INFECTION WITH MYCOBACTERIUM-AVIUM COMPLEX IN PATIENTS WITHOUT PREDISPOSING CONDITIONS
INFECTION WITH MYCOBACTERIUM-AVIUM COMPLEX IN PATIENTS WITHOUT PREDISPOSING CONDITIONS
复制标题
DOI：
10.1056/nejm198909283211304
复制
发表时间：
1989-09-28
影响因子：
158.5
通讯作者：
FISH, JE
中科院分区：
文献类型：
--
作者：
PRINCE, DS;PETERSON, DD;FISH, JE
由鸟分枝杆菌复合体引起的肺部疾病通常发生在患有慢性肺部疾病或细胞免疫缺陷的患者中，并且其患病率正在增加。我们描述了 21 名没有常见诱发因素的感染患者（平均年龄 66 岁），占接受调查的 119 名患者的 18%。 1978 年至 1987 年间，17 名女性和 4 名男性被诊断为鸟分枝杆菌复合体，根据肺部症状、胸片异常、培养阳性以及 14 名侵袭性疾病的活检证据，十年来发病率稳定。大多数患者（86%）表现为持续咳嗽和脓痰，通常没有发烧或体重减轻。在做出正确诊断之前，咳嗽平均持续了 25 周。放射线照相模式以缓慢进展的结节性混浊为主（71%）；只有五名患者就诊时患有空洞病。所有患者最初都对抗分枝杆菌治疗有反应，但八名患者在停止治疗后最终复发。 4 名患者死于鸟分枝杆菌复合体引起的进行性肺部感染。疾病进展的患者最初肺部受累的程度比病情好转的患者更大。我们的结论是，由鸟分枝杆菌复合体引起的肺部疾病可以影响没有诱发条件的人，特别是老年妇女，并且由于其惰性性质，对这种疾病的认识常常被延迟。
Pulmonary disease caused by Mycobacterium avium complex usually occurs in patients with chronic lung disease or deficient cellular immunity, and its prevalence is increasing. We describe 21 patients (mean age, 66 years) with such infection without the usual predisposing factors, representing 18 percent of the 119 patients surveyed. Seventeen women and 4 men were given a diagnosis of M. avium complex from 1978 to 1987, with a stable incidence over the decade, on the basis of pulmonary symptoms, abnormalities on chest films, positive cultures, and in 14, biopsy evidence of invasive disease. Most of the patients (86 percent) presented with persistent cough and purulent sputum, usually without fever or weight loss. The cough was present for a mean of 25 weeks before the correct diagnosis was made. Radiographic patterns of slowly progressive nodular opacities predominated (71 percent); only five patients had cavitary disease at presentation. All patients responded initially to antimycobacterial therapy, but eight eventually relapsed when it was stopped. Four patients died of progressive pulmonary infection caused by M. avium complex. The extent of the initial pulmonary involvement was greater in patients with progressive disease than in those whose condition improved. We conclude that pulmonary disease caused by the M. avium complex can affect persons without predisposing conditions, particularly elderly women, and that recognition of this disease is often delayed because of its indolent nature.