Please use this identifier to cite or link to this item: http://hdl.handle.net/11455/92627
標題: 雲嘉南地區區域醫院與地區醫院的分枝桿菌結果探討之比較
Difference of Mycobacterium Bacteria between Regional and Community Hospitals in Yunlin,Chiayi and Tainan Areas
作者: 黃玉駿
Yu - Jiun Huang
關鍵字: 無;no
引用: 1.中文部份 (1) 圖書 王桂芸、李惠玲,2009 。呼吸系統疾病之護理。於劉雪娥總校閱,成人內外科護理,第四版 。 吳俊忠、周以正等,2012。臨床微生物-細菌與黴菌學。於吳俊忠總校閱。 陸坤泰,2004。結核菌檢驗手冊。 陳豪勇,2003。最新醫用微生物學(上)。 蔡文城,2005。實用臨床為生誤診斷學,第九版 (2)期刊論文 沈光漢,2007。台灣中部地區分枝桿菌檢測,分子流行病學與藥物敏感性之研究。國立中興大學分子生物學研究所博士學位論文。 呂振富,2009。台灣中部地區之區域醫院與RCW型地區醫院的分枝桿菌培養結果特性之比較。醫檢會報會員大會暨學術發表會手冊。 吳盈勳醫師,行政院衛生署胸腔病院 The journal of Taiwan Pharmacy2008 第25卷第3 期。 ( 3 )其他 台塑生醫結核桿菌抗原快速菌種鑑定檢驗試劑使用說明書 馬援雯,2012。結核菌培養委託代檢標準作業手冊。 2.西文部份 ( 1 ) Book Clinical Microbiology Procedures Handbook, 2nd Edition, Henry D. Isenberg,2004. ( 2 ) Journal Articles Abdul Rahman JA, Moodley YP, Phillips MJ. Pulmonary alveolar proteinosis associated with psoriasis and complicated by mycobacterial infection : successful treatment with granulocyte- macrophage colony stimulating factor after a partial response to whole lung lavage. Respirology 9(3) : 419-422. 2004. Burns DN, Wallace RJ, Jr., Schultz ME, Zhang YS, Zubairi SQ, Pang YJ, Gibert CL, Brown BA, Noel ES, Gordin FM. Nosocomial Outbreak of respiratory tract colonization with Mycobacterium fortuitum : demonstration of the usefulness of pulsed-field gel electrophoresis in an epidemiologic investigation. Am Rev Respir Dis 144(5): 1153-1159. 1991. Co Do, Hgan LH, Kim SI, Sandor M. Mycobacterial granulomas:keys to a long-lasting host-pathogen relationship. Clin Immunol 113(2): 130-136. 2004. El Sahly HM, Septimus E, Soini H, Septimus J, Wallace RJ, Pan X, Williams-Bouyer N, Musser JM, Graviss EA. Mycobacterium simiae pseudo-outbreak resulting from a contaminated hospital water supply in Houston, Texas. Clin Infect Dis 35(7): 802-807. 2002. Falkinham, J. O., 3 rd . Epidemiology of infection by nontuberculous mycobacteria. Clin. Microbiol Rev. 9. 177-215. 1996. Field SK, Cowie RL. Lung disease due to the more common nontuberculous mycobacteria. Chest; 129: 1653-1665. 2006. Gatf ield J,Pieters J . Molecular mecha nis ms of host- pathogen in teractio n : entr y an d survi val of m yco bacteri a in mac rophage s.Adv I mmunol 8 1:45-95 . 2003. Glassroth J. Pulmonary disease due to non- tuberculous mycobacteria. Chest; 133:243-251. 2008. 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; 175:367-416. 2007. Henry MT, Inamdar L, O'Riordain D, et al. Nontuberculous mycobacteria in non-HIV patients : epidemiology, treatment and response.Eur Respir J; 23: 741-746. 2004. Holland SM. Nontuberculous mycobacterium. Am j Med Sci 321(1): 49-55. 2001. Horsburgh CR, Jr. Epidemiology of disease caused by nontuber- culous mycobacterium. Semin Respir Infect 11(4):244-251. 1996. Hsu PY, Yang YH, Hsiao CH, Lee PI, Chiang BL. Mycobacterium kansasii infection presenting as cellulitis in a patient with systemic lupus erythematosus. J Forms Med Assoc 101(8): 581-584. 2002. Hsueh PR, Liu YC, So J, Liu CY, Yang PC, Luh KT. Mycobact- erium tuberculosis in Taiwan. The Journal of infection 52(2):77-85. 2006. Laussucq S, Baltch AL, Smith RP, Smithwick RW, Davis BJ, Desjardin EK, Silcox VA, Spellac AB, Zeimis RT, Gruft HM, et al. Nosocomial Mycobacterium fortuitum colonization from a contaminated ice machine. Am Rev Respir Dis 138(4): 891-894. 1998. Legrand E, Goh KS, Sola C, Rastogi N. Description of a novel Mycobacterium simiae allelic variant isolated from Caribbean AIDS patients byPCR-restriction enzyme analysis and sequencing of hsp65 gene. Mol Cell Probes 14(6): 355-363. 2000. Maloney JA, Awni WM. High-performance liquid chromatographic determination of isepamicin in plasma, urine and dialysate. J Chromatogr 526(2): 487-496. 1990. Meng RL, et al., Factors Associated with Lung Function Decline in Patients with Non-Tuberculous Mycobacterial Pulmonary Disease. 8(3): e58214. 2013. Papp-Wallace KM, Maguire ME. Manganese transport and the role of manganese in virulence. Annu Rev Microbiol 60: 187-209. 2006. Schluger NW. Tuberculosis and nontuberculous mycobacterial infections in older adults.Clin Chest Med; 28: 773-781. 2007. Shen GH, Chang KM, Shih CM, et al. Diagnosis and treatment of pulmonary infection induced by nontberculous mycobacterium in non-AIDS patients. J Intern Med Taiwan; 12: 161-167. 2001. Wallace RJ Jr, Cook JL, Glassroth J, et al. American Thoracic Society statement: diagnosis and treatment of disease caused by nontuberculous mycobacteria. Am J Respir Crit Care Med; 156: S1-S25. 1997. Wan GH, Lu SC, Tsai YJ. Polymerase chain reaction used for the detection of airborne Mycobacterium tuberculosis in health care settings. Am J Infect Control 32(1): 17-22. 2004. Zumla A, Grange J. Infection and disease caused by environmental mycobacteria. Curr Opin Pulm Med 8(3): 166-172. 2002.
摘要: 
非結核性分枝桿菌(Non-tuberculous Mycobacteria,NTM)廣泛存在於自然界中,但卻長期被忽略。近年來由於愛滋病患逐年增加及分枝桿菌檢驗技術的進步, NTM 的分離率及罹病率正不斷上升。
NTM 的罹病率日益增加,若沒有詳細加以鑑定,往往會被誤認為肺結核來治療,造成結核病疫情的誤差。另外由於國內各醫院內呼吸照護病房
(Respiratory Care Ward , RCW)的成立,產生許多疑似分枝桿菌群聚感染事件,也必須盡速將疫情釐清,以免造成社會大眾的恐慌。於是筆者進行雲嘉南地區區域醫院與地區醫院的分枝桿菌培養結果之比較。
兩院皆委由衛生福利部分枝桿菌之合約實驗室進行代檢,檢體處理流程皆有相關標準流程與一致性,且對於非結核分枝桿菌均會鑑定到種名,本計
劃收集培養菌株之後,由六個方面來判斷菌株的種類,包括菌落的表面特
徵、菌株的抗酸性染色、菌的生長天數、菌落經光照後顏色的變化與菌株生化試驗,及配合 MeDiPro (台塑生醫) 結核桿菌抗原快速菌種鑑定檢驗試劑操作來判斷菌株的種類。
數據顯示區域醫院與地區醫院的分枝桿菌培養菌種排名前4名是同樣的
菌種;排名第一為 Mycobacterium tuberculosis complex ,排名第二是 M.abscessus,排名第三是 M. avium complex,排名第四則是 M. gordonae。地區醫院病人的分枝桿菌培養,分離的 Mycobacterium tuberculosis complex 的機率佔總送檢數的 1/3 (排除培養前已確診為 TB 之病人)。而區域醫院NTM 的分離菌株雖仍以 M. abscessus 為主,其次才是(M. avium complex,MAC)。另外,區域與地區兩家醫院的 M. tuberculosis complex 和 NTM 分離率經數據比較,發現並無顯著差異。
此外,區域醫院之呼吸照護病房 (以下簡稱 RCW ) M. tuberculosis complex 與 NTM 的分離率為7.15 % 比92.85 %;地區醫院 RCW(排除培養前已確診TB病例共8例)其 M. tuberculosis complex 與 NTM的分離率為13.33 % 比86.67 %;皆可以發現其 NTM 分離率遠遠高於 M. tuberculosis complex 分離率,且主要為移生性的的分枝桿菌,尤其是M. abscessus。也因為這類分枝桿菌係移生於呼吸照護病房病人的呼吸道,所以抹片中的抗酸
菌濃度大多比較低。從其他研究報告數據顯示, RCW 的病人抹片中的分枝桿菌濃度普遍非常低,而且接近九成八是屬於非結核分枝桿菌。

Non-tuberculous mycobacteria (NTM) is commonly ignored althrough they are widely distributed in the world. As the number of AIDS patients increases and isolation technique of Mycobacterium is improving, the roles of NTM in health are increasing noticed.
If NTM is not well-identified, it might be mistaken for TB. Furthermore, the incidence rate of TB might be over-estimated . The numbers of respiratory care wards (RCW) are increasing in our country, so the cluster of suspicious NTM infection increases, thus differentiating NTM from TB is particularly important.
In this study, we analyzed the different strains of NTM and TB strain between two Regional and community hospitals in Yunlin, Chiayi and Tainan Areas to clarify the prevalence of different Mycobacterium strains.
The isolation of Mycobacteria strains in both hospital were conducted in a qualified lab , approved by the Ministry of Health and Welfare in Taiwan.
Mycobacteria strains were isolated according to the following 6 categories:colony surface, acid-fast stain of the bacteria, time-interval till the colony grew,change in colony color after light perception, biochemistry test, and rapid antigen-isolating kits conducted by MeDiPro company.


Four most commonly isolated Mycobacteria strains from both hospitals were similar: Mycobacterium tuberculosis complex, M. abscessus, M. avium complex,and M. gordonae , respectively. The isolation rate of TB is only 1/3 of all the Mycobacteria cultured in community hospital. In the regional hospital the isolated NTM strains was mainly Mycobacteria abscessus followed by M. avium complex. The isolation rate was not significant between both hospitals.
The isolation rate of M. tuberculosis complex and NTM in the RCW were of 7.15 % and 92.85 %, respectively, in regional hospital, wherease in the RCW in community hospital were of 13.33 % and 86.67 %, respectively. NTM was more commonly isolated from RCW patients than TB complex did , possibly because NTM was mainly colonized in the airways of RCW patients.
URI: http://hdl.handle.net/11455/92627
其他識別: U0005-0607201516485400
Rights: 同意授權瀏覽/列印電子全文服務,2015-07-15起公開。
Appears in Collections:生命科學院碩士在職專班

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