肺奴卡菌感染2例报道并文献复习  

Clinical analysis of pulmonary nocardia infection:2 cases report and literatures review

作　　者：圣朝军 张杜超[1] 徐雅萍[2] 刘超[1] 方向群[1] 

机构地区：[1]解放军总医院南楼呼吸科,北京100853 [2]解放军总医院南楼检验科,北京100853

出　　处：《疑难病杂志》2014年第10期1008-1011,共4页Chinese Journal of Difficult and Complicated Cases

摘　　要：目的探讨肺奴卡菌感染的临床特征、诊治方法及预后。方法对解放军总医院2009-2011年收治的2例肺奴卡菌感染病例进行报道,同时检索国内同期文献共35例,对以上37例进行回顾性分析。结果 37例肺奴卡菌感染患者中,26例(70.3%)存在基础疾病,21例(56.8%)有糖皮质激素或免疫抑制剂治疗史。孤立性肺部感染26例(70.3%),播散性感染11例(29.7%)。主要临床表现为发热34例(91.9%)、咳嗽29例(78.4%)、咯痰25例(67.6%)等。27例(73.0%)胸部CT主要表现为结节状或肿块影,9例(24.3%)伴有空洞形成。37例均培养出奴卡菌,其中星形奴卡菌感染19例(51.4%),巴西奴卡菌感染2例(5.4%),未分型16例(43.2%)。13例(35.1%)接受复方磺胺甲恶唑单药治疗,16例(43.2%)接受复方磺胺甲恶唑联合其他药物治疗,8例(21.6%)接受喹诺酮类、氨基糖苷类、β-内酰胺类等单用或联合治疗,合并脓胸者给予引流。好转或治愈33例(89.2%),无效1例(2.7%),因呼吸衰竭死亡3例(8.1%)。结论患有基础疾病及免疫功能低下是发生肺奴卡菌感染的基础,胸部CT主要表现为结节状或肿块影、部分伴有空洞形成,奴卡菌培养阳性是确诊该病的惟一方法,治疗药物首选磺胺类,必要时应联合用药。Objective To investigate the clinical characteristics, diagnosis and treatment and prognosis of 2 cases with pulmonary nocardia infection. Methods From 2009 to 2011,2 patients in PLA General Hospital who were suffering from pulmonary nocardia infection were reported, and searched the domestic literature in the same period with a total of 35 cases, the above 37 patients were analyzed retrospectively. Results Among the 37 cases of pulmonary nocardia infection patients, 26 cases （70.3%） had underlying diseases, 21 cases （56.8%） with glucocorticoids or immunosuppressive treatment history. 26 cases with solitary pulmonary infection （70.3%）, 11 cases with disseminated infection （29.7%）. The main clinical manifestation of 34 patients was fever （91.9%）, 29 cases of cough （78.4%） , 25 cases of expectoration （67.6%）. In 27 cases （73.0%） , chest CT mainly manifested as nodular or mass, 9 cases （24.3%） formed with cavities. 37 cases were positively cultured with Nocardia, star Nocardia infection among 19 cases （51.4%） , 2 cases of Brazil Nocardia infection （5.4%） , undifferentiated type in 16 cases （43.2%）. 13 patients （35.1%） received compound sulfamethoxazole monotherapy, 16 patients （43.2%） received compound sulfamethoxazole in combination with other drugs, 8 cases （21.6%） were treatment with quinolones, aminoglycosides, beta lactam etc. single or combined, empyema were treated with drainage. Improved or cured in 33 cases （ 89.2% ）, invalid in 1 case （2.7 % ）, died of respiratory failure in 3 cases （8.1% ）. Conclusion Underlying di eases and low immune function is basic for pulmonary nocardia infection, chest CT mainly manifested as nodular or mass shadows, some accompanied with cavity formation, nocardia positive culture is the only way for diagnosis of the disease, sulfonyl amine is the first choice of treatment, when necessary, combined use of other drugs.

关 键 词：奴卡菌 肺部感染 药物治疗 

分 类 号：R563.1[医药卫生—呼吸系统]