快速生长分枝杆菌菌血症的菌种分布及临床研究

Species distribution and clinical study of rapidly growing mycobacteria bacteremia

摘要:

目的 对5例快速生长分枝杆菌菌血症患者进行菌种鉴定和临床特征分析，提高该病诊疗水平。方法 对海南省人民医院2016—2017年收集的5株快速生长分枝杆菌采用基质辅助激光解析电离飞行时间质谱（MALDI-TOF MS）技术进行初步鉴定，16s rRNA确证，结合文献报道的15例快速生长分枝杆菌菌血症病例分析其临床特征。结果 MALDI-TOF MS鉴定结果为马德里分枝杆菌、脓肿分枝杆菌、产黏液分枝杆菌各一株，偶发分枝杆菌群2株。16s rRNA鉴定结果为马德里分枝杆菌、脓肿分枝杆菌、产黏液分枝杆菌、偶发分枝杆菌、猪分枝杆菌各1株。主要临床症状为发热，2例死亡，3例治疗后好转。结论 MALDI-TOF MS是一种简单、方便、快速的快速生长分枝杆菌鉴定方法，鉴定结果与16s rRNA序列分析的符合率高。快速生长分枝杆菌菌血症多发生于人工材料、导管植入患者，实验室和临床应重视该病的诊断。

Abstract:

Objective To identify species of rapidly growing mycobacteria (RGM) and analyze clinical characteristics of 5 patients with mycobacteria bacteremia, and improve diagnosis and treatment level of the disease. Methods Five strains of RGM collected from Hainan General Hospital between 2016 and 2017 were preliminarily identified by MALDI-TOF MS technique and confirmed by 16s rRNA, clinical characteristics were analyzed combined with 15 cases of RGM bacteremia reported in the literatures. Results MALDI-TOF MS identification results were Mycobacterium mageritense, Mycobacterium abscessus,and Mycobacterium mucogenicum, each had 1 strain, Mycobacterium fortuitum had 2 strains. 16s rRNA identification results were Mycobacterium mageritense,Mycobacterium abscessus,Mycobacterium mucogenicum, Mycobacterium fortuitum and Mycobacterium porcinum, each had 1 strain. The main clinical symptom was fever, 2 patients died and 3 patients got better after treatment. Conclusion MALDI-TOF MS is a simple, convenient, and rapid method for the identification of RGM, identification results were highly conformed to 16s rRNA sequencing analysis. RGM bacteremia mostly occurrs in patients who receives artificial material and catheterization, laboratory and clinical diagnosis of the disease should be paid attention.