关节腔积液中分离偶发分枝杆菌1例分析  

A case report of isolating Mycobacterium fortuitum from joint effusion

作　　者：李玉栋[1] 喜贺热[2] 孙巧英 Li Yudong;Xi Here;Sun Qiaoying(Department of Laboratory,the Third Affiliated Hospital of Baotou Medical College,Baotou 014030,Inner Mongolia Autonomous Region,China;Department of Laboratory,Bayannor Hospital,Bayannor 015000,Inner Mongolia Autonomous Region,China;Department of Laboratory,Inner Mongolia Maternal and Child Health Care Hospital,Huhhot 010020,Inner Mongolia Autonomous Region,China)

机构地区：[1]包头医学院第三附属医院检验科,内蒙古自治区包头014030 [2]巴彦淖尔市医院检验科,内蒙古自治区巴彦淖尔015000 [3]内蒙古妇幼保健院检验科,内蒙古自治区呼和浩特010020

出　　处：《实用检验医师杂志》2019年第1期59-61,共3页Chinese Journal of Clinical Pathologist

摘　　要：包头医学院第三附属医院于2017年5月31日收治1例在关节腔积液中发现偶发分枝杆菌的患者,对其进行膝关节DR影像学诊断,采用美国BD公司普通血培养瓶对无菌体液进行增菌,延长培养时间4～7 d,并进行飞行时间质谱仪鉴定。确诊为偶发分枝杆菌感染后联合使用利奈唑胺和莫西沙星对患者进行治疗。结果显示,延长培养时间4～7 d可提高阳性率;感染偶发分枝杆菌后膝关节的X线影像发生改变,DR片示左膝关节骨密度稍增高致密,关节面边缘见骨赘形成,左胫骨踝间隆起变尖,关节间隙清晰,周围软组织影肿胀;使用飞行时间质谱仪可准确快速鉴定非结核分枝杆菌(NTM),以质谱图为证。联合使用抗菌药物利奈唑胺和莫西沙星3个月后病情好转。Mycobacterium fortuitum was isolated from the fluid in the articular cavity in a patient with joint effusion in the Third Affiliated Hospital of Baotou Medical Collage on May 31, 2017. CT imaging was used for the diagnosis of the knee joint lesion. Aseptic body fluids in French Bio-Meriere ordinary blood culture bottle was used for bacterial culture, in which the culture time was prolonged for 4-7 days, and the time-of-flight mass spectrometer was used for identification. After confirming thelesion was due to Mycobacterium fortuitum infection, the patient was treated with linezolid and moxifloxacin. The results showed that the prolongation of the culture time for 4-7 days could increase the positive rate;the X-ray imaging of the knee joint showed changes after the infection withMycobacterium fortuitum, and the film revealed that the bone density of the left kneejoint was slightly increased, osteophyte formation was seen at the edge of the articular surface, the left tibia at the middle of the ankle became sharpened, the joint space was clear, and its surrounding soft tissue was swollen;using time-of-flight mass spectrometer could accurately and quickly identify non-tuberculous mycobacteria (NTM), and the figure of the spectrometer was shown in this paper. In addition, the combination of linezolid and moxifloxacin, the antibacterial drugs, for treatment of this patient could improve the condition after 3 months.

关 键 词：关节腔积液 偶发分枝杆菌 飞行时间质谱仪 

分 类 号：R684[医药卫生—骨科学] R446.5[医药卫生—外科学]