Нетуберкулезные микобактериозы часто являются причиной хронического, вялотекущего заболевания легких. В настоящей статье рассматриваются многообразные рентгенологические проявления микобактериозов легких, такие как полостная и бронхоэктатическая формы, одиночные очаги и округлые образования. Знание спектра рентгенологических изменений является важным для своевременной постановки диагноза и определения тактики лечения.
The nontuberculous mycobacterial infection (NTMB) usually cause chronic, indolent pulmonary infection. The purpose of this article is to review radiologic manifestations of pulmonary nontuberculous mycobacterial infection. Common and well-recognized patterns of NTMB infection include cavitary and bronchiectatic disease. Less common manifestations include nodules or masses mimicking malignancy and others. Definitive diagnosis can be difficult and patterns may overlap. Knowledge of the full spectrum of radiological findings is important to facilitate diagnosis and treatment.
1. Определитель бактерий Берджи. 9-е изд. В 2 т. Пер. с англ. Под ред. Дж.Хоулта, Н.Крига, П.Снита и др. М.: Мир, 1997. / Opredelitel' bakterii Berdzhi. 9-e izd. V 2 t. Per. s angl. Pod red. Dzh.Khoulta, N.Kriga, P.Snita i dr. M.: Mir, 1997. [in Russian]
2. Marras TK, Daley CL. Epidemiology of human pulmonary infection with nontuberculous mycobacteria. Clin Chest Med 2002; 23: 553–67.
3. Литвинов В.И., Макарова Н.В., Краснова М.А. Нетуберкулезные микобактерии. М.: МНПЦБТ, 2008. / Litvinov V.I., Makarova N.V., Krasnova M.A. Netuberkuleznye mikobakterii. M.: MNPTsBT, 2008. [in Russian]
4. Miller WT, Miller WT. Pulmonary infections with atypical mycobacteria in the normal host. Semin Roentgenol 1993; 28 (2): 139–49.
5. MacDonnell KB, Glassroth J. Mycobacterium avium-complex and other non-tuberculous mycobacteria in patients with HIV infection. Semin Respir Infect 1989; 4: 123–32.
6. Woodring JH, Vandiviere HM. Pulmonary disease caused by nontuberculous mycobacteria. J Thorac Imaging 1990; 5: 64–76.
7. Murray JF, Ellis K. Pulmonary complications of human immunodeficiency virus infection in adults. In: Potchen EJ, Granger RG, Greene R, eds. Pulmonary radiology. Philadelphia, Pa: Saunders, 1993; p. 285–307.
8. Гунтупова Л.Д., Борисов С.Е., Соловьева И.П. и др. Микобактериозы во фтизиопульмонологической практике: обзор литературы и собственный опыт. Практ. медицина. 2011; 3 (51): 39–50. / Guntupova L.D., Borisov S.E., Solov'eva I.P. i dr. Mikobakteriozy vo ftiziopul'monologicheskoi praktike: obzor literatury i sobstvennyi opyt. Prakt. meditsina. 2011; 3 (51): 39–50. [in Russian]
9. Оттен Т.Ф. Микобактериоз легких: клинико-бактериологические критерии диагностики. БЦЖ о туб. 1999; 5: 17–9. / Otten T.F. Mikobakterioz legkikh: kliniko-bakteriologicheskie kriterii diagnostiki. BTsZh o tub. 1999; 5: 17–9. [in Russian]
10. Ellis SM, Hansell DM. Imaging of non-tuberculous (atypical) mycobacterial pulmonary infection. Clin Radiol 2002; 57: 661–9.
11. Iseman MD. Mycobacterium avium complex and the normal host. N Engl J Med 1989; 321: 896–8.
12. Griffith DE, Aksamit T, Brown-Elliott BA et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175: 367–416.
13. Marinelli DL, Albelda SM, Williams TM et al. Nontuberculous mycobacterial infection in AIDS: clinical, pathologic, and radiographic features. Radiology 1986; 160: 77–82.
14. Miller WT. Spectrum of pulmonary nontuberculous mycobacterial infection. Radiology 1994; 191: 343–50.
15. Erasmus JJ, McAdams HP, Farrell MA, Patz EF. Pulmonary nontuberculous mycobacterial infection: radiologic manifestations. Radiographics 1999; 19: 1487–505.
16. Christensen EE, Dietz GW, Ahn CH et al. Initial roentgenographic manifestations of pulmonary Mycobacterium tuberculosis, M kansasii, and M intracellularis infections. Chest 1981; 80: 132–6.
17. Albelda SM, Kern JA, Marinelli DL, Miller WT. Expanding spectrum of pulmonary disease caused by nontuberculous mycobacteria. Radiology 1985; 157: 289–96.
18. Levin DL. Radiology of pulmonary Mycobacterium avium-intracellulare complex. Clin Chest Med 2002; 23: 603–12.
19. Matveychuk A, Fuks L, Priess R et al. Clinical and radiological features of Mycobacterium kansasii and other NTM infections. Respir Med 2012; 106 (10): 1472–7.
20. Marras TK, Wagnetz U, Jamieson FB, Patsios DA. Chest computed tomography predicts microbiological burden and symptoms in pulmonary Mycobacterium xenopi. Respirology 2013; 18 (1): 92–101.
21. Carrillo MC, Patsios D, Wagnetz U et al. Comparison of the spectrum of radiologic and clinical manifestations of pulmonary disease caused by Mycobacterium avium complex and Mycobacterium xenopi. Can Assoc Radiol J 2014; 65 (3): 207–13.
22. Kim YK, Hahn S, Uh Y et al. Comparable characteristics of tuberculous and non-tuberculous mycobacterial cavitary lung diseases. Int J Tuberc Lung Dis 2014; 18 (6): 725–9.
23. Polverosi R, Guarise A, Balestro E et al. High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients. Radiol Med 2010; 115 (2): 191–204.
24. Gommans EP, Even P, Linssen CF et al. Risk factors for mortality in patients with pulmonary infections with non-tuberculous mycobacteria: a retrospective cohort study. Respir Med 2015; 109 (1): 137–45.
25. Prince DS, Peterson DD, Steiner RM et al. Infection with Mycobacterium avium complex in patients without predisposing conditions. N Engl J Med 1989; 321: 863–8.
26. Hollings NP, Wells AU, Wilson R, Hansell DM. Comparative appearances of non-tuberculous mycobacteria species: a CT study. Eur Radiol 2002; 12: 2211–7.
27. Swensen SJ, Hartman TE, Williams DE. Computed tomographic diagnosis of Mycobacterium avium intracellulare complex in patients with bronchiectasis. Chest 1994; 105: 49–52.
28. Hazelton TR, Newell JD, Cook JL et al. CT findings in 14 patients with Mycobacterium chelonae pulmonary infection. AJR 2000; 175: 413–6.
29. Han D, Lee KS, Koh WJ et al. Radiographic and CT findings of nontuberculous mycobacterial pulmonary infection caused by Mycobacterium abscessus. AJR 2003; 181: 513–7.
30. Reich JM, Johnson RE. Mycobacterium avium complex pulmonary disease presenting as an isolated lingular or middle lobe pattern: the Lady Windermere syndrome. Chest 1992; 101: 1605–9.
31. Dhillon SS, Watanakunakorn C. Lady Windermere syndrome: middle lobe bronchiectasis and Mycobacterium avium complex infection due to voluntary cough suppression. Clin Infect Dis 2000; 30: 572–5.
32. Jeong YJ, Lee KS, Koh WJ et al. Nontuberculous mycobacterial pulmonary infection in immunocompetent patients: comparison of thin-section CT and histopathologic findings. Radiology 2004; 231: 880–6.
33. Koh WJ, Lee KS, Kwon OJ et al. Bilateral bronchiectasis and bronchiolitis at thin-section CT: diagnostic implications in nontuberculous mycobacterial pulmonary infection. Radiology 2005; 235 (1): 282–8.
34. Kwak N, Lee CH, Lee HJ et al. Non-tuberculous mycobacterial lung disease: diagnosis based on computed tomography of the chest. Eur Radiol 2016; 26 (12): 4449–56.
35. Yano S, Kusumoto M, Asamuara H et al. A case of Mycobacterium avium complex infection showing solitary pulmonary mass. Radiat Med 2002; 20: 147–50.
36. Gribetz AR, Damsker B, Bottone EJ et al. Solitary pulmonary nodules due to nontuberculous mycobacterial infection. Am J Med 1981; 70: 39–43.
37. Del Giudice G, Bianco A, Cennamo A et al. Lung and Nodal Involvement in Nontuberculous Mycobacterial Disease: PET/CT Role. Biomed Res Int 2015; 2015: 353202.
38. Hadjiliadis D, Adlakha A, Prakash UB. Rapidly growing mycobacterial lung infection in association with esophageal disorders. Mayo Clin Proc 1999; 74: 45–51.
39. El-Solh AA, Nopper J, Abdul-Khoudoud MR et al. Clinical and radiographic manifestations of uncommon pulmonary nontuberculous mycobacterial disease in AIDS patients. Chest 1998; 114 (1): 138–45.
40. Laissy JP, Cadi M, Cinqualbre A et al. Mycobacterium tuberculosis versus nontuberculous mycobacterial infection of the lung in AIDS patients: CT and HRCT patterns. J Comput Assist Tomogr 1997; 21 (2): 312–7.
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1. Opredelitel' bakterii Berdzhi. 9-e izd. V 2 t. Per. s angl. Pod red. Dzh.Khoulta, N.Kriga, P.Snita i dr. M.: Mir, 1997. [in Russian]
2. Marras TK, Daley CL. Epidemiology of human pulmonary infection with nontuberculous mycobacteria. Clin Chest Med 2002; 23: 553–67.
3. Litvinov V.I., Makarova N.V., Krasnova M.A. Netuberkuleznye mikobakterii. M.: MNPTsBT, 2008. [in Russian]
4. Miller WT, Miller WT. Pulmonary infections with atypical mycobacteria in the normal host. Semin Roentgenol 1993; 28 (2): 139–49.
5. MacDonnell KB, Glassroth J. Mycobacterium avium-complex and other non-tuberculous mycobacteria in patients with HIV infection. Semin Respir Infect 1989; 4: 123–32.
6. Woodring JH, Vandiviere HM. Pulmonary disease caused by nontuberculous mycobacteria. J Thorac Imaging 1990; 5: 64–76.
7. Murray JF, Ellis K. Pulmonary complications of human immunodeficiency virus infection in adults. In: Potchen EJ, Granger RG, Greene R, eds. Pulmonary radiology. Philadelphia, Pa: Saunders, 1993; p. 285–307.
8. Guntupova L.D., Borisov S.E., Solov'eva I.P. i dr. Mikobakteriozy vo ftiziopul'monologicheskoi praktike: obzor literatury i sobstvennyi opyt. Prakt. meditsina. 2011; 3 (51): 39–50. [in Russian]
9. Otten T.F. Mikobakterioz legkikh: kliniko-bakteriologicheskie kriterii diagnostiki. BTsZh o tub. 1999; 5: 17–9. [in Russian]
10. Ellis SM, Hansell DM. Imaging of non-tuberculous (atypical) mycobacterial pulmonary infection. Clin Radiol 2002; 57: 661–9.
11. Iseman MD. Mycobacterium avium complex and the normal host. N Engl J Med 1989; 321: 896–8.
12. Griffith DE, Aksamit T, Brown-Elliott BA et al. An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases. Am J Respir Crit Care Med 2007; 175: 367–416.
13. Marinelli DL, Albelda SM, Williams TM et al. Nontuberculous mycobacterial infection in AIDS: clinical, pathologic, and radiographic features. Radiology 1986; 160: 77–82.
14. Miller WT. Spectrum of pulmonary nontuberculous mycobacterial infection. Radiology 1994; 191: 343–50.
15. Erasmus JJ, McAdams HP, Farrell MA, Patz EF. Pulmonary nontuberculous mycobacterial infection: radiologic manifestations. Radiographics 1999; 19: 1487–505.
16. Christensen EE, Dietz GW, Ahn CH et al. Initial roentgenographic manifestations of pulmonary Mycobacterium tuberculosis, M kansasii, and M intracellularis infections. Chest 1981; 80: 132–6.
17. Albelda SM, Kern JA, Marinelli DL, Miller WT. Expanding spectrum of pulmonary disease caused by nontuberculous mycobacteria. Radiology 1985; 157: 289–96.
18. Levin DL. Radiology of pulmonary Mycobacterium avium-intracellulare complex. Clin Chest Med 2002; 23: 603–12.
19. Matveychuk A, Fuks L, Priess R et al. Clinical and radiological features of Mycobacterium kansasii and other NTM infections. Respir Med 2012; 106 (10): 1472–7.
20. Marras TK, Wagnetz U, Jamieson FB, Patsios DA. Chest computed tomography predicts microbiological burden and symptoms in pulmonary Mycobacterium xenopi. Respirology 2013; 18 (1): 92–101.
21. Carrillo MC, Patsios D, Wagnetz U et al. Comparison of the spectrum of radiologic and clinical manifestations of pulmonary disease caused by Mycobacterium avium complex and Mycobacterium xenopi. Can Assoc Radiol J 2014; 65 (3): 207–13.
22. Kim YK, Hahn S, Uh Y et al. Comparable characteristics of tuberculous and non-tuberculous mycobacterial cavitary lung diseases. Int J Tuberc Lung Dis 2014; 18 (6): 725–9.
23. Polverosi R, Guarise A, Balestro E et al. High-resolution CT of nontuberculous mycobacteria pulmonary infection in immunocompetent, non-HIV-positive patients. Radiol Med 2010; 115 (2): 191–204.
24. Gommans EP, Even P, Linssen CF et al. Risk factors for mortality in patients with pulmonary infections with non-tuberculous mycobacteria: a retrospective cohort study. Respir Med 2015; 109 (1): 137–45.
25. Prince DS, Peterson DD, Steiner RM et al. Infection with Mycobacterium avium complex in patients without predisposing conditions. N Engl J Med 1989; 321: 863–8.
26. Hollings NP, Wells AU, Wilson R, Hansell DM. Comparative appearances of non-tuberculous mycobacteria species: a CT study. Eur Radiol 2002; 12: 2211–7.
27. Swensen SJ, Hartman TE, Williams DE. Computed tomographic diagnosis of Mycobacterium avium intracellulare complex in patients with bronchiectasis. Chest 1994; 105: 49–52.
28. Hazelton TR, Newell JD, Cook JL et al. CT findings in 14 patients with Mycobacterium chelonae pulmonary infection. AJR 2000; 175: 413–6.
29. Han D, Lee KS, Koh WJ et al. Radiographic and CT findings of nontuberculous mycobacterial pulmonary infection caused by Mycobacterium abscessus. AJR 2003; 181: 513–7.
30. Reich JM, Johnson RE. Mycobacterium avium complex pulmonary disease presenting as an isolated lingular or middle lobe pattern: the Lady Windermere syndrome. Chest 1992; 101: 1605–9.
31. Dhillon SS, Watanakunakorn C. Lady Windermere syndrome: middle lobe bronchiectasis and Mycobacterium avium complex infection due to voluntary cough suppression. Clin Infect Dis 2000; 30: 572–5.
32. Jeong YJ, Lee KS, Koh WJ et al. Nontuberculous mycobacterial pulmonary infection in immunocompetent patients: comparison of thin-section CT and histopathologic findings. Radiology 2004; 231: 880–6.
33. Koh WJ, Lee KS, Kwon OJ et al. Bilateral bronchiectasis and bronchiolitis at thin-section CT: diagnostic implications in nontuberculous mycobacterial pulmonary infection. Radiology 2005; 235 (1): 282–8.
34. Kwak N, Lee CH, Lee HJ et al. Non-tuberculous mycobacterial lung disease: diagnosis based on computed tomography of the chest. Eur Radiol 2016; 26 (12): 4449–56.
35. Yano S, Kusumoto M, Asamuara H et al. A case of Mycobacterium avium complex infection showing solitary pulmonary mass. Radiat Med 2002; 20: 147–50.
36. Gribetz AR, Damsker B, Bottone EJ et al. Solitary pulmonary nodules due to nontuberculous mycobacterial infection. Am J Med 1981; 70: 39–43.
37. Del Giudice G, Bianco A, Cennamo A et al. Lung and Nodal Involvement in Nontuberculous Mycobacterial Disease: PET/CT Role. Biomed Res Int 2015; 2015: 353202.
38. Hadjiliadis D, Adlakha A, Prakash UB. Rapidly growing mycobacterial lung infection in association with esophageal disorders. Mayo Clin Proc 1999; 74: 45–51.
39. El-Solh AA, Nopper J, Abdul-Khoudoud MR et al. Clinical and radiographic manifestations of uncommon pulmonary nontuberculous mycobacterial disease in AIDS patients. Chest 1998; 114 (1): 138–45.
40. Laissy JP, Cadi M, Cinqualbre A et al. Mycobacterium tuberculosis versus nontuberculous mycobacterial infection of the lung in AIDS patients: CT and HRCT patterns. J Comput Assist Tomogr 1997; 21 (2): 312–7.
Авторы
И.А.Соколина
ГБУЗ «Московский научно-практический центр борьбы с туберкулезом» Департамента здравоохранения г. Москвы. 107014, Россия, Москва, ул. Стромынка, д. 10 isokolina@yandex.ru
________________________________________________
I.A.Sokolina
Moscow Research and Clinical Center for Tuberculosis Control of the Moscow Government Health. 107014, Russian Federation, Moscow, ul. Stromynka, d. 10 isokolina@yandex.ru