经验性治疗肝移植术后非结核分枝杆菌感染1例附文献复习

毛家玺; 邹游; 郭闻渊

doi:10.3969/j.issn.1674-7445.2017.03.009

经验性治疗肝移植术后非结核分枝杆菌感染1例附文献复习

doi: 10.3969/j.issn.1674-7445.2017.03.009

200003　上海，第二军医大学附属长征医院器官移植中心

基金项目:

国家自然科学基金面上项目 31370896

详细信息

通讯作者:
郭闻渊，Email：guowenyuan@medmail.com.cn

中图分类号: R617, R378.91
计量
- 文章访问数: 207
- HTML全文浏览量: 93
- PDF下载量: 10
- 被引次数: 0
出版历程
- 收稿日期: 2017-02-10
- 网络出版日期: 2021-01-19
- 刊出日期: 2017-05-15

Empirical treatment of nontuberculosis mycobacterium infection after liver transplantation: one case report and literature

Department of Liver Transplantation, Changzheng Hospital of Second Military Medical University, Shanghai 200003, China

More Information

Corresponding author: Guo Wenyuan, Email: guowenyuan@medmail.com.cn

摘要

摘要: 目的总结肝移植术后非结核分枝杆菌（NTM）感染的诊疗经验。方法对第二军医大学附属长征医院收治的1例肝移植术后NTM成功经验性治疗病例进行研究分析，并对相关文献进行回顾。结果 1例肝移植术后7个月NTM感染患者，临床表现以午后发热为主，动态CT检查提示病情进展时右肺下叶基底段内病灶扩大融合且出现薄壁空洞。采用纤维支气管镜检查（刷检或灌洗）、结核分枝杆菌感染T细胞免疫斑点试验（T-SPOT.TB）、多次痰培养及经验性抗结核治疗支持NTM感染的诊断。该患者诊断性四联抗结核治疗有效，治愈后出院。随访持续至投稿日，患者病情平稳，无再次出现发热、咳喘症状，肝功能正常。结论肝移植术后NTM感染罕见但不可忽视，纤维支气管镜刷检或灌洗可提高阳性发现率，诊断性四联抗结核治疗有效。
- 肝移植 /
- 后感染 /
- 非结核分枝杆菌 /
- 结核分枝杆菌感染T细胞免疫斑点试验(T-SPOT.TB) /
- 纤维支气管镜 /
- 抗酸染色 /
- 痰培养
Abstract: Objective To summarize the clinical experience of diagnosis and treatment of nontuberculosis mycobacterium (NTM) infection after liver transplantation. Methods Clinical experience of effective treatment of 1 case with NTM at 7th month after liver transplantation at the Shanghai Changzheng Hospital affiliated to the Second Military Medical University was summarized and literature review was performed. Results Following liver transplantation, the NTM patient was clinically manifested with fever in the afternoon. CT scan prompted the progression of the disease. The lesions were enlarged and fused with thin-walled cavity in the right upper lung. The diagnosis of NTM infection was validated by fiberoptic bronchoscopy (brush or lavage approach), spot test of T cells infected with mycobacterium tuberculosis (T-SPOT.TB), multiple phlegm culture and empirical anti-tuberculosis therapy. The patient was effectively treated and successfully discharged after diagnostic quadruple anti-tuberculosis therapy. The patient was followed up until the day of manuscript submission. The patient was physically stable without the symptoms of fever and cough with asthma. The liver function was normal. Conclusions The incidence of NTM infection is rare and inneglectable after liver transplantation. Application of fibrobronchoscopy via brush or lavage approach can enhance the positive diagnostic rate. Diagnostic quadruple anti-tuberculosis therapy is efficacious for NTM infection.
- Liver transplantation /
- Postoperative infection /
- Nontuberculosis mycobacterium /
- Spot test of T cells infected with mycobacterium tuberculosis (T-SPOT.TB) /
- Fibrobronchoscopy /
- Acid-fast stain /
- Phlegm culture

HTML全文

图 1 本例肝移植术后NTM患者入院后第1日的X线胸片

Figure 1. X-ray on the patients with NTM after liver transplantation at the first day after admission

下载: 全尺寸图片幻灯片

图 2 本例肝移植术后NTM患者的胸部CT图片

A、B图为第1次胸部CT（d4）；C、D图为第2次胸部CT（d12）；E、F图为第3次胸部CT（d16）；G、H图为第4次胸部CT（d27）；I、J图为第5次胸部CT（d41）；K、L图为第6次胸部CT（d49）；M、N图为第7次胸部CT（d57）

Figure 2. Chest CT image of the patient with NTM after liver transplantation

下载: 全尺寸图片幻灯片

参考文献(10)

[1]	Doucette K, Fishman JA. Nontuberculous mycobacterial infection in hematopoietic stem cell and solid organ transplant recipients[J]. Clin Infect Dis, 2004, 38(10):1428-1439. DOI: 10.1086/420746.
[2]	Longworth SA, Vinnard C, Lee I, et al. Risk factors for nontuberculous mycobacterial infections in solid organ transplant recipients: a case-control study[J]. Transpl Infect Dis, 2014, 16(1):76-83. DOI: 10.1111/tid.12170.
[3]	Maybrook RJ, Campsen J, Wachs ME, et al. A case of mycobacterium mucogenicum infection in a liver transplant recipient and a review of the literature[J]. Transpl Infect Dis, 2013, 15(6):E260-E263. DOI: 10.1111/tid.12154.
[4]	Singhal A, Gates C, Malhotra N, et al. Successful management of primary nontuberculous mycobacterial infection of hepatic allograft following orthotopic liver transplantation for hepatitis C[J]. Transpl Infect Dis, 2011, 13(1):47-51. DOI: 10.1111/j.1399-3062.2010.00521.x.
[5]	杨美芳, 俞海英, 吴炜, 等. 肝移植术后非结核分枝杆菌感染2例并文献复习[C]. 浙江省医学会结核病学分会第一届学术年会论文汇编, 2015: 183-185. Yang MF, Yu HY, Wu W, et al. Non tuberculous mycobacterial infection after liver transplantation: a report of 2 cases and literature review[C]. First Academic Conference Proceedings of Tuberculosis Section in Zhejiang Province Medical Association, 2015:183-185.
[6]	周先志.器官移植患者中非结核分枝杆菌的感染[J].传染病信息, 1994, 7(4):151. http://www.cnki.com.cn/Article/CJFDTOTAL-CRBX199404031.htm Zhou XZ. Infection of non tuberculous mycobacteria in organ transplant recipients[J]. Infect Dis Inform, 1994, 7(4):151. http://www.cnki.com.cn/Article/CJFDTOTAL-CRBX199404031.htm
[7]	Han YM, Kim HS, Kim CH, et al. Analysis of patients with positive acid-fast bacilli culture and negative T-SPOT. TB results[J]. Korean J Lab Med, 2010, 30(4):414-419. DOI: 10.3343/kjlm.2010.30.4.414.
[8]	段新亚. 48例非结核分枝杆菌肺病的临床分析[J].云南医药, 2016, 37(4): 445-447. http://cpfd.cnki.com.cn/Article/CPFDTOTAL-ZGFN201008001052.htm Duan XY. Clinical analysis of 48 cases with non tuberculous mycobacterial lung disease[J]. Med Pharm Yunnan, 2016, 37(4): 445-447. http://cpfd.cnki.com.cn/Article/CPFDTOTAL-ZGFN201008001052.htm
[9]	吴海峰, 张辉, 王艳彬, 等.非结核分枝杆菌快速药敏试验研究[J].医学动物防制, 2014, 30(6):591-593. DOI: 10.7629/yxdwfz201406001. Wu HF, Zhang H, Wang YB, et al. Rapid drug susceptibility experimental research on nontuberculosis mycobacteria[J]. J Med Pest Control, 2014, 30(6):591-593. DOI: 10.7629/yxdwfz201406001.
[10]	董波, 王冕.非结核分枝杆菌肺病与肺结核临床特征对比分析[J].现代实用医学, 2016, 28(4): 546-547. DOI: 10.3969/j.issn.1671-0800.2016.04.070. Dong B, Wang M. Comparative analysis of clinical features of pulmonary tuberculosis and non tuberculous mycobacterial lung disease[J]. Mod Pract Med, 2016, 28(4):546-547. DOI: 10.3969/j.issn.1671-0800.2016.04.070.