Co-infection of Pulmonary Mycobacterium chelonae and Spinal Mycobacterium tuberculosis: A Case Report

同時感染肺龜鱉型分枝桿菌與脊椎結核分枝桿菌－一病例報告

王孝為(Hsiao-Wei Wang) ； 李聰明(Chun-Ming Lee)

《胸腔醫學》 25卷3期 (2010/06) Pp. 161-167

https://doi.org/10.29806/TM.201006.0009

摘要

臨床上同時感染肺龜鱉型分枝桿菌和脊椎結核分枝桿菌的案例相當罕見。本文報告一例32歲年輕女性病人，起初的臨床表現為長期咳嗽與非特異性的側腹疼痛，胸部X光片呈現右上肺葉纖維鈣化、右下肺葉不規則實質化病變及肋模增厚，脊椎磁振影像檢查呈現T12-L1感染性脊椎炎及疑似腰肌膿瘍。檢驗結果三套痰液均培養出龜鱉型分枝桿菌，但脊椎膿瘍培養結果為結核分枝桿菌。病人接受抗龜鱉型分枝桿菌治療治癒肺部感染，並且以標準抗結核藥物及手術治癒脊椎結核感染。臨床上診斷及治療不同分枝桿菌同時感染肺內和肺外部位，有賴於醫師的警覺、適當的樣本處理切片、耐酸性染色與細菌培養、以及抗結核藥物的敏感性測試結果，作為治療的依據。

關鍵字

雙重感染 ； 結核分枝桿菌 ； 龜鱉型分枝桿菌 ； 體外藥物敏感性試驗

並列摘要

Co-infection of pulmonary M. chelonae and spinal M. tuberculosis in an immunocompetent adult is a rare condition. We reported a 32-year-old woman who developed chronic productive cough and nonspecific bilateral flank pain. Acid-fast bacterial cultures isolated M. chelonae from sputum samples and M. tuberculosis from a paraspinal abscess. She was finally cured by standard anti-tuberculosis regimens plus surgical intervention, and anti-chelonae therapy according to in vitro susceptibility testing. The diagnosis and treatment of both pulmonary and extrapulmonary mycobacterial infection require a high index of suspicion, adequate samples for smears and cultures, and in vitro susceptibility testing.

並列關鍵字

co-infection ； Mycobacterium tuberculosis ； Mycobacteria chelonae ； susceptibility testing