| Objective: Summarizing the clinical data of two cases of non-tuberculous mycobacteria disease(NTM disease)caused by mycobacterium triviale(M.triviale)infection,so that we could improve the clinical understanding and attract attention to the pathogenicity of M.triviale,reducing misdiagnosis as much as possible.Methods: the clinical data of 2 patients with NTM disease caused by M.triviale in the First Affiliated Hospital of Guangxi Medical University were collected,and their symptoms,etiological confirming ways,laboratory examinations,diagnosis and treatment were analyzed.Domestic and foreign databases were searched and related literatures were analyzed to explore the characteristics,diagnosis and treatment strategies of NTM disease caused by M.triviale.Results: 1.Clinical data results:(1)one male patient with 37 years old and one female patient with 25 years old respectively.(2)Clinical manifestations:both had a fever,cough,anorexia and fatigue.Besides,case 1 male patient had hemoptysis,chest pain,dyspnea,with a history basic disease of bronchiectasis.Case 2 female patient had no history of basic disease.(3)physical signs: 2patients was thin,with lower BMI index than the normal value.In case 1,the left chest was sunken and moderate dry rales could be heard in the left lung.Case 2 had no positive signs.(4)Laboratory examination: the percentage of neutrophils,C-reactive protein and erythrocyte sedimentation rate increased,while hemoglobin and albumin decreased during the course of the disease.(5)Imaging examination: chest CT of case 1 showed patchy,speckled and striped density increase in both lungs,irregular multiple cavities in the upper lobe of the left lung,collapse of the left chest,narrowing of the intercostal space,thickening and calcification of the left pleura.Bone ECT showed hypermetabolic changes in some ribs and ultrasonography showed enlarged cervical lymph nodes.In case 2,CT showed ground glass shadow in both lungs,multiple cloud-like high-density foci in the right lung with blurred edges,enlarged lymph nodes in the left hilum and mediastinum,and bronchial stenosis.Echocardiography showed a small amount of pericardial effusion.(6)bronchoscopic examination showed that the lumen mucosa was obviously congested.Case 1 showed a large amount of purulent secretion.Case 2 showed a small amount of serous secretion,EBUS-TBNA detected obviously enlarged lymph nodes in the subcarinal lymph nodes and hilum of left lung,and external compression stenosis in the dorsal segment of the left lower lobe.(7)etiological confirming ways: M.triviale were confirmed in case 1 BALF,case 2 BALF and mediastinal lymph nodes samples by MALDI-TOF-MS,it cost 6 days.(8)diagnosis:Both were diagnosed disseminated NTM disease caused by M.triviale finally.(9)treatment and outcome: Case 1 was treated with clarithromycin+ imipenem/cilastatin +rifampicin during hospitalization,supplemented with thymalfasin regulation of immune function,body temperature returned to normal and discharged.After discharge,Moxifloxacin+ clarithromycin+compound sulfamethoxazole+rifampicin were given.The patient has been followed up for more than 3 months.Case 2 was treated with moxifloxacin + isoniazid + rifampicin + ethambutol +pyrazinamide and followed up for more than 1 month.The symptoms,laboratory examination and imaging were improved and the condition was stable.The results of literature review: A total of 4 case reports were retrieved in foreign databases,with no related case reports were found in China.The main results were as follows:(1)among the 4 patients,the ratio of male to female was1: 3,the age of onset ranged from 6 months to 75 years old,the average age was34.9 years old,and the median age was 32 years old.Three of the four patients had a history of lung cancer surgery and chemotherapy,asthma with Bell’s paralysis with recurrent pulmonary infection,diabetic nephropathy and peritoneal dialysis,respectively.Two patients were thin and small.(2)the site of infection: the respiratory system was involved in 2 cases,and the clinical manifestations were cough,expectoration and fever.Chest imaging showed consolidation of the lung with cavity and enlargement of hilar lymph nodes.The peritoneum was involved in 1 case,and the clinical manifestation was consistent with the symptoms of peritonitis,pleural effusion and peritoneal Candida infection.The joint was involved in 1 case,which was characterized by suppurative hip arthritis with effusion in the articular cavity.(3)the time from onset to final diagnosis ranged from 25 days to 42 days,with an average of 33.8days.Before definite diagnosis,it was misdiagnosed as community-acquired pneumonia,pulmonary fungal infection,bacterial peritonitis,bacterial arthritis and so on.Finally,the diagnosis was confirmed by sputum culture,lymph node culture,peritoneal dialysis catheter tip culture and articular effusion culture.The culture cycle of specimens ranged from 10 days to 30 days,with an average of18.8 days.(4)treatment and outcome: all were improved after treatment with two to four antibiotics,including imipenem/ cilastatin,clarithromycin,isoniazid,rifampicin,levofloxacin,ciprofloxacin,pyrazinamide,ethambutol and erythromycin.The shortest course of treatment was 2 months and the longest was 12 months.The patients were followed up for 2-18 months after discharge,and all symptoms were improved.Conclusion: 1.Pay attention to the pathogenicity of M.triviale though it’s rare.2.The symptoms of NTM disease caused by M.triviale are similar to those caused by common strains,and there is no obvious specificity,which is difficult to make a differential diagnosis only by clinical manifestations.The lesions can be limited or diffusive.when making a diagnosis.3.Most of the patients in this study suffered from chronic underlying diseases with low body weight.4.The gold criteria diagnosis is dentifing microbiologic Specimens,combined with symptoms,signs and auxiliary examination.Traditional microbiologic culture methods have a long cycle,while new molecular biological technique of MALDITOF-MS detection achieves rapid diagnosis.5.The commonly used anti-slow NTM drugs macrolides,quinolones,isoniazid,rifampicin and ethambutol are effective against M.triviale,while some anti-rapid NTM drugs like imipenem/cilastatin and compound sulfamethoxazole also have certain antibacterial effect.Regular combination of antibiotics indicates a good prognosis. |
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