于SGM而不是RGM(39%与13%,p=0.04)。两组的生存率相似(48%SGM和55%RGM)。与更好的生存率相关的因素是孤立的CNS病变(OR5.9,p=0.01)和仅通过CSF采样进行诊断(OR9.9,p=0.04)。
■NTM感染引起多种神经系统表现,SGM和RGM感染之间有一些区别。组织取样可能是建立诊断所必需的,应该努力确定潜在的免疫疾病。
UNASSIGNED: Nontuberculous mycobacteria (NTM) mediated infections are important to consider in cases with neuroinflammatory presentations. We aimed to characterize cases of NTM with neurological manifestations at the National Institutes of Health (NIH) Clinical Center and review the relevant literature.
UNASSIGNED: Between January 1995 and December 2020, six cases were identified. Records were reviewed for demographic, clinical, and radiological characteristics. A MEDLINE search found previously reported cases. Data were extracted, followed by statistical analysis to compare two groups [cases with slow-growing mycobacteria (SGM) vs. those with rapidly growing mycobacteria (RGM)] and evaluate for predictors of survival. NIH cases were evaluated for clinical and radiological characteristics. Cases from the literature were reviewed to determine the differences between SGM and RGM cases and to identify predictors of survival.
UNASSIGNED: Six cases from NIH were identified (age 41 ± 13, 83% male). Five cases were caused by SGM [Mycobacterium avium complex (MAC) n = 4; Mycobacterium haemophilum n = 1] and one due to RGM (Mycobacterium abscessus). Underlying immune disorders were identified only in the SGM cases [genetic (n = 2), HIV (n = 1), sarcoidosis (n = 1), and anti-interferon-gamma antibodies (n = 1)]. All cases were diagnosed using tissue analysis. A literature review found 81
reports on 125 cases (SGM n = 85, RGM n = 38, non-identified n = 2). No immune disorder was reported in 26 cases (21%). Within SGM cases, the most common underlying disease was HIV infection (n = 55, 65%), and seizures and focal lesions were more common. In RGM cases, the most common underlying condition was neurosurgical intervention or implants (55%), and headaches and meningeal signs were common. Tissue-based diagnosis was used more for SGM than RGM (39% vs. 13%, p = 0.04). Survival rates were similar in both groups (48% SGM and 55% in RGM). Factors associated with better survival were a solitary CNS lesion (OR 5.9, p = 0.01) and a diagnosis made by CSF sampling only (OR 9.9, p = 0.04).
UNASSIGNED: NTM infections cause diverse neurological manifestations, with some distinctions between SGM and RGM infections. Tissue sampling may be necessary to establish the diagnosis, and an effort should be made to identify an underlying immune disorder.