顳顎關節注射後導致非結核分枝桿菌感染－病例報告和文獻回顧

Nontuberculous Mycobacteria Infections after Temporomandibular Joint Intra-auricular Injection-A Case Report and Literature Review

葉梓賢(Tzu-Hsien Yeh) ； 柯惠馨(Hui-Hsin Ko) ； 鄭世榮(Shih-Jung Cheng)

《臺灣口腔顎面外科學會雜誌》 32卷1期 (2021/03) Pp. 23-29

摘要

近年來，非結核分枝桿菌感染有日益增多的趨勢，其病原體可從自然環境或人為的地方分離出來，它感染的範圍很廣，幾乎涵蓋所有的器官，其中又以肺臟、皮膚和軟組織最為常見。現在因為有聚合酶連鎖反應和新的結核菌培養技術，增加非結核分枝桿菌被診斷出來的機會，但是因為其快速生長以及多重抗藥性的特性，治療上是十分棘手的。有時候，需要合併抗生素治療以及手術治療才能控制非結核分枝桿菌的感染。另外，術後有非結核分枝桿菌感染的比例越來越高，因此術前的感染控制是需要加強和嚴格地執行。這次的病例報告中提出一位32歲女性在牙科門診接受顳顎關節腔注射後產生非結核分枝桿菌的感染，經過抗生素和手術治療，感染受到控制。爾後在全身麻醉下接受雙側顳顎關節鏡手術探查與沖洗，術後沒有非結核分枝桿菌感染的復發。另外我們也針對非結核分枝桿菌的感染、治療及預防做文獻回顧。

關鍵字

非結核分枝桿菌 ； 膿腫分枝桿菌複合群

並列摘要

Nontuberculous mycobacterial (NTM) infection has been reported mor frequently in recent years. The pathogen can be isolated in natural and artificial environments. Almost all organs are affected by NTM infection, and lung, skin and soft tissue account for the majority. The polymerase chain reaction (PCR) and new culture-free microbiologic methods can expedite the diagnosis of NTM infections. Due to NTM is rapid growing and multidrug resistance, the treatment is difficult. Sometimes, combined therapy of surgical debridement and antimicrobial treatment is beneficial to the immunocompetent patients. Moreover, postsurgical or postprocedural NTM infection is increasing; laborious infection control is needed to reduce the possibility of NTM infection. In this case report, we present a case of 32-year-old woman with NTM infection following intra-auricular injection of temporomandibular joint (TMJ) in dental office. After combined therapy of surgical debridement and antimicrobial agent treatment, the infection was controlled. And later, she received bilateral TMJ arthrocentesis under general anesthesia. Postsurgical condition is fair and no NTM infection was found. We also reviewed literatures about NTM infection, associated treatment and prevention in this report.

並列關鍵字

Nontuberculous mycobacteria ； Mycobacteria abscessus complex