关键词: 分枝杆菌感染,非典型性, 分枝杆菌,龟亚科, 疾病特征, 诊断技术和方法, 药物疗法,联合, 结果与过程评价(卫生保健)

Abstract:

Objective To investigate the pathogenic characteristics of Mycobacterium abscess, helping clinicians to improve the awareness of the disease and the level of diagnosis and treatment. Methods The clinical data, diagnosis and treatment, as well as follow-up and prognosis of a multisystemic disseminated infection in a patient caused by Mycobacterium abscess admitted to the Third People’s Hospital of Kunming on June 9, 2018 were reviewed. Results The patient visited the People’s Hospital of Lancang County in July 2017 with the chief complaint of fever and cough for more than one month. Then, the patient was transferred to the People’s Hospital of Pu’er County because of two-week ineffective anti-pulmonary infection treatment for, and was treated with “tuberculosis” diagnostic anti-tuberculosis drugs until December, 2017. The symptoms of cough and fever were relieved. However, on December 20th, 2017, the patient was admitted to the Pu’er City People’s Hospital because that fever and cough suddenly worsened with chest tighness, and continued to be treated with anti-tuberculosis and anti-infective treatment based on the diagnosis of pulmonary tuberculosis complicated with pulmonary infection. One month later, the patient was transferred to an affiliated hospital of Kunming Medical University due to poor effect, however, the condition did not improve after treatment. On February 14, 2018, the patient returned to the original residence, and received intermittent anti-infection and symptomatic treatment in the outpatient clinic of the local hospital. On May 8, the patient was admitted to a tumor hospital in Yunnan Province due to the aggravation of the condition and the swollen right cervical lymph node. No malignant cells were detected in the pathological examination of the lymph node specimen, therefore, the possibility of “drug-resistant tuberculosis” was considered. On June 9, the patient was transferred to our hospital. After blood culture, lymph node pus culture, and 22 molecular diagnostic tests for mycobacterium in alveolar lavage fluid, Mycobacterium abscess was identified. After 40-day combination therapy of linezolid, moxifloxacin, clofazimine, amikacin and clarithromycin, the condition was improved. The patient discharged from our hospital, and the follow-up showed a good prognosis. Conclusion If repeatedly positive in acid-fast bacilli test was found in patients with suspected tuberculosis, and the effect of diagnostic anti-tuberculosis treatment was poor, in addition to considering the possibility of drug-resistant tuberculosis, new molecular biology tests should be activety performed to exclude NTM disease, to improve the diagnostic rate and cure rate.

Key words: Mycobacterium infections,atypical, Mycobacterium chelonae, Disease characteristics, Diagnostic techniques and procedures, Drug therapy,combination, Outcome and process assessment (health care)