Molecular and Histopathologic Evidence for Systemic Infection by Mycobacterium Bovis in a Patient with Tuberculous Enteritis, Peritonitis, and Meningitis: A Case Report

在其它國家已經有報導指出許多愛滋病人感染牛型分枝桿菌，台灣的結核病的流行程度高於世界衛生組織的標準，然而有關牛型分枝桿菌感染的報導仍然很少。一位 47 歲的男性有生飲鹿血及鹿奶的習慣。在一次急性的腹痛造成他必須接受緊急剖腹手術，病理發現為結核性腸炎及結腸穿孔。藉由巢氏聚合酵素連鎖反應 (nested polymerase chain reaction，PCR) 及單股構型多型性分析 (single-strand conformation polymorphism，SSCP) 的分子診斷得知牛型分枝桿菌感染了小腸、腸淋巴結及腦脊髓液。我們懷疑牛型分枝桿菌經由腸胃道進入人體的可能性要比從呼吸道來的大。攝取未消毒的鹿奶可能會使牛型分枝桿菌進入到腸黏膜的巨噬細胞中，再逐漸流進中腸的淋巴結。當免疫力下降時，腸系膜淋巴結的細菌就會傳播到其它器官及腦脊髓液中。改進現有的培養方式，或引進分生技術，以增加牛型分枝桿菌的培養率與鑑定率，將是台灣檢驗所要面臨的工作。

關鍵字

腸炎；腹膜炎；腦膜炎；牛型分枝桿菌

並列摘要

Mycobacterium bovis infection has been reported in several patients with AIDS in other countries. The prevalence of tuberculosis in Taiwan is higher than the World Health Organization standard. However, reports of M. bovis infection are rare. A 47-year-old male had the habit of drinking uncooked fresh deer’s blood and unpasteurized deer’s milk. He suffered from acute abdominal pain and underwent emergency laparotomy. Pathology demonstrated tuberculosis enteritis with colon perforation. The molecular diagnosis by nested polymerase chain reaction assay and single-strand conformation polymorphism assay showed M. bovis infection in the small intestine, mesenteric lymph nodes, and cerebrospinal fluid (CSF). Our results suggest that the most likely portal of entry of M. bovis is the gastrointestinal rather than the respiratory tract. Ingested M. bovis from unpasteurized deer’s milk probably entered the mucosal macrophages of the intestine and then the draining mesenteric lymph nodes. As immunity declined, bacilli from the mesenteric lymph nodes disseminated to other organs and into the CSF.

並列關鍵字

enteritis ； peritonitis ； meningitis ； Mycobacterium bovis

國際替代計量

Molecular and Histopathologic Evidence for Systemic Infection by Mycobacterium Bovis in a Patient with Tuberculous Enteritis, Peritonitis, and Meningitis: A Case Report

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