非結核分枝桿菌感染與臨床檢驗

Infection with Nontuberculous Mycobacterium and its Clinical Diagnosis

近年非結核分枝桿菌(non-tuberculous mycobacterium; NTM)所分離的種類與比例越來越高，臨床上一般認為屬於環境中的腐生菌和引起人類低病原性微生物，但因為愛滋病(acquired immunodeficiency syndrome; AIDS)的盛行而日趨受到重視。根據在已發表文獻中發現AIDS病人在結核病盛行地區感染NTM的比率較在非結核病盛行地區來得低，但是NTM盛行率的相關報告目前仍不足以來回答這個問題。一些文獻推測原因可能是分布情況、重視程度及診斷技術差異有關。NTM所感染的部位包含肺臟、淋巴結、皮膚、骨骼與關節等處局部性 的感染，有時甚至造成全身瀰漫性的感染。由呼吸道檢體快速區分與鑑定分枝桿菌是非常困難的，但是這對於治療的方法與對策卻非常重要。臨床檢驗室可以藉由優良的檢體採集、培養技術及分子生物技術提高NTM的檢出率。在台灣，NTM亦隨著AIDS病人的增多而受到重視，如何可以快速診斷及治療NTM在未來將會是一個重要課題。

In recent years, nontuberculous mycobacteria (NTM) are commonly isolated from clinical specimens. NTM is typically present in the environment and are not very pathogenic to humans. These bacteria started attracting wide attention after the onset of the acquired immunodeficiency syndrome (AIDS) epidemic. Most reports on NTM infections have been from countries where tuberculosis (TB) is not endemic. Very few reports have been published in countries where TB is endemic. There is not enough research about the prevalence of NTM to answer this condition.[A4] This is probably attributable to geographical distribution, different research concentrations, and disparity in laboratory techniques[A5]. NTM can cause localized diseases in the lungs, lymph glands, skin, bone, and joints. Occasionally, they may spread throughout the body, thus causing more generalized diseases. It is very important to isolate and rapidly identify NTM from representative specimens, as the treatment strategy for NTM infections is different from that of TB. Clinical laboratories need to enhance the screening rate of NTM by employing high-quality techniques for sample collection, culturing, and molecular analysis. In Taiwan, NTM infections have become more common because of the increasing incidence of AIDS. Hence, it is important to know how to rapidly diagnose and treat NTM infections.