《1999BTS条件致病性分枝杆菌属感染的管理指南》内容预览

Guidelines have been produced for tuberculo- sis by the British Thoracic Society (BTS), the American Thoracic Society (ATS), the International Union Against Tuberculosis and
Lung Disease, and the World Health Organisation. These, however, deal mainly with Mycobacterium tuberculosis complex infec- tions (M tuberculosis, M africanum, and M bovis). With the exception of the ATS guide-lines on non-tuberculous mycobacteria,these do not address the opportunist mycobacteria (also called atypical mycobacteria, mycobacte-ria other than tuberculosis (MOTT), non- tuberculous mycobacteria (NTM), or environ- mental mycobacteria). The number of isolates of such opportunist mycobacteria has been increasing,both in HIV negative and HIV positive individuals. Because of the growing numbers of patients with disease due to infection by these mycobac-teria, the wide range of species, the diYculties in both diagnosis and management, and in response to increasing requests for advice on management, the BTS Joint Tuberculosis Committee has reviewed the evidence on man-agement of these infections. On the whole theevidence is not derived from controlled clinical trials as very few have been reported but, where possible, we have graded the evidence accord- ing to the criteria in table 1. Sections cover epi- demiology, bacteriological aspects, diagnosis and treatment in adults and children, separated where appropriate into sections according to their HIV infection status.

Epidemiology
Opportunist mycobacteria can be found throughout the environment and can be isolated from soil, water (including tap water), dust, milk, and various animals and birds. The significance of an isolate can only be established by considering the type of speci- men from which the Mycobacterium was isolated, the number of isolates, the degree ofgrowth, and the identity of the organism. In general, multiple isolates are needed from non- sterile sites to establish disease whereas one positive culture from a sterile site, particularly where there is supportive histopathology, is usually suYcient. The epidemiology may be complicated by the frequent isolation of opportunist mycobacteria from bronchoscopes and therefore from bronchial washings/lavages. The clinical presentation and any predisposing factors are also helpful. Patients with pre-existing lung disease or deficient immune systems seem more prone to these infections than those without such predisposing condi- tions. Good communication between the labo- ratory and clinician is essential. Additional specimens should be taken if unusual oppor- tunist mycobacteria are identified at sites that do not appear to fit the clinical picture. Clinicians should ensure that adequate speci-mens are sent and that the laboratory receives clear information regarding the site and type of specimen, the patient’s age and clinical details, including whether the patient is immunocom- promised.

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