Distribution and clinical feathers of 106 patients with non-tuberculous mycobacteria pulmonary diseases in Tianjin

doi:10.11958/20221639

Abstract

Abstract:

Objective To analyze the strain distribution and clinical characteristics of non-tuberculous Mycobacterium (NTM) lung disease patients in Tianjin area, and to provide reference for clinical diagnosis and treatment of NTM lung disease in Tianjin area. Methods A total of 106 patients with NTM pulmonary disease were selected. The distribution of NTM bacteria, the distribution of complications and clinical manifestations of patients and the chest imaging manifestations with different NTM bacteria infection were analyzed. Levels of leukocyte, hemoglobin and serum albumin in patients infected with Mycobacterium intracellular, Mycobacterium chelonabscessus and Mycobacterium kansasii were compared. Results Among 106 patients with NTM lung disease, the top three strains were Mycobacterium intracellular (39.62%, 42/106), Mycobacterium kansasii (23.58%, 25/106) and Mycobacterium chelonabscessus (23.58%, 25/106). The main complications were pulmonary tuberculosis, bronchiectasis, chronic obstructive pulmonary disease and diabetes. Cough and expectoration were the most common clinical manifestations (64.15%, 68/106), followed by fever (35.85%, 38/106), shortness of breath (16.98%, 18/106) and hemoptysis (16.04%, 17/106). The imaging features of 100 patients were mainly exudation, cavity and bronchiectasis. The proportion of pleural effusion in Mycobacterium intracellular infection patients was higher than that in Mycobacterium chelonabscessus infection patients and Mycobacterium kansasii infection patients (P<0.05). The proportion of bronchiectasis was lower in Mycobacterium kansasii infection patients than that in Mycobacterium intracellular infection patients and Mycobacterium chelonabscessus infection patients (P<0.01). The hemoglobin level was lower in patients with mycobacterium intracellular infection than that in patients with Mycobacterium chelonabscessus and Mycobacterium kansasii infection (P<0.05). Albumin level was lower than that in patients with Mycobacterium chelonabscessus infection (P<0.05). Conclusion The prevalent strains of NTM pulmonary disease patients in Tianjin are mainly Mycobacterium intracellular, kansasii and chelonabscessus. Clinical manifestations are mainly cough, expectoration and fever. The imaging manifestations are mainly exudation, cavity and bronchiectasis.

Key words: nontuberculous mycobacteria, mycobacterium kansasii, mycobacterium abscessus, non-tuberculous mycobacteria pulmonary disease, strain identification, clinical feather

CLC Number:

Figures/Tables 3

References 20

[1]	中华医学会结核病学分会. 非结核分枝杆菌病诊断与治疗指南(2020年版)[J]. 中华结核和呼吸杂志, 2020, 43(11):918-946.
	Chinese Society for Tuberculosis, Chinese Medical Association. Guidelines for the diagnosis and treatment of nontuberculous mycobacterial disease(2020)[J]. Chin J Tuberc Respir Dis, 2020, 43(11):918-946. doi:10.3760/cma.j.cn112147-20200508-00570.
[2]	WINTHROP K L, MARRAS T K, ADJEMIAN J, et al. Incidence and prevalence of nontuberculous mycobacterial lung disease in a large United States managed care health plan,2008-2015[J]. Ann Am Thorac Soc, 2020, 17(2):178-185. doi:10.1513/AnnalsATS.201804-236OC.
[3]	LEE H, MYUNG W, KOH W J, et al. Epidemiology of nontuberculous mycobacterial infection,South Korea,2007-2016[J]. Emerg Infect Dis, 2019, 25(3):569-572. doi:10.3201/eid2503.181597.
[4]	全国第五次结核病流行病学抽样调查技术指导组, 全国第五次结核病流行病学抽样调查办公室. 2010年全国第五次结核病流行病学抽样调查报告[J]. 中国防痨杂志, 2012, 34(8):485-508.
	Technical Guidance Group of the Fifth National TB Epidemiological Survey,The Office of the Fifth National TB Epidemiological survey. The fifth tuberculosis epidemiological survey in 2010[J]. Chin J Antituberc, 2012, 34(8):485-508.
[5]	PORVAZNIK I, SOLOVIČ I, MOKRÝ J. Non-tuberculous mycobacteria:Classification,diagnostics,and therapy[J]. Adv Exp Med Biol, 2017, 944:19-25. doi:10.1007/5584_2016_45.
[6]	林建, 林淑芳, 戴志松, 等. 福建省非结核分枝杆菌菌种分布及其流行病学特征初步研究[J]. 中国防痨杂志, 2020, 42(5):518-522.
	LIN J, LIN S F, DAI Z S, et al. Study on the distribution and epidemiological characteristics of non-tuberculous mycobacterium strains in Fujian Province[J]. Chin J Antituberc, 2020, 42(5):518-522. doi:10.3969/j.issn.1000-6621.2020.05.018.
[7]	栗坤, 曹彦, 曹艳龙, 等. 结核病专科非结核分枝杆菌肺病菌种分布及病例特点研究[J]. 中国人兽共患病学报, 2018, 34(12):1137-1141.
	LI K, CAO Y, CAO Y L, et al. Strains and case characteristics of non-tuberculous mycobacterium lung diseases in tuberculosis special department[J]. Chinese Journal of Zoonoses, 2018, 34(12):1137-1141. doi:10.3969/j.issn.1002-2694.2018.00.198.
[8]	楼海, 孙勤, 顾谨, 等. 常见非结核分枝杆菌肺病的临床特征及药物敏感试验结果分析[J]. 中华结核和呼吸杂志, 2019, 42(12):901-906.
	LOU H, SUN Q, GU J, et al. Clinical characteristics and drug susceptibility test of nontuberculous mycobacterial lung disease[J]. Chin J Tuberc Respir Dis, 2019, 42(12):901-906. doi:10.3760/cma.j.issn.1001-0939.2019.12.005.
[9]	张洁, 苏建荣, 丁北川, 等. 北京地区非结核分枝杆菌菌种分布及耐药性研究[J]. 中华结核和呼吸杂志, 2017, 40(3):210-214.
	ZHANG J, SU J R, DING B C, et al. Distribution and drug resistance of nontuberculous Mycobacteria in Beijing[J]. Chin J Tuberc Respir Dis, 2017, 40(3):210-214. doi:10.3760/cma.j.issn.1001-0939.2017.03.013.
[10]	张洁, 王嫩寒, 易俊莉, 等. 2016-2017年北京地区非结核分枝杆菌菌种分布观察[J]. 山东医药, 2019, 59(12):34-36.
	ZHANG J, WANG N H, YI J L, et al. Species distribution of nontuberculous mycobacteria in Beijing from 2016 to 2017[J]. Shandong Med J, 2019, 59(12):34-36. doi:10.3969/j.issn.1002-266X.2019.12.009.
[11]	LIN S, WEI S, ZHAO Y, et al. Epidemiology of human pulmonaryinfection with nontuberculous mycobacteria in southeast China:A prospective surveillance study[J]. Infect Drug Resist, 2019, 12:3515-3521. doi:10.2147/IDR.S223828.
[12]	封彬彬, 金锋, 景辉, 等. 山东地区439株非结核分枝杆菌临床分离株菌种鉴定及耐药情况[J]. 中国防痨杂志, 2021, 43(5):516-520.
	FENG B B, JIN F, JING H, et al. Identification and drug resistance of 439 clinical isolates of non-tuberculosis mycobacterium in Shandong[J]. Chin J Antituberc, 2021, 43(5):516-520. doi:10.3969/j.issn.1000-6621.2021.05.019.
[13]	BEMER P, PEUCHANT O, GUET-REVILLET H, et al. Management of patients with pulmonary mycobacteriosis in France:a multicenter retrospective cohort study[J]. BMC Pulm Med, 2021, 21(1):333. doi:10.1186/s12890-021-01701-5.
[14]	LEE Y M, KIM M J, KIM Y J. Increasing trend of nontuberculous mycobacteria isolation in a referral clinical laboratory in South Korea[J]. Medicina (Kaunas), 2021, 57(7):720. doi:10.3390/medicina57070720.
[15]	AHMED I, JABEEN K, HASAN R. Identification of non-tuberculous mycobacteria isolated from clinical specimens at a tertiary care hospital:A cross-sectional study[J]. BMC Infect Dis, 2013, 13:493. doi:10.1186/1471-2334-13-493.
[16]	陈晓红, 廖小琴, 吴迪, 等. 福州地区非结核分枝杆菌肺病临床特征[J]. 中国感染控制杂志, 2021, 20(8):688 -693.
	CHEN X H, LIAO X Q, WU D, et al. Clinical characteristics of non-tuberculous mycobacterial pulmonary disease in Fuzhou[J]. Chin J Infect Control, 2021, 20(8):688 -693. doi:10.12138/j.issn.1671-9638.20218191.
[17]	周秋菊, 於青峰, 杨阳, 等. 非结核分枝杆菌临床分离株的流行病学及临床特征分析[J]. 中国现代医生, 2020, 58(31):125-129.
	ZHOU Q J, YU Q F, YANG Y, et al. Analyses on epidemiology and clinical feather of clinical isolates of non-tuberculous mycobacteria[J]. China Modern Doctor, 2020, 58(31):125-129.
[18]	CHANDA-KAPATA P, KAPATA N, KLINKENBERG E, et al. Non-tuberculous mycobacteria(NTM)in Zambia:prevalence,clinical,radiological and microbiological characteristics[J]. BMC Infect Dis, 2015, 15:500. doi:10.1186/s12879-015-1264-6.
[19]	ALMUTAIRI T, ALMOHAYA A M, ALQAHTANI A, et al. Clinical characteristics and imaging features of patients with nontuberculous mycobacteria in a tertiary care center[J]. J Clin Tuberc Other Mycobact Dis, 2022, 26:100294. doi:10.1016/j.jctube.2021.100294.
[20]	李芳, 贺伟, 周新华, 等. 非结核分枝杆菌肺病和活动性肺结核的高分辨率CT表现异同性分析[J]. 中国防痨杂志, 2018, 40(5):499-505.
	LI F, HE W, ZHOU X H, et al. The similarities and differences of HRCT imaging feathers between nontuberculous mycobacterial lung diseases and active pulmonary tuberculosis[J]. Chin J Antituberc, 2018, 40(5):499-505. doi:10.3969/j.issn.1000-6621.2018.05.012.

感染菌种	n	艾滋病	慢性阻塞性肺疾病	支气管扩张	肺结核	糖尿病	自身免疫性疾病	间质性肺病	肿瘤	血液病	咳嗽咳痰	气短喘息	发热	咯血	纳差	恶心	胸闷胸痛
胞内分枝杆菌	42	1	2	2	8	5	3	3	2	1	28	9	18	6	3	1	7
龟脓肿分枝杆菌	25	0	1	10	3	3	1	0	1	0	16	3	8	5	0	0	2
堪萨斯分枝杆菌	25	1	4	0	2	1	1	0	0	0	13	3	7	3	2	1	1
鸟分枝杆菌	7	1	1	1	1	0	1	0	0	0	5	1	3	2	0	0	1
偶然分枝杆菌	3	0	1	1	0	1	0	0	0	0	3	1	1	1	0	0	0
蟾蜍分枝杆菌	2	0	1	0	0	0	0	0	0	0	1	1	0	0	0	0	1
耻垢分枝杆菌	1	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0	0
戈登分枝杆菌	1	0	1	0	0	0	1	0	0	0	1	0	1	0	0	0	0
合计	106	3	11	14	14	10	7	3	3	1	68	18	38	17	5	2	12

感染菌种	n	艾滋病	慢性阻塞性肺疾病	支气管扩张	肺结核	糖尿病	自身免疫性疾病	间质性肺病	肿瘤	血液病	咳嗽咳痰	气短喘息	发热	咯血	纳差	恶心	胸闷胸痛
胞内分枝杆菌	42	1	2	2	8	5	3	3	2	1	28	9	18	6	3	1	7
龟脓肿分枝杆菌	25	0	1	10	3	3	1	0	1	0	16	3	8	5	0	0	2
堪萨斯分枝杆菌	25	1	4	0	2	1	1	0	0	0	13	3	7	3	2	1	1
鸟分枝杆菌	7	1	1	1	1	0	1	0	0	0	5	1	3	2	0	0	1
偶然分枝杆菌	3	0	1	1	0	1	0	0	0	0	3	1	1	1	0	0	0
蟾蜍分枝杆菌	2	0	1	0	0	0	0	0	0	0	1	1	0	0	0	0	1
耻垢分枝杆菌	1	0	0	0	0	0	0	0	0	0	1	0	0	0	0	0	0
戈登分枝杆菌	1	0	1	0	0	0	1	0	0	0	1	0	1	0	0	0	0
合计	106	3	11	14	14	10	7	3	3	1	68	18	38	17	5	2	12

感染菌种	n	白细胞计数（×10⁹/L）	血红蛋白（g/L）	白蛋白（g/L）
胞内分枝杆菌	42	7.07±2.72	118.02±19.83	35.82±6.54
龟脓肿分枝杆菌	25	7.34±2.03	127.36±13.73^a	39.91±4.35^a
堪萨斯分枝杆菌	25	7.71±2.57	129.80±18.07^a	37.66±6.37
F		0.510	4.090^＊	3.706^＊

感染菌种	n	白细胞计数（×10⁹/L）	血红蛋白（g/L）	白蛋白（g/L）
胞内分枝杆菌	42	7.07±2.72	118.02±19.83	35.82±6.54
龟脓肿分枝杆菌	25	7.34±2.03	127.36±13.73^a	39.91±4.35^a
堪萨斯分枝杆菌	25	7.71±2.57	129.80±18.07^a	37.66±6.37
F		0.510	4.090^＊	3.706^＊