Mycobacterium tuberculosis Complicated with Acute Respiratory Distress Syndrome-A Case Report

社區型肺炎對經驗性抗生素無效－肺結核併發急性呼吸窘迫症候群個案報告

陳友木(Yu-Mu Chen) ； 高旭卿(Hsu-Ching Kao) ； 周柏安(Po-An Chou) ； 方文豐(Wen-Feng Fang) ； 王金洲(Chin-Chou Wang) ； 曾嘉成(Chia-Cheng Tseng)

《胸腔醫學》 28卷4期 (2013/08) Pp. 228-234

摘要

肺結核是由結核桿菌感染所造成肺結核造成之急性呼吸窘迫症候群臨床上並不常見，也因為診斷上的困難，死亡率較其他原因造成之急性呼吸窘迫症候群高出許多。近年來由於愛滋病患者增加，肺結核感染個案節節上升，使的防疫工作更加困難。我們提出的個案為一位中年男性表現為對經驗性療法無效之社區型肺炎。病人血液，痰液培養，肺炎雙球菌抗原，退伍軍人症肺炎抗原，新型隱球菌抗原，以及肺炎黴漿菌抗體試驗皆陰性。該病患之後演變為呼吸窘迫症候群併發呼吸衰竭，經由支氣管沖洗液中結核菌聚合酶連鎖反應陽性而確診為肺結核。且病人在給予肺結核藥物後得到臨床上的改善。

關鍵字

結核菌 ； 急性呼吸窘迫症候群 ； 聚合酶連鎖反應

並列摘要

Tuberculosis (TB) that is caused by M. tuberculosis complex accounts for approximately 2.5% of all deaths in the world. The TB infection rate has increased as well with the rapid growth of the human immunodeficiency virus (HIV)-infected population in HIV endemic areas. The mortality rate of patients with TB-related acute respiratory distress syndrome (ARDS) ranges from 33% to 100%, which is higher than the ARDS mortality rate due to other causes. Early recognition and prescription of anti-TB medication is very difficult, which also explains the higher mortality rate of TB -related ARDS.Herein, we reported a 60-year-old man who presented with non-responding communityacquired pneumonia. The final diagnosis was TB-related ARDS, which was confirmed by clinical evidence and positive TB polymerase chain reaction (PCR) testing. A literature review is also included.

並列關鍵字

pulmonary tuberculosis ； acute respiratory distress syndrome (ARDS) ； polymerase chain reaction