成人之非結核性分支桿菌耳乳突炎－一個快速增加的疾病

Nontuberculous Mycobacterial Otomastoiditis in the Adult-A Rapidly Increasing Disease

王信堯(Hsin-Yao Wang) ； 林凱南(Kai-Nan Lin) ； 陳正文(Jeng-Wen Chen)

《台灣耳鼻喉頭頸外科雜誌》 47卷4期 (2012/12) Pp. 358-364

https://doi.org/10.6286/2012.47.4.358

摘要

非結核性分支桿菌耳乳突炎（Nontuberculous mycobacterial otomastoiditis，簡稱NTM otomastoiditis）在臨床上相當罕見但近年來有逐漸增加的趨勢。一般非結核性分支桿菌感染常見於肺部疾病，淋巴結發炎，皮膚病變。耳部非結核性分支桿菌感染最早於1976年由Austin所發表。然而，過去文獻所發表的此類感染多見於小兒，且需要合併多種抗生素長期治療。我們近年來治療8例成人患者，5例為女性3例為男性。就感染菌種而言，3例是Mycobacterium fortuitum的感染，3例是Mycobacterium abscessus，1例是Mycobacterium smegmatis，還有1例則是未知的Nontuberculosis mycobacteria species。就症狀而言，1例病患因耳後傷口癒合不良而被發現特殊感染；2例病患因為Mycobacterium abscessus感染同時伴隨有Gradenigo syndrome；2例病患出現顱底骨髓炎的情形；1例病患是為一acid-fast stain出現過一套陽性的患者；1例病患初期伴隨特殊的顏面神經麻痺現象；1例病患出現subperiosteal abscess及pachy meningitis的併發症。這8例病患都是症狀嚴重度很大且併發症多的案例，經過手術及多種抗生素合併治療多日才獲得改善，有鑑於在台灣本土病例稀少但有逐漸增加趨勢，針對那些病史不長但症狀較嚴重的中耳炎病患，值得我們提高警覺。

關鍵字

非結核性分支桿菌耳乳突炎 ； Gradenigo症候群 ； 顱底骨髓炎

並列摘要

BACKGROUND: Nontuberculous mycobacterial (NTM) otomastoiditis is very rare and usually associated with prolonged clinical course, severer symptoms, and frequent complications. Firstly reported by Austin in 1976, NTM otomastoiditis was observed to affect children mostly and required repeated surgical treatment and long-term multiple antibiotic therapy. Despite the increasing incidence, the clinical feature and therapeutic strategies remains not clear.METHODS: Eight adult cases of NTM otomastoiditis encountered from February 2008 to February 2011 in National Taiwan University Hospital and Cardinal Tien Hospital were reported.RESULTS: Bacteriological studies revealed 3 cases caused by Mycobacterium fortuitum, 3 by Mycobacterium abscessus, 1 by Mycobacterium smegmatis, and one caused by nonspecific Nontuberculous mycobacterium species. In these 8 cases with clinical symptoms, 6 cases had severe headache. Among 4 cases of skull base osteomyelitis, 2 cases were found to have Gradenigo syndrome. Besides, post-operative unhealed wound, facial palsy, subperioseal absess and pachy meningitis, were found respectively. Multiple antibiotic treatments with lengthened duration, ranging from 3 months to 1 year, were prescribed to each case.CONCLUSIONS: In most of these 8 cases, severe headache and skull base complications were the major clinical manifestation. In addition, all the patients required operation, multiple antibiotic treatments for long term, as well as increased length of hospital stay. Physicians dealing with chronic otitis media should be aware of NTM otomastoiditis, especially for patients with serious symptoms at early stage.

並列關鍵字

nontuberculous mycobacterium ； otomastoiditis ； Gradenigo syndrome ； skull base osteomyelitis