肺炎奴卡菌合并天美奴卡菌肺部感染1例报道并文献复习  

Pulmonary infection caused by Nocardia pneumoniae and Nocardia amamiensis: a case report and literature review

作　　者：安袁笑雪 杜以明 田甜[1] 张一[1] 薛玉文[1] AN Yuanxiaoxue;DU Yiming;TIAN Tian;ZHANG Yi;XUE Yuwen(Department of Pulmonary and Critical Care Medicine,Qilu Hospital of Shandong University,Jinan 250012,Shandong,China;Department of Gerontology,The First Affiliated Hospital of Shandong First Medical University,Jinan 250014,Shandong,China)

机构地区：[1]山东大学齐鲁医院呼吸与危重症医学科,山东济南250012 [2]山东第一医科大学第一附属医院老年医学科,山东济南250014

出　　处：《山东大学学报（医学版）》2022年第3期59-63,70,共6页Journal of Shandong University:Health Sciences

摘　　要：目的探讨肺炎奴卡菌和天美奴卡菌肺部感染的临床特征及治疗选择。方法总结和分析1例肺部肺炎奴卡菌合并天美奴卡菌感染患者的临床特征及治疗转归,并检索有关资料进行文献复习。结果该患者为免疫功能低下及结构性肺病患者,临床表现为发热、咳脓痰、呼吸困难。CT表现为双肺多发大小不等结节影、团块影及实变影,可见空洞形成,洞壁上有赘生物样突起;伴液气胸。经BALF mNGS及胸水培养加质谱分析确诊为肺炎奴卡菌和天美奴卡菌感染,两菌对利奈唑胺、复方新诺明、亚胺培南、头孢曲松敏感,对喹诺酮类耐药。结论肺炎奴卡菌和天美奴卡菌是肺部感染的重要病原菌,利奈唑胺联合亚胺培南及复方新诺明是其有效的治疗措施。Objective To describe the clinical characteristics and treatment options of Nocardia pneumoniae and Nocardia amamiensis pulmonary infection.Methods The clinical characteristics and treatment option of a patient with Nocardia pneumoniae and Nocardia amamiensis pulmonary infection were collected and analyzed.A series of relevant literature was reviewed.Results The patient was an immunocompromised host and had structural lung disease.The clinical manifestations were fever,expectoration and dyspnea.Chest CT showed multiple nodules,masses and consolidation in both lungs,with cavity formation,protrusions on the wall of cavity and liquid pneumothorax.The pathogens were identified as Nocardia pneumoniae and Nocardia amamiensis by BALF mNGS and pleural fluid bacteria culture with mass spectrometry analysis.Both of the bacteria were susceptible to linezolid,trimethoprim-sulfamethoxazole,imipenem and ceftriaxone,and resistant to quinolones.Conclusion Nocardia pneumoniae and Nocardia amamiensis are important pathogens of pulmonary infection.Combined linezolid and imipenem with trimethoprim-sulfamethoxazole is an effective anti-infection therapy.

关 键 词：肺部感染 肺炎奴卡菌 天美奴卡菌 宏基因组二代测序 抗菌药物 

分 类 号：R519.1[医药卫生—内科学]