Urgentna patologija: bolest pluća prouzrokovana Mycobacterium xenopi – izazov u kliničkoj praksi
Sažetak
Apstrakt
Uvod. Broj obolelih od bolesti izazvanih netuberkuloznim mikobakterijama (NTM) – mikobakterijama iz okoline, je u porastu. Faktori rizika za pojavu ovih bolesti nisu jasni, a uočene su razlike zavisno od klime, gustine naseljenosti i predispozicije ljudskog organizma. Većoj izolaciji uzročnika doprinosi i dostupnost molekularnih tehnika za njihovu identifikaciju. Ovaj rad je poziv kolegama da svoje retke pojedinačne slučajeve priključe u veliku studijsku grupu. Prikaz bolesnika. Povodom epizode produktivnog kašlja i febrilnosti, u tri uzorka sputuma 73-godišnjeg HIV-negativnog bolesnika, dugogodišnjeg pušača sa minimalnim sekvelama plućne tuberkuloze, nađeni su acido-alkoholo-rezistentni bacili direktnom mikroskopijom. Rezultati kulture Löwenstein-Jensen bili su pozitivni sa 20, 30 i 50 kolonija, a molekularna identifikacija je potvrdila Mycobacterium xenopi (M. xenopi). Kako je standardni radiogram grudnog koša bio bez znakova aktivnih lezija, ispitivanje je dopunjeno bronhoskopijom i multi-slajsnom kompjuterizovanom tomografijom (MSCT) toraksa. Otkrivene su ekskavirane promene u apikoposteriornom delu levog gornjeg režnja pluća. Pod terapijom (rifampicin, etambutol i klaritromicin) postignuta je konverzija sputuma, ali se nepravilna ekskavacija održavala na MSCT toraksa posle šest i posle 12 meseci uz znake minimalne regresije. Opšte stanje bolesnika je bilo nepromenjeno, uključujući i asteniju. Faktori rizika u ovom slučaju su prethodna plućna bolest, pušenje, pothranjenost i produženi emotivni stres. Zaključak. Plućna bolest izazvana M. xenopi predstavlja izazov u kliničkoj praksi. Teško se leči i ima neizvesnu prognozu. Kako optimalni terapijski pristup još nije poznat, potrebna su dobro kontrolisana klinička ispitivanja. Uključivanje retkih pojedinačnih slučajeva u tekuću međunarodnu multicentričnu studiju dovelo bi do velikog uzorka bolesnika i donošenja novih smernica korisnih za praksu.
Reference
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