BACKGROUND Musculoskeletal nontuberculous Mycobacterium(NTM)infections are rare,partic-ularly post-acupuncture therapy,and present diagnostic challenges due to their infrequency and potential severity.Prompt recogniti...BACKGROUND Musculoskeletal nontuberculous Mycobacterium(NTM)infections are rare,partic-ularly post-acupuncture therapy,and present diagnostic challenges due to their infrequency and potential severity.Prompt recognition and appropriate manage-ment are crucial for optimal outcomes.NTM-infected wounds involving the joints are difficult to treat,and only a few cases have been reported.CASE SUMMARY We present a case of a chronic intractable NTM-infected wound on the elbow joint that completely healed with conservative wound care and antibiotic treatment.An 81-year-old woman presented with a chronic,ulcerative wound on the right elbow joint where she had undergone repeated acupuncture therapy for chronic intolerable pain.Magnetic resonance imaging revealed synovial thickening,effusion,and subcutaneous cystic lesions.An orthopedic surgeon performed open synovectomy and serial debridement.However,1 month postoperatively,the wound had not healed and became chronic.A wound culture revealed NTM(Mycobacterium abscessus),and the patient was referred to the Department of Plastic and Reconstructive Surgery.Instead of surgical intervention,conservative wound care with intravenous antibiotics was provided,considering the wound status and the patient’s poor general condition.Complete wound healing was achieved in 12 months,with no impact on the range of motion of the elbow joint.CONCLUSION With clinical awareness,musculoskeletal NTM infection can be treated with conservative wound care and appropriate antimicrobial agents.展开更多
Goal of this study was to analyse the clinical course of cystic fibrosis (CF) patients with nontuberculous mycobacteria (NTM) in their respiratory secretions and to investigate the molecular epidemiology of the most p...Goal of this study was to analyse the clinical course of cystic fibrosis (CF) patients with nontuberculous mycobacteria (NTM) in their respiratory secretions and to investigate the molecular epidemiology of the most prevalent NTM species by multilocus sequence analysis (MLSA). The respiratory specimen and the clinical parameters forced expiratory volume in one second (FEV1), body-mass-index (BMI), erythrocyte sedimentation rate (ESR) 1 h and immunoglobulin G (IgG) of 357 CF patients, 0 - 52.4 years, mean FEV1 2009 81.5% pred were analysed between 1998 and 2010. In 13 patients NTM were detected. 12 of 13 patients carried M. abscessus, for one patient the NTM species was not characterized. 4 patients carried a second NTM species (M. avium, M. chelonae (2x), M. intracellulare). 6 patients exhibited a significant decline in FEV1, however changes in BMI, IgG and ESR were discordant. Molecular genotyping of M. abscessus isolates revealed a unique MLSA pattern in 6 patients. 2 patients harboured identical strains, and one patient a closely related strain. Whether the presence of identical strains is attributed to the acquisition of NTM clones from common environmental sources or to patient-to-patient transmission cannot be definitely clarified. Although cross-in- fection of the three patients with identical/closely related strains in the present cohort is highly unlikely, we recommend strict hygiene measures for all CF patients harbouring NTM.展开更多
We report two cases of pulmonary sequestration infected with nontuberculous mycobacteria(NTM): Mycobacterium avium and Mycobacterium abscessus.Chest computed tomography showed pneumonic consolidation in the right lowe...We report two cases of pulmonary sequestration infected with nontuberculous mycobacteria(NTM): Mycobacterium avium and Mycobacterium abscessus.Chest computed tomography showed pneumonic consolidation in the right lower lobe,which received a systemic blood supply from the descending aorta in both patients.Video-assisted thoracoscopic surgeries were successfully performed and pathologica]examinations revealed multiple caseating granulomas.A review of the literature revealed only seven previous case reports of pulmonary sequestration infected with NTM,and no case with Mycobacterium abscessus has been reported.展开更多
Background: Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by the presence of gas in the intestinal wall. Aim: We report two rare cases of PCI that are complicated during the chemotherapy for...Background: Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by the presence of gas in the intestinal wall. Aim: We report two rare cases of PCI that are complicated during the chemotherapy for pulmonary nontuberculous mycobacterial (NTM) disease. Case Presentation: In this report, we described two cases (a 72-year-old woman and a 60-year-old woman) of PCI that appeared during the combined chemotherapy consisting of rifampicin, ethambutol and clarithromycin. Because there were few clinical symptoms and increased inflammatory responses, the diagnosis of PCI was delayed. However, there were fortunately no severe complications in both cases. Conclusion: Respiratory physicians should be aware of the potential development of PCI in patients during the chemotherapy for pulmonary NTM disease. It is important to detect PCI in the early stage through radiological examinations to avoid severe complications.展开更多
Introduction: The objective of this study was the estimation of the clinical characteristics of patients with pulmonary nontuberculous mycobacterial (NTM) disease complicated by lung cancer during the follow-up period...Introduction: The objective of this study was the estimation of the clinical characteristics of patients with pulmonary nontuberculous mycobacterial (NTM) disease complicated by lung cancer during the follow-up periods. Methods: We analyzed the clinical findings of four patients (2.0%) complicated by lung cancer during the follow-up periods of over six months at least after the definite diagnosis of pulmonary NTM disease of 202 patients with pulmonary NTM disease experienced in our hospital in the last decade. Results: There were four patients with pulmonary NTM disease complicated by lung cancer and all of them were caused by Mycobacterium avium complex (MAC). They were all elderly male patients and had underlying diseases. Three patients were diagnosed with primary lung cancer and one diagnosed with metastatic lung cancer from colon cancer within 3 years after the diagnosis of pulmonary NTM disease. The treatments for lung cancer were surgical resection for all patients with localized lesions. One patient died due to the worsening of underlying disease and the remaining three survived except for the recurrence of one patient. Conclusion: Although the complication rate of pulmonary NTM disease and lung cancer was a lower percentage (2.0%) than in previous reports, the careful follow-up for patients with pulmonary NTM disease without forgetting the possible complication of lung cancer is necessary.展开更多
Objective This study aimed to explore the diagnostic value of novel technique-targeted next-generation sequencing(tNGS)of bronchoalveolar lavage fluid(BALF)in pulmonary mycobacterial infections.Methods This retrospect...Objective This study aimed to explore the diagnostic value of novel technique-targeted next-generation sequencing(tNGS)of bronchoalveolar lavage fluid(BALF)in pulmonary mycobacterial infections.Methods This retrospective study was conducted on patients who underwent bronchoscopy and tNGS,smear microscopy,and mycobacterial culture of BALF.Patients with positive Mycobacterium tuberculosis(MTB)culture or GeneXpert results were classified into the tuberculosis case group.Those diagnosed with nontuberculous mycobacteria(NTM)-pulmonary disease(NTM-PD)composed the case group of NTM-PD patients.The control group comprised patients without tuberculosis or NTM-PD.Sensitivity,specificity,and receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance.Results For tuberculosis patients with positive mycobacterial culture results,the areas under the ROC curves(AUCs)for tNGS,GeneXpert,and smear microscopy were 0.975(95%CI:0.935,1.000),0.925(95%CI:0.859,0.991),and 0.675(95%CI:0.563,0.787),respectively.For tuberculosis patients with positive GeneXpert results,the AUCs of tNGS,culture,and smear microscopy were 0.970(95%CI:0.931,1.000),0.850(95%CI:0.770,0.930),and 0.680(95%CI:0.579,0.781),respectively.For NTM-PD,the AUCs of tNGS,culture,and smear-positive but GeneXpert-negative results were 0.987(95%CI:0.967,1.000),0.750(95%CI:0.622,0.878),and 0.615(95%CI:0.479,0.752),respectively.The sensitivity and specificity of tNGS in NTM-PD patients were 100%and 97.5%,respectively.Conclusion tNGS demonstrated superior diagnostic efficacy in mycobacterial infection,indicating its potential for clinical application.展开更多
We report an unusual manifestation of nontuberculous mycobacterial infection characterized by a giant bursitis on wrist and multiple tenosynovitis with many rice bodies formations. The clinical and radiological examin...We report an unusual manifestation of nontuberculous mycobacterial infection characterized by a giant bursitis on wrist and multiple tenosynovitis with many rice bodies formations. The clinical and radiological examinations are neither rather sensitive nor rather specific. The nuclear imagery of rice bodies formations provides elements of guidance. Cause of absence of the germ isolation, diagnosis was retained on probability items based on a suspicion of arguments beam: clinical, biological, bacteriological and histological. The patient was treated with medical and surgical procedure and provided a satisfactory evolution. At follow-up of 15 months, there were no clinical signs of local recurrence. Through a literature review, the problem of diagnosis of certainty will be discussed.展开更多
The purpose of this study was to assess the value of metagenomic next-generation sequencing(mNGS)for rapid diagnosis of diseases caused by nontuberculous mycobacteria(NTM).We retrospectively reviewed four NTM-infected...The purpose of this study was to assess the value of metagenomic next-generation sequencing(mNGS)for rapid diagnosis of diseases caused by nontuberculous mycobacteria(NTM).We retrospectively reviewed four NTM-infected cases diagnosed by smear microscopy,mycobacterial culture and mNGS methods.We found that the mNGS method not only had a shorter detection turnaround time(3–4 days)than Mycobacterium culture(15–20 days)but also had higher sensitivity and specificity to identify NTM compared with conventional detection methods.In addition,mNGS was able to identify coinfections by NTM and other bacteria,fungi or viruses.Overall,diagnosis of NTM by mNGS can provide timely and precise guidance for subsequent clinical treatment of NTM infections.展开更多
The incidence of Mycobacterium avium complex pulmonary disease (MACPD) has been globally increasing. The present study aims to provide a comprehensive analysis of clinical characteristics and treatment response among ...The incidence of Mycobacterium avium complex pulmonary disease (MACPD) has been globally increasing. The present study aims to provide a comprehensive analysis of clinical characteristics and treatment response among patients in the Amazon region of Brazil and conduct a retrospective cohort study at a prominent referral hospital in the State of Par, Brazil, from 2012 to 2020. The M. avium group represented 58.9% of cases, followed by M. intracellulare (35.7%), M. colombiense (3.6%), and M. chimaera (1.8%). The majority of patients (73.2%) were female and with an average age of 63 years. Primary clinical manifestations included persistent cough and sputum production. The Charlson comorbidity index (CCI) averaged 2.47, with 36.3% of patients having a CCI score equal to higher than 3. Notably, over 70% of patients had received treatment for pulmonary tuberculosis before initiating treatment for MAC infection. The fibrocavitary radiologic form was the most prevalent (55.4%), frequently exhibiting a bilateral distribution (53.6%). Antimicrobial susceptibility revealed a significant prevalence of MAC resistance to drugs in the therapeutic regimen. Despite this, most of the patients experienced clinical improvement (50%). In conclusion, this study highlights a higher prevalence of MAC infections among middle-aged women, with a history of pulmonary tuberculosis treatment and presenting the fibrocavitary radiological form was predominant.展开更多
文摘BACKGROUND Musculoskeletal nontuberculous Mycobacterium(NTM)infections are rare,partic-ularly post-acupuncture therapy,and present diagnostic challenges due to their infrequency and potential severity.Prompt recognition and appropriate manage-ment are crucial for optimal outcomes.NTM-infected wounds involving the joints are difficult to treat,and only a few cases have been reported.CASE SUMMARY We present a case of a chronic intractable NTM-infected wound on the elbow joint that completely healed with conservative wound care and antibiotic treatment.An 81-year-old woman presented with a chronic,ulcerative wound on the right elbow joint where she had undergone repeated acupuncture therapy for chronic intolerable pain.Magnetic resonance imaging revealed synovial thickening,effusion,and subcutaneous cystic lesions.An orthopedic surgeon performed open synovectomy and serial debridement.However,1 month postoperatively,the wound had not healed and became chronic.A wound culture revealed NTM(Mycobacterium abscessus),and the patient was referred to the Department of Plastic and Reconstructive Surgery.Instead of surgical intervention,conservative wound care with intravenous antibiotics was provided,considering the wound status and the patient’s poor general condition.Complete wound healing was achieved in 12 months,with no impact on the range of motion of the elbow joint.CONCLUSION With clinical awareness,musculoskeletal NTM infection can be treated with conservative wound care and appropriate antimicrobial agents.
文摘Goal of this study was to analyse the clinical course of cystic fibrosis (CF) patients with nontuberculous mycobacteria (NTM) in their respiratory secretions and to investigate the molecular epidemiology of the most prevalent NTM species by multilocus sequence analysis (MLSA). The respiratory specimen and the clinical parameters forced expiratory volume in one second (FEV1), body-mass-index (BMI), erythrocyte sedimentation rate (ESR) 1 h and immunoglobulin G (IgG) of 357 CF patients, 0 - 52.4 years, mean FEV1 2009 81.5% pred were analysed between 1998 and 2010. In 13 patients NTM were detected. 12 of 13 patients carried M. abscessus, for one patient the NTM species was not characterized. 4 patients carried a second NTM species (M. avium, M. chelonae (2x), M. intracellulare). 6 patients exhibited a significant decline in FEV1, however changes in BMI, IgG and ESR were discordant. Molecular genotyping of M. abscessus isolates revealed a unique MLSA pattern in 6 patients. 2 patients harboured identical strains, and one patient a closely related strain. Whether the presence of identical strains is attributed to the acquisition of NTM clones from common environmental sources or to patient-to-patient transmission cannot be definitely clarified. Although cross-in- fection of the three patients with identical/closely related strains in the present cohort is highly unlikely, we recommend strict hygiene measures for all CF patients harbouring NTM.
基金supported by Mid-career Researcher Program through NRF grant funded by the MEST(2011-0015546)
文摘We report two cases of pulmonary sequestration infected with nontuberculous mycobacteria(NTM): Mycobacterium avium and Mycobacterium abscessus.Chest computed tomography showed pneumonic consolidation in the right lower lobe,which received a systemic blood supply from the descending aorta in both patients.Video-assisted thoracoscopic surgeries were successfully performed and pathologica]examinations revealed multiple caseating granulomas.A review of the literature revealed only seven previous case reports of pulmonary sequestration infected with NTM,and no case with Mycobacterium abscessus has been reported.
文摘Background: Pneumatosis cystoides intestinalis (PCI) is a rare disease characterized by the presence of gas in the intestinal wall. Aim: We report two rare cases of PCI that are complicated during the chemotherapy for pulmonary nontuberculous mycobacterial (NTM) disease. Case Presentation: In this report, we described two cases (a 72-year-old woman and a 60-year-old woman) of PCI that appeared during the combined chemotherapy consisting of rifampicin, ethambutol and clarithromycin. Because there were few clinical symptoms and increased inflammatory responses, the diagnosis of PCI was delayed. However, there were fortunately no severe complications in both cases. Conclusion: Respiratory physicians should be aware of the potential development of PCI in patients during the chemotherapy for pulmonary NTM disease. It is important to detect PCI in the early stage through radiological examinations to avoid severe complications.
文摘Introduction: The objective of this study was the estimation of the clinical characteristics of patients with pulmonary nontuberculous mycobacterial (NTM) disease complicated by lung cancer during the follow-up periods. Methods: We analyzed the clinical findings of four patients (2.0%) complicated by lung cancer during the follow-up periods of over six months at least after the definite diagnosis of pulmonary NTM disease of 202 patients with pulmonary NTM disease experienced in our hospital in the last decade. Results: There were four patients with pulmonary NTM disease complicated by lung cancer and all of them were caused by Mycobacterium avium complex (MAC). They were all elderly male patients and had underlying diseases. Three patients were diagnosed with primary lung cancer and one diagnosed with metastatic lung cancer from colon cancer within 3 years after the diagnosis of pulmonary NTM disease. The treatments for lung cancer were surgical resection for all patients with localized lesions. One patient died due to the worsening of underlying disease and the remaining three survived except for the recurrence of one patient. Conclusion: Although the complication rate of pulmonary NTM disease and lung cancer was a lower percentage (2.0%) than in previous reports, the careful follow-up for patients with pulmonary NTM disease without forgetting the possible complication of lung cancer is necessary.
文摘Objective This study aimed to explore the diagnostic value of novel technique-targeted next-generation sequencing(tNGS)of bronchoalveolar lavage fluid(BALF)in pulmonary mycobacterial infections.Methods This retrospective study was conducted on patients who underwent bronchoscopy and tNGS,smear microscopy,and mycobacterial culture of BALF.Patients with positive Mycobacterium tuberculosis(MTB)culture or GeneXpert results were classified into the tuberculosis case group.Those diagnosed with nontuberculous mycobacteria(NTM)-pulmonary disease(NTM-PD)composed the case group of NTM-PD patients.The control group comprised patients without tuberculosis or NTM-PD.Sensitivity,specificity,and receiver operating characteristic(ROC)curves were used to evaluate the diagnostic performance.Results For tuberculosis patients with positive mycobacterial culture results,the areas under the ROC curves(AUCs)for tNGS,GeneXpert,and smear microscopy were 0.975(95%CI:0.935,1.000),0.925(95%CI:0.859,0.991),and 0.675(95%CI:0.563,0.787),respectively.For tuberculosis patients with positive GeneXpert results,the AUCs of tNGS,culture,and smear microscopy were 0.970(95%CI:0.931,1.000),0.850(95%CI:0.770,0.930),and 0.680(95%CI:0.579,0.781),respectively.For NTM-PD,the AUCs of tNGS,culture,and smear-positive but GeneXpert-negative results were 0.987(95%CI:0.967,1.000),0.750(95%CI:0.622,0.878),and 0.615(95%CI:0.479,0.752),respectively.The sensitivity and specificity of tNGS in NTM-PD patients were 100%and 97.5%,respectively.Conclusion tNGS demonstrated superior diagnostic efficacy in mycobacterial infection,indicating its potential for clinical application.
文摘We report an unusual manifestation of nontuberculous mycobacterial infection characterized by a giant bursitis on wrist and multiple tenosynovitis with many rice bodies formations. The clinical and radiological examinations are neither rather sensitive nor rather specific. The nuclear imagery of rice bodies formations provides elements of guidance. Cause of absence of the germ isolation, diagnosis was retained on probability items based on a suspicion of arguments beam: clinical, biological, bacteriological and histological. The patient was treated with medical and surgical procedure and provided a satisfactory evolution. At follow-up of 15 months, there were no clinical signs of local recurrence. Through a literature review, the problem of diagnosis of certainty will be discussed.
基金the Science&Technology Key Program of Zhejiang China(2017C03051)Key Research and Development Program of Zhejiang Province(2020c03123-1).
文摘The purpose of this study was to assess the value of metagenomic next-generation sequencing(mNGS)for rapid diagnosis of diseases caused by nontuberculous mycobacteria(NTM).We retrospectively reviewed four NTM-infected cases diagnosed by smear microscopy,mycobacterial culture and mNGS methods.We found that the mNGS method not only had a shorter detection turnaround time(3–4 days)than Mycobacterium culture(15–20 days)but also had higher sensitivity and specificity to identify NTM compared with conventional detection methods.In addition,mNGS was able to identify coinfections by NTM and other bacteria,fungi or viruses.Overall,diagnosis of NTM by mNGS can provide timely and precise guidance for subsequent clinical treatment of NTM infections.
文摘The incidence of Mycobacterium avium complex pulmonary disease (MACPD) has been globally increasing. The present study aims to provide a comprehensive analysis of clinical characteristics and treatment response among patients in the Amazon region of Brazil and conduct a retrospective cohort study at a prominent referral hospital in the State of Par, Brazil, from 2012 to 2020. The M. avium group represented 58.9% of cases, followed by M. intracellulare (35.7%), M. colombiense (3.6%), and M. chimaera (1.8%). The majority of patients (73.2%) were female and with an average age of 63 years. Primary clinical manifestations included persistent cough and sputum production. The Charlson comorbidity index (CCI) averaged 2.47, with 36.3% of patients having a CCI score equal to higher than 3. Notably, over 70% of patients had received treatment for pulmonary tuberculosis before initiating treatment for MAC infection. The fibrocavitary radiologic form was the most prevalent (55.4%), frequently exhibiting a bilateral distribution (53.6%). Antimicrobial susceptibility revealed a significant prevalence of MAC resistance to drugs in the therapeutic regimen. Despite this, most of the patients experienced clinical improvement (50%). In conclusion, this study highlights a higher prevalence of MAC infections among middle-aged women, with a history of pulmonary tuberculosis treatment and presenting the fibrocavitary radiological form was predominant.
