Marinum分枝杆菌是一种普遍存在的水性非结核分枝杆菌(NTM)病原体。在人类中,M.marinum感染是通过直接接种皮肤伤口而获得的,并且几乎完全局限于皮肤和软组织。marinum分枝杆菌肺部感染极为罕见,根据我们的知识,侵袭性支气管疾病尚未见报道。这里,我们介绍了一例71岁的免疫功能正常的男性冲浪者,患有侵袭性气管内分枝杆菌肉芽肿病。患者通过阿奇霉素250mg/天的方案成功治愈,乙胺丁醇900毫克(15毫克/千克)每天和利福平600毫克每天培养转化后12个月。这个案例突出了几个重要的概念:首先,M.marinum感染,包括侵袭性支气管感染,应被认为是NTM肺部疾病的罕见原因。其次,通过这种选择的治疗方案可以成功根除气管内感染。最后,该患者不存在M.marinum皮肤或软组织感染,增加了人类疾病也可能是通过在罕见情况下吸入M.marinum污染的水而获得的可能性。
Mycobacterium marinum is a ubiquitous water-borne non-tuberculous mycobacterial (NTM) pathogen. In humans, M. marinum infections are acquired through direct inoculation of skin wounds and are almost exclusively localized to skin and soft tissues. Pulmonary infection with M. marinum is extremely rare, and to our knowledge, invasive endobronchial disease has not been reported. Here, we present a case of a 71-year-old immunocompetent male surfer with invasive endotracheal M. marinum granulomatous disease. The patient was successfully cured with a regimen of azithromycin 250 mg daily, ethambutol 900 mg (15 mg/kg) daily and rifampicin 600 mg daily for 12 months following culture conversion. This case highlights several important concepts: Firstly, M. marinum infection, including invasive endobronchial infection, should be considered a rare cause of NTM pulmonary disease. Secondly, endotracheal infection can be successfully eradicated with this selected therapeutic regimen. Finally, the absence of M. marinum skin or soft-tissue infection in this patient, raises the possibility that human disease might also be acquired via inhalation of M. marinum contaminated water in rare circumstances.