Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis
Clinical Features and Prognosis of Nontuberculous Mycobacterial Pleuritis
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DOI：
10.1159/000490548
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发表时间：
2018-01-01
期刊：
影响因子：
3.7
通讯作者：
Ohta, Ken
中科院分区：
文献类型：
--
作者：
Ando, Takahiro;Kawashima, Masahiro;Ohta, Ken
背景：虽然非结核性分枝杆菌（NTM）胸膜炎很少并发肺部NTM感染，但在病例报告和小型研究中报道了高死亡率。目的：探讨肺部NTM感染合并NTM胸膜炎的临床特点及治疗效果。方法：回顾性分析1044例肺NTM疾病患者的医疗记录，筛选出NTM证实并发胸膜炎的患者。我们调查了NTM胸膜炎患者的临床特征、病原体、胸腔积液检查、影像学表现、治疗和临床病程。结果：1044例肺NTM中，发生NTM胸膜炎15例（1.4%）。平均年龄69岁，表现状态2级及以上者居多（80.0%），合并气胸6例（40.0%）。胸膜下腔11例（73.3%），肺外气液水平14例（93.3%）。11例患者联合使用包括克拉霉素在内的2-4种抗真菌药物，2例患者联合使用异烟肼、利福平和乙胺丁醇。11例行胸管引流，6例加行手术入路。2例仅用抗菌药物治疗后胸腔积液逐渐恶化。在平均1.8年的随访期间，2例患者死于NTM胸膜炎，1例患者死于肺炎。结论：NTM胸膜炎合并症单靠药物治疗难以治愈，预后较差。除了抗细菌药物外，早期应考虑胸腔管引流和外科手术治疗NTM胸膜炎。(C) 2018作者：s . Karger AG，巴塞尔出版
Background: While nontuberculous mycobacterial (NTM) pleuritis rarely complicates pulmonary NTM infection, high mortality has been reported in case reports and small studies. Objectives: The purpose of this study was to clarify the clinical features and treatment outcomes of pulmonary NTM infection cases accompanied by NTM pleuritis. Methods: Medical records of 1,044 patients with pulmonary NTM disease were retrospectively reviewed to select patients complicated by NTM-proven pleuritis. We investigated clinical characteristics, pathogens, pleural effusion examinations, radiographic findings, treatments, and clinical course of the NTM pleuritis patients. Results: Among 1,044 cases with pulmonary NTM, NTM pleuritis occurred in 15 cases (1.4%). The mean age was 69 years with a performance status of mostly 2 or better (80.0%), and 6 cases (40.0%) were complicated by pneumothorax. Subpleural cavities were radiologically detected in 11 cases (73.3%), and extrapulmonary air-fluid level was detected in 14 cases (93.3%). Eleven patients were treated with combinations of 2-4 antimycobacterial drugs, including clarithromycin, and 2 patients were treated with isoniazid, rifampicin, and ethambutol. Chest tube drainage was performed in 11 cases, and surgical approach was added in 6 cases. The pleural effusion of 2 patients treated with only antimycobacterial medications gradually deteriorated. Two patients died from NTM pleuritis, and 1 patient died from pneumonitis during a mean of 1.8 years of follow-up. Conclusions: Comorbid NTM pleuritis was difficult to treat by medical therapy alone and resulted in a poor prognosis. In addition to antimycobacterial agents, chest tube drainage and surgical procedures in the early stages should be considered to treat NTM pleuritis. (C) 2018 The Author(s) Published by S. Karger AG, Basel