关键词: 分枝杆菌,结核, 分枝杆菌,非典型性, 综述文献(主题), 误诊

Abstract:

Objective: To report the clinical diagnosis and treatment of a patient with Mycobacterium asiaticum pulmonary disease, and to analyze the clinical features, imaging characteristics, and prognosis of the disease in conjunction with a review of the literature. Methods: From January 1971 to September 2019, we searched, 27 relevant literatures were retrieved from PubMed database with “Mycobacterium asiaticum” as the searching term, of which only 7 cases were Mycobacterium asiaticum pulmonary disease cases. “Mycobacterium asiaticum, pulmonary disease” as the search term, no relevant literature was found in both Wanfang database and CNKI database. We summarized the characteristics of our patient and reviewed the literature of the selected cases. Results: Our patient with Mycobacterium asiaticum pulmonary disease was a middle-aged woman with structural pulmonary disease, with cough and sputum as the main complaints, bronchial dilatation and cavitation as the main image manifestations. Sputum and bronchoalveolar lavage fluid were positive for acid-fast staining and mycobacterial culture. DNA microarray chip method identified all as Mycobacterium tuberculosis complex, and they were resistant to rifampicin, isoniazid, levofloxacin, and bedaquiline. However, negative IGRA, and negative sputum/bronchoalveolar lavage fluid (BALF) TB-RNA and TB-DNA, and negative Mycobacterium tuberculosis molecular drug resistance detection (INH, RFP; probe melting curve method). BALF tNGS results suggested a clinical diagnosis of Mycobacterium asiaticum pulmonary disease. After treatment with anti-non-tuberculous mycobacterium drugs, the patient’s respiratory symptoms were relieved after 8 months of treatment, the lesion improved, and mycobacterial culture of sputum and BALF turned negative, indicating effective treatment. In the other 7 cases, there were 4 cases complicated with structural lung disease and 1 case complicated with tumor (no treatment was started). The lung lesions were mainly nodules and cavities formed, and there were differences in treatment plans. Finally, 3 cases achieved clinical cure after more than 1 year of treatment, 2 cases showed improvement in clinical symptoms and imaging (including 1 case achieved bacteriological negative conversion), and 1 case relapsed. Conclusion: Reports on Mycobacterium asiaticum pulmonary disease are scarce, and the clinical manifestations are atypical and easily misdiagnosed. In patients with positive acid-fast staining and mycobacterial culture and mycobacterial identification suggestive of the Mycobacterium tuberculosis complex but negative for TB-RNA and TB-DNA, it is important to consider non-tuberculous mycobacterial pulmonary disease. The tNGS test aids in clinical diagnosis and should be emphasized by clinicians.

Key words: Mycobacterium tuberculosis, Mycobacterium, atypical, Review literature as topic, Misdiagnose