1例婴幼儿脓肿分枝杆菌复合群肺病报道并文献复习  

Mycobacterium Abscessus Complex Pulmonary Disease in an Infant:a Case Report and Literature Review

作　　者：梁嘉慧 王双杰[1] 李林霖 刘敏雪 张欢 陈洁琳 Liang Jiahui;Wang Shuangjie;Li Linlin;Liu Minxue;Zhang Huan;Chen Jielin(Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region,Nanning 530003,China)

机构地区：[1]广西壮族自治区妇幼保健院,南宁530003

出　　处：《儿科药学杂志》2025年第4期34-39,共6页Journal of Pediatric Pharmacy

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题,编号Z-A20220288,Z20200641。

摘　　要：目的:探讨婴幼儿感染脓肿分枝杆菌复合群(MABC)的临床特征和诊疗要点,以加深实验室及临床对该病的认识。方法:分析1例婴幼儿MABC肺病临床诊疗过程,检索国内外数据库相关文献进行复习,分析该病的临床特征、实验室诊断、治疗及预后等。结果:患儿,男,3个月17天,临床表现为发热、反复咳嗽;影像学提示肺部团块状病灶,有空洞伴坏死;肺泡灌洗液抗酸染色涂片及培养均为阳性,经肺泡灌洗液多种病原体靶向高通量测序(t NGS)及质谱仪鉴定提示为MABC而确诊。给予亚胺培南/西司他丁钠、复方磺胺甲?唑、阿奇霉素及头孢西丁联合治疗2个月后,患儿呼吸道症状缓解、肺部病灶好转,肺泡灌洗液抗酸染色涂片及培养均阴性。患儿治疗有效,出院随访至今无复发。检索出符合条件的文献20篇,共23例,加上本病例,共纳入24例MABC患儿,肺部感染是最常见的感染类型,肺部病灶以炎性渗出、结节和实变为主;临床表现以发热、咳嗽为主;治疗方案存在差异,但均以联合用药为主。结论:MABC导致婴幼儿肺病相关报道较少,临床表现缺乏特异性,易误诊漏诊,抗酸杆菌涂片及培养等传统病原学检查仍是主要检查手段,t NGS检测有助于临床快速诊断,多学科协作诊疗结合多药联合治疗方案,疗效显著,治愈率高。Objective:To explore the clinical features,diagnosis and treatment of Mycobacterium abscessus complex(MABC)infection in infants,so as to deepen the laboratory and clinical understanding of the disease.Methods:Clinical diagnosis and treatment of an infant with MABC pulmonary disease were analyzed.Relevant literature from domestic and international databases were retrieved to analyze the clinical characteristics,laboratory diagnosis,treatment options,and prognosis of the disease.Results:A 3 months and 17 days male patient was admitted with clinical manifestations of fever and recurrent cough.Imaging suggested pulmonary mass-like lesions with cavities and associated necrosis.Both the acid-fast staining results and cultures of bronchoalveolar lavage fluid were positive.Targeted next-generation sequencing(tNGS)of various pathogens in the bronchoalveolar lavage fluid,along with MALDI-TOF mass spectrometry(MS),indicated the diagnosis of MABC.After two months of combination treatment including imipenem and cilastatin sodium,sulfamethoxazole,azithromycin,and cefoxitin,the respiratory symptoms were improved,pulmonary lesions showed notable improvement,and both the acid-fast staining smear and culture results for bronchoalveolar lavage fluid were negative.The treatment was effective,and the infant had no recurrence during follow-up after discharge.A total of 20 eligible literature(23 cases)were retrieved,and 24 children(including this case)with MABC were enrolled.Pulmonary infection was the most common type of infection,with pulmonary lesions mainly characterized by inflammatory exudate,nodules,and consolidation.The primary clinical manifestations were fever and cough.There were differences in the treatment regimens,yet most of them were drug combination.Conclusion:There are limited reports on pulmonary disease in infants induced by MABC.The clinical manifestations are lack of specificity,making it prone to misdiagnosis.Traditional etiological tests such as acid-fast staining results and cultures are still the main means of

关 键 词：脓肿分枝杆菌复合群 婴幼儿 肺病 

分 类 号：R978[医药卫生—药品] R725.6[医药卫生—药学]