关键词: 分枝杆菌, 非典型性, 耳鼻咽喉疾病, 疾病特征, 微生物敏感性试验, 治疗结果

Abstract:

Objective To analyze the clinical characteristics, therapeutic schemes and treatment effects of non-tuberculosis mycobacteria (NTM) diseases concerning eyes, ears, nose and throat (EENT). Methods Retrospective analysis on clinical data of 18 patients diagnosed with NTM diseases concerning EENT from January 2010 to January 2013 in Guangzhou Chest Hospital was performed, including five cases with cornea NTM, six with auris media NTM, two with nasopharynx NTM and the rest five with larynx NTM. Summary analysis was carried out based on the detailed record of strain identification, drug sensitivity results, clinical characteristics, therapeutic schemes and treatment effects. Results Patients with cornea NTM were mainly characterized with the clinical manifestation of corneal ulcers, those with auris media NTM were primarily accompanied by tympanic membrane perforation and purulent discharge, and the rest with nasopharynx NTM and larynx NTM mainly presented with neoformations, local ulcers and increasing secretions in nasopharynx and larynx. A total of 39 NTM strains were isolated from the secretions of 18 patients, of which 9, 7 and 2 were Mycobacterium chelonae-abscessus complex, Mycobacterium avium-intracellulare complex and Mycobacterium fortuitum, respectively. Result of drug sensitivity indicated that the strains were resistant to isoniazide, rifampicin, ethambutol, streptomycin, levofloxacin, moxifloxacin, pasiniazid, rifabutin, protionamide, capreomycin and ciprofloxacin. Oral treatment was performed with levofloxacin or moxifloxacin, amikacin sulfate, clarithromycin sustained release tablets, clindamycin palmitate hydrochloride dispersible tablets and ethambutol, and local therapy was also performed with macrocyclic lipids and aminoglycosides according to the drug sensitivity. All the 18 patients finally got better with symptoms disappearing and lesion sites healing. Conclusion Most NTM diseases concerning EENT had resistance to the antituberculosis drugs. In light of the characteristics and treatment effects of lesion sites, local application of amikacin sulfate was adopted accordingly before the drug sensitivity result. When the result was obtained, a good treatment effect could be achieved by systemic medication and local therapy with sensitive drugs.

Key words: Mycobacteria, atypical, Otorhinolaryngologic diseases, Disease attributes, Microbial sensitivity tests, Treatment outcome