atypical mycobacteria

非典型分枝杆菌
  • 文章类型: Journal Article
    本研究的目的是确定有关复发性非典型分枝杆菌颈面部淋巴结炎的现有文献,以增强我们对一位特殊患者的认识,该患者在治疗5年后出现刮宫复发,并出现在我们的三级护理中心。
    OVIDMedline,Scopus,和WebofScience。
    进行了文献检索,产生了49篇原创文章,由两名独立评审员进行了两次筛选,结果有14项研究符合Covidence软件数据提取的纳入标准。两名独立评审员提取了非典型分枝杆菌颈面部淋巴结炎复发的数据,并就所有纳入研究的数据点达成共识。
    本研究揭示了关于非典型分枝杆菌淋巴结炎的文献中很少有复发报告。在我们的审查中确定的16项研究包括关于复发的讨论,除了复发率之外,很少详细说明它们的管理。16项研究中有14项提供了其队列的复发率,14个中有11个指定了初始治疗方式,8项研究中只有5项描述了手术的初始治疗,将完全切除和不完全切除的复发率区分开来。纳入研究的平均随访时间为20个月。以前曾报道过一例5年晚期复发病例。
    我们发现很少有关于非典型分枝杆菌颈面部淋巴结炎复发处理的报告。关于手术治疗方式之间复发率的数据很少。我们研究中讨论的病例表明,刮宫治疗有可能出现晚期复发。
    UNASSIGNED: The purpose of this study is to identify existing literature on recurrent atypical mycobacterial cervicofacial lymphadenitis to augment our understanding of a unique patient who presented to our tertiary-care center 5-years posttreatment with recurrence following curettage.
    UNASSIGNED: OVID Medline, Scopus, and Web of Science.
    UNASSIGNED: A literature search was conducted yielding 49 original articles which were screened twice by two independent reviewers resulting in 14 studies meeting inclusion criteria for data extraction using Covidence software. Two independent reviewers extracted data on recurrence of atypical mycobacterial cervicofacial lymphadenitis and consensus was reached on data points from all included studies.
    UNASSIGNED: This study illuminated the paucity of recurrence reporting in the literature regarding atypical mycobacterial lymphadenitis. Sixteen studies identified in our review included discussions on recurrence with few elaborating beyond the rate of recurrence to describe their management. Fourteen out of sixteen studies provided recurrence rates for their cohort, 11 out of 14 specified the initial treatment modality, and only five out of eight studies that described initial treatment with surgery differentiated recurrence rates between complete and incomplete excision. The mean length of follow-up in the included studies was 20 months. There was one previously reported case of late recurrence at 5-years.
    UNASSIGNED: We identified few reports that discussed the management of recurrence of atypical mycobacterial cervicofacial lymphadenitis. There was minimal data on recurrence rates between surgical treatment modalities. The case discussed in our study showcases that treatment with curettage has the potential to present with late recurrence.
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  • 文章类型: Journal Article
    简介腹腔镜技术已成为许多手术的标准,提供的好处,如更快的恢复和更少的痛苦。然而,港口感染(PSIs)可能会发生并构成挑战。PSI可以提前(七天内)或延迟(三到四周后),通常由非结核分枝杆菌(NTM)引起的延迟PSIs。NTM难以治疗,对抗生素的反应也不好,导致长期和反复感染。PSI管理指南是有限的。本摘要重点介绍了10例PSIs患者的病例系列,讨论他们的治疗经验,并介绍我们研究所使用的治疗算法。方法回顾性研究(2015-2020年)腹腔镜手术慢性港口感染(PSIs)。收集了患者人口统计学数据,手术类型,治疗前,和管理研究所。结果该研究分析了2015年至2020年腹腔镜手术后10例慢性PSIs患者。腹腔镜胆囊切除术是最常见的索引手术。三名患者有不同持续时间的抗结核治疗史,其中一人在就诊前已完成抗结核治疗.完整的手术切除与组织病理学检查和真菌,进行细菌和分枝杆菌培养.10例患者中有7例口服环丙沙星和克拉霉素联合治疗3个月,其中2例接受基于培养物的抗生素治疗,1例接受抗结核治疗.所有患者经治疗好转。平均随访时间为52±9.65个月,没有复发的报道。结论端口部位感染(PSIs)是腹腔镜手术的麻烦并发症,会削弱手术的益处。由耐药分枝杆菌引起的延迟性PSIs难以治疗。改进的灭菌方法和彻底的微生物检查至关重要。根治性切除和长期口服抗生素是有效的治疗方法。临床医生应避免经验性抗生素治疗,以防止抗生素耐药性。
    Introduction Laparoscopic techniques have become standard for many surgeries, offering benefits such as quicker recovery and less pain. However, port-site infections (PSIs) can occur and pose challenges. PSIs can be early (within seven days) or delayed (after three to four weeks), with delayed PSIs often caused by non-tuberculous mycobacteria (NTMs). NTMs are difficult to treat and do not respond well to antibiotics, leading to prolonged and recurrent infections. Guidelines for PSI management are limited. This summary highlights a case series of 10 patients with PSIs, discussing their treatment experience and presenting a treatment algorithm used at our institute. Methods This is a retrospective study (2015-2020) on chronic port-site infections (PSIs) in laparoscopic surgeries. Data were collected on patient demographics, surgery type, prior treatment, and management at the institute. Results The study analyzed 10 patients with chronic PSIs following laparoscopic surgery between 2015 and 2020. Laparoscopic cholecystectomy was the most frequent index surgery. Three patients had a history of treatment with varying durations of anti-tubercular therapy, one of whom had completed anti-tubercular treatment prior to presentation. Complete surgical excision with histopathological examination and fungal, bacterial and mycobacterial cultures were performed. Seven of the 10 patients were treated with oral ciprofloxacin and clarithromycin combination therapy for three months, two were treated with culture-based antibiotics and one was treated with anti-tubercular therapy. All patients improved on treatment. The mean follow-up period was 52 ± 9.65 months, with no relapses being reported.  Conclusion Port-site infections (PSIs) are troublesome complications of laparoscopic surgery that can erode the benefits of the procedure. Delayed PSIs caused by drug-resistant mycobacteria are difficult to treat. Improved sterilization methods and thorough microbiological work-up are crucial. Radical excision and prolonged oral antibiotics are effective treatments. Clinicians should avoid empirical antibiotic therapy to prevent antimicrobial resistance.
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  • 文章类型: Case Reports
    偶发分枝杆菌与皮肤和软组织感染有关,然而孤立的肝脏受累是罕见的。一名67岁无症状的男子被转介接受内窥镜超声检查(EUS)以评估胃部病变和偶然的肝脏肿块。EUS显示取样的肝脏质量不均匀。病理显示坏死性肉芽肿性炎症和抗酸杆菌阳性。左氧氟沙星加甲氧苄啶和磺胺甲恶唑3个月用于完全缓解肝脏病变。孤立的非结核性肝脏受累并不常见。我们报告了第一例由EUS细针穿刺诊断的由M.fortuitum引起的肝脏肿块。
    Mycobacterium fortuitum is associated with skin and soft-tissue infections, yet isolated liver involvement is rare. A 67-year-old asymptomatic man was referred for endoscopic ultrasound (EUS) to evaluate a gastric lesion and an incidental liver mass. EUS revealed a heterogeneous liver mass that was sampled. Pathology revealed necrotic granulomatous inflammation and positive acid-fast bacilli stain with M. fortuitum deoxyribonucleic acid. Levofloxacin plus trimethoprim and sulfamethoxazole for 3 months were used for complete resolution of liver lesion. Isolated nontuberculous liver involvement is uncommon. We report the first case of a liver mass caused by M. fortuitum diagnosed by EUS-fine needle aspiration.
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  • 文章类型: Case Reports
    非结核分枝杆菌(NTM)是普遍存在的微生物,可以引起皮肤,软组织,和呼吸道感染。这些细菌中的一些对医院中常用的消毒剂具有抗性并导致手术后的伤口感染。NTM感染的诊断需要高的临床怀疑指数,因为它们的临床表现通常与其他细菌感染重叠。此外,从临床样品中分离NTM是困难和耗时的。此外,缺乏NTM感染的标准化治疗方案.我们报告了四例胆囊切除术后延迟伤口感染的病例,可能是由于NTM所致,并通过克拉霉素的组合成功治疗。环丙沙星,还有阿米卡星.
    Nontuberculous mycobacteria (NTM) are ubiquitous micro-organisms that can cause skin, soft tissue, and respiratory infections. Some of these bacteria are resistant to the commonly used disinfectants in hospitals and lead to wound infections after surgery. The diagnosis of NTM infections requires a high index of clinical suspicion as their clinical presentation often overlaps with other bacterial infections. Moreover, the isolation of NTM from clinical samples is difficult and time-consuming. Also, there is a lack of standardized treatment protocols for NTM infections. We report four cases of delayed wound infections after cholecystectomy probably due to NTM which were successfully treated by a combination of clarithromycin, ciprofloxacin, and amikacin.
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  • 文章类型: Case Reports
    未经证实:肌肉骨骼系统的非结核分枝杆菌(NTM)感染通常因其罕见且没有全身症状而被漏诊。这里,我们介绍了1例罕见的NTM感染病例,该病例是由一个专门研究肌肉骨骼感染的多学科团队管理的免疫能力宿主修复了断裂的胸大肌肌腱后发生的.
    UNASSIGNED:一名23岁的男性患者,表现为右腋窝鼻窦排出6个月。事故发生后,他持续了右胸大肌撕脱伤,并使用FiberWire®和endo按钮进行了手术修复。手术后4个月,他出现了一个放电窦。尽管在其他地方使用了经验性抗生素,但他仍表现出持续感染。X线照片和MRI超声图显示,肱骨近端髓内内纽扣,腋窝区域有边缘脓液收集,沿上部向胸大肌和小肌的内侧延伸最小。在多学科骨感染小组的投入下,制定了详细的计划。伤口被彻底清创,移除植入物和缝线,肱骨刮伤了,和组织送去微生物学和组织病理学。如ID专家建议的那样,深层组织培养的延长孵育生长迅速的分枝杆菌,手术后3周的NTM类型。根据抗生素敏感性,患者开始静脉注射阿米卡星以及口服克拉霉素和利奈唑胺。手术后伤口放电持续近5周,并在开始使用适当的抗生素后2周停止。给予阿米卡星1个月,口服抗生素6个月。手术后胸肌主要功能未受影响,清创后3个月患者恢复正常活动。患者无感染随访4年。
    UNASSIGNED:此病例概述了高度怀疑骨科NTM感染的重要性。此外,它展示了外科医生之间良好沟通的优势,传染病专家,和微生物学家实现良好的功能结果。
    UNASSIGNED: Non-tuberculous mycobacteria (NTM) infections of the musculoskeletal system are commonly missed due to their rarity and the absence of systemic symptoms. Here, we present a rare case of NTM infection following repair of an avulsed pectoralis major tendon in an immunocompetent host managed by a multi-disciplinary team specializing in musculoskeletal infections.
    UNASSIGNED: A 23-year-old male patient presented with discharging sinus in the right axilla for 6 months. He sustained the right pectoralis major muscle avulsion following an accident which was surgically repaired using FiberWire® and endo buttons. He developed a discharging sinus 4-month post-surgery. He presented with persistent infection in spite of empirical antibiotics elsewhere. Radiographs and MRI sonogram showed intra-medullar endo buttons in the proximal humerus with marginal pus collection in the axillary region with minimal medial extension into pectoralis major and minor muscles along the superior aspect. A detailed plan was made with inputs from a multidisciplinary bone infection team. Wound was radically debrided, implants and sutures removed, humerus scraped, and tissues sent for microbiology and histopathology. Extended incubation of deep tissue culture as suggested by ID specialists grew Rapidly growing mycobacteria, a type of NTM 3 weeks after surgery. Patient was started on intravenous amikacin along with oral clarithromycin and linezolid based on antibiotic susceptibility. Wound discharge persisted for almost 5-week post-surgery and stopped 2 weeks after initiation of appropriate antibiotics. Amikacin was given for 1 month and oral antibiotics were continued for 6 months. The pectoralis major function was unaffected after surgery and patient returned to normal activities 3 months after debridement. Patient has an infection free follow-up of 4 years.
    UNASSIGNED: This case outlines the importance of having a high degree of suspicion for the diagnosing orthopedic NTM infections. In addition, it showcases the advantages of having good communication between surgeons, infectious disease specialist, and microbiologist for achieving good functional outcomes.
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  • 文章类型: Case Reports
    由非结核分枝杆菌(NTM-PD)引起的肺部疾病可能是医疗保健提供者管理的复杂疾病,延迟诊断和治疗失败是常见的。在这里,我们提出了三个案例研究,说明在诊断和治疗NTM-PD的关键挑战,并就这些问题提供指导。此外,我们就如何改善NTM-PD的整体管理提出建议,通过医生教育等策略来识别NTM-PD,以及多学科团队和患者支持小组的发展。
    Pulmonary disease caused by non-tuberculous mycobacteria (NTM-PD) can be a complex condition for health care providers to manage, and delayed diagnosis and treatment failure are common. Here we present three case studies that illustrate key challenges in the diagnosis and treatment of NTM-PD, and provide guidance on these issues. In addition, we make recommendations on how the overall management of NTM-PD may be improved, through strategies such as physician education to recognise NTM-PD, and the development of multidisciplinary teams and patient-support groups.
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  • 文章类型: Case Reports
    眶周非结核分枝杆菌(NTM)感染并不常见。据我们所知,之前尚未报道过Müller肌肉结膜切除术(MMCR)手术后的并发症NTM感染。我们报告了MMCR手术后左上眼睑M.Chelonae感染的病例。一名61岁的女士在双侧MMCR手术后4周出现左上眼睑肿胀和结节状肿块。既往病史和眼部病史包括系统性红斑狼疮(SLE),慢性乙型肝炎感染,14年前进行的双侧白内障手术和3年前进行的Descemet剥离自动内皮角膜移植术的右眼Fuch's营养不良。她最初接受了局部和口服抗生素治疗,以及反复切开刮宫和病灶内注射类固醇,但改善有限。MMCR后七个月,进行了重复活检和结节减影。活检显示肉芽肿性炎症伴分枝杆菌感染,PCR鉴定出M.Chelonae。总共给予6个月的联合全身抗生素疗程,有良好的反应。在初始MMCR手术后15个月进行了有限的眼睑成形术,并重复进行结节切除。活检培养和PCR均为阴性。在30个月的随访中,没有发现症状复发,并且保持了良好的眼睑高度。眶周NTM感染的管理可能具有挑战性。临床医生应考虑在可疑病例中使用分枝杆菌培养和PCR进行早期诊断检查,随后迅速开始全身性大环内酯类药物的经验性治疗。需要结合手术切除结节和长期的全身抗菌治疗才能完全根除生物体。
    Periorbital non-tuberculous mycobacterium (NTM) infections are uncommon. To the best of our knowledge, NTM infection as a complication following Müller\'s muscle-conjunctival resection (MMCR) surgery has not been reported before. We report a case of left upper lid M. Chelonae infection following MMCR surgery. A 61-year-old lady presented with left upper lid swelling and nodular mass 4 weeks after bilateral MMCR surgery for aponeurotic ptosis. Past medical and ocular history include systemic lupus erythematosus (SLE), chronic hepatitis B infection, bilateral cataract operation done 14 years ago and right eye Fuch\'s dystrophy with Descemet stripping automated endothelial keratoplasty done 3 years ago. She was initially treated with topical and oral antibiotics, as well as repeated incision and curettage and intralesional steroid injection with limited improvement. Seven months post-MMCR, repeated biopsy and nodule debulking were performed. Biopsy revealed granulomatous inflammation with mycobacterial infection and PCR identified M. Chelonae. A total of 6 months course of combination systemic antibiotics were given, with good response. Limited blepharoplasty with repeat nodular excision was performed 15 months after the initial MMCR surgery, and biopsy culture and PCR were both negative. No relapse of symptoms was noted and good lid height was maintained at 30 months of follow-up. Management of periorbital NTM infections can be challenging. Clinicians should consider early diagnostic workup with mycobacterial culture and PCR in suspicious cases, followed by prompt initiation of empiric treatment with systemic macrolides. A combination of surgical excision of nodules and prolonged systemic antimicrobial treatment is needed for complete organism eradication.
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  • 文章类型: Case Reports
    BACKGROUND: To report three cases of nontuberculous mycobacterial (NTM) endophthalmitis following multiple ocular surgeries and to review previous literature in order to study the clinical profile, treatment modalities, and visual outcomes among patients with NTM endophthalmitis.
    METHODS: Clinical manifestation and management of patients with NTM endophthalmitis in the Department of Ophthalmology, Faculty of Medicine, Siriraj hospital, Mahidol University, Bangkok, Thailand were described. In addition, a review of previously reported cases and case series from MEDLINE, EMBASE, and CENTRAL was performed. The clinical information and type of NTM from the previous studies and our cases were summarized.
    RESULTS: We reported three cases of NTM endophthalmitis caused by M. haemophilum, M. fortuitum and M. abscessus and a summarized review of 112 additional cases previously published. Of 115 patients, there were 101 exogenous endophthalmitis (87.8%) and 14 endogenous endophthalmitis (12.2%). The patients\' age ranged from 13 to 89 years with mean of 60.5 ± 17.7 years with no gender predominance. Exogenous endophthalmitis occurred in both healthy and immunocompromised hosts, mainly caused by cataract surgery (67.3%). In contrast, almost all endogenous endophthalmitis patients were immunocompromised. Among all patients, previous history of tuberculosis infection was identified in 4 cases (3.5%). Rapid growing NTMs were responsible for exogenous endophthalmitis, while endogenous endophthalmitis were commonly caused by slow growers. Treatment regimens consisted of macrolides, fluoroquinolones or aminoglycosides, which were continued for up to 12 months. Initial and final vision were generally worse than 6/60.
    CONCLUSIONS: NTM endophthalmitis is a serious intraocular infection that leads to irreversible loss of vision. The presentation can mimic a chronic recurrent or persistent intraocular inflammation. History of multiple intraocular surgeries or immune-deficiency in patient with chronic panuveitis should raise the practioner\'s suspicion of NTM endophthalmitis. Appropriate diagnosis and treatment are important to optimize visual outcome.
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  • 文章类型: Case Reports
    BACKGROUND: Eight new cases of chronic otomastoiditis due to nontuberculous mycobacteria were reported at Center Hospitalier Universitaire Sainte-Justine (CHUSJ) between 2008 and 2018. In the literature, only 89 cases have been described since 1972. This case series aims to define the clinical presentation, infectious pathogens, as well as diagnostic and therapeutic means employed in cases of nontuberculous mycobacteria otitis media encountered in our tertiary pediatric reference center.
    METHODS: All cases of otitis media caused by nontuberculous mycobacteria diagnosed at Sainte-Justine between 2008 and 2018 were reviewed. Species identification was retrieved from the Laboratoire de Santé Publique du Québec, Quebec\'s provincial public health and reference laboratory.
    RESULTS: All 8 cases occurred in immunocompetent children. Clinical features on presentation were chronic tympanostomy tube otorrhea with abundant granulation tissue in 7 cases. CT scan demonstrated coalescent mastoiditis in 3 cases. The median delay between initial presentation and identification of nontuberculous mycobacteria was 81 days. Seven patients had a Mycobacterium (M.) abscessus complex infection. Treatment consisted of weekly microscopic granulation debridement, a combined systemic antibiotic therapy for an average duration of 21 weeks, as well as instillation of boric acid into the middle ear. While 3 cases required at least one mastoidectomy, 2 cases were treated only medically.
    CONCLUSIONS: Nontuberculous mycobacteria otitis media is a rare clinical entity, for which high clinical suspicion and specific microbiological analyses could minimize diagnostic delay. The use of boric acid as a desiccating agent may allow for a better local control.
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  • 文章类型: Case Reports
    我们报告了一例罕见的由kansasii分枝杆菌引起的Brodie脓肿(M.kansasii)。我们的患者是一名39岁的男性,在新诊断为HIV感染后一个月出现右脚疼痛。做了X线和MRI检查,并确诊Brodie的脓肿。进行了手术清创,五周后,骨骼培养物生长。Brodie脓肿是一种亚急性骨髓炎,通常由葡萄球菌引起。一些病例报告中还涉及其他一些细菌。据我们所知,这是Brodie\的第一例由M.kansasii引起的脓肿。KansasiiM.是引起免疫受损宿主感染的非典型分枝杆菌,如CD4计数低的HIV患者。与我们的病例一样,KansasiiM.通常与肺部感染有关,并伴有罕见的肺外表现。
    We report a rare case of Brodie\'s abscess caused by Mycobacterium kansasii (M. kansasii). Our patient is a 39-year-old male who presented with right foot pain a month after a new diagnosis of HIV infection. X-ray and MRI were done, and the diagnosis of Brodie\'s abscess was confirmed. Surgical debridement was done, and bone cultures grew M. kansasii after five weeks. Brodie\'s abscess is a subacute form of osteomyelitis usually caused by Staphylococcus. Some other bacteria have been implicated in several case reports. To best of our knowledge, this is the first case of Brodie\'s abscess caused by M. kansasii. M. kansasii is the atypical mycobacteria causing infections in immunocompromised hosts as in HIV patients with low CD4 count. M. kansasii is usually associated with lung infections with rare extrapulmonary manifestations as in our case.
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