兩型非結核分枝桿菌之中耳乳突炎－病例報告

Nontuberculous Mycobacterial Otomastoiditis with Two Different Species-Case Report

黎子瑜(Tzu-Yu Li) ； 羅武嘉(Wu-Chia Lo) ； 鄭博文(Po-Wen Cheng)

《台灣耳鼻喉頭頸外科雜誌》 57卷2期 (2022/06) Pp. 146-150

https://doi.org/10.6286/jtohns.202206_57(2).146

摘要

非結核分枝桿菌（nontuberculous mycobacteria, NTM）廣泛存在於自然界水源及土壤中。有別於結核病（tuberculosis），由於NTM人傳人的風險極低，因此較少受到重視。但隨著培養試劑及診斷工具之進步，臨床上發現NTM個案數也相對隨之上升，進而成為重要感染症之議題。本篇報告為一病人術後持續性耳痛合併耳漏，發現為NTM耳乳突炎，且同一部位治療過程中還培養出了不同種NTM。起初病人因左側慢性中耳炎合併耳膜穿孔來院接受中耳手術，術前細菌培養為陰性。病理報告僅為慢性發炎組織。病人術後傷口恢復緩慢，抗生素療程結束後，仍持續中耳腔膿狀分泌物合併漸進式耳痛。分泌物培養後發現為膿腫分枝桿菌群（Mycobacteriumabscessus complex）及治療過程中培養轉為鳥型結核菌（Mycobacterium avium complex）。經1年藥物治療合併局部治療後症狀緩解。經由此次病人的經驗，發現起初的細菌培養為陰性而手術後耳痛及耳漏症狀未緩解，最後診斷為NTM耳乳突炎。建議常規治療無效或是慢性中耳炎之病人術前應加做分枝桿菌培養及polymerase chain reaction檢查。

關鍵字

mastoidectomy ； nontuberculous mycobacteria ； otalgia ； otitis media（乳突切除術 ； 非結核分枝桿菌 ； 耳痛 ； 中耳炎）

並列摘要

Nontuberculous mycobacteria (NTM) are widely distributed in the environment, such as in rivers, soil, and dust. Human-to-human transmission of NTM was generally thought to be uncommon. However in recent years, NTM has emerged as an important pathogen worldwide due to improved techniques in isolation of mycobacteriology. This is a rare case of a patient infected with 2 species of NTM that were subsequently isolated from the otomastoid region. Initial samples collected during operation showed chronic inflammation of the middle ear. Left otorrhea and otalgia persisted after surgery and the symptoms were refractory to oral antibiotics. Culture and NTM PCR of middle ear discharge later proved to be Mycobacterium abscessus complex and Mycobacterium avium complex infection. The patient had no symptoms recurrent after kept receiving 1-year-NTM treatment. In addition to anaerobic and aerobic culture, we recommend routine mycobacterial culture or polymerase chain reaction in patients with otomastoiditis who are refractory to empirical antibiotics and the preoperative patients. This case serves as a reminder of NTM infection despite its rare entity.

並列關鍵字

mastoidectomy ； nontuberculous mycobacteria ； otalgia ； otitis media