肺放线菌病血培养阳性一例并文献复习  

Pulmonary Actinomycosis with Positive Blood Culture: One Case Report and Literature Review

作　　者：张有志[1] 章鹏[1] 杨海华[1] 许育[2] 龙丰[1] 陈小东[1] 金先桥[1] 

机构地区：[1]复旦大学附属华山医院北院呼吸科,上海201907 [2]复旦大学附属华山医院北院检验科,上海201907

出　　处：《中国呼吸与危重监护杂志》2014年第6期565-568,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的提高临床医生对肺放线菌病临床特点、发病机制、诊断及治疗的认识。方法报告2013年12月复旦大学附属华山医院北院呼吸科收治的1例肺放线菌病血培养阳性病例,并复习国内外相关文献,对肺放线菌病进行分析。结果患者男性,57岁。发热24 d,胸部CT均示右中叶肺炎,2次厌氧血培养放线菌阳性。经大剂量青霉素和多西环素治疗患者体温正常,病情稳定。结合本例并复习国内外文献报道肺放线菌病资料,结果显示本病男性多见,任何年龄均可发病,中老年多见;口腔卫生不良是主要发病诱因;咳嗽、咳痰、胸痛、咯血为常见症状。CT增强扫描外周延迟强化和实性部分逐渐强化为其特点;PET显示病灶18F-FDG摄取值增高,与肺癌难以鉴别。肺活检/手术病理为主要确诊方式。大剂量青霉素为首选用药方案;药物治疗反应不佳、反复咯血患者需要外科手术治疗。结论肺放线菌病是一种少见病,临床及影像学表现无特异性,临床疗效及预后佳。本病例为首次血培养阳性病例报道。Objective To improve the knowledge of pulmonary actinomycosis. Methods One case of pulmonary actinomycosis with positive blood culture diagnosed on December 2013 in North Huashan Hospital was analyzed,and related literature from CNKI and Medline after 1990 were reviewed. Results A57-year-old male had recurrent fever for 24 days. Chest CT showed pneumonia in the right middle lobe.Actinomyce culture was twice positive by anaerobic blood culture. The patient’s temperature was normal after large doses of penicillin and doxycycline therapy. Literature review revealed that the incidence of pulmonary actinomycesis is common in males. Poor oral hygiene is the main predisposing factors. The common clinical presentations include cough,sputum production,chest pain and hemoptysis. The peripherally progressive enhancement on CT has a certain diagnostic value for pulmonary actinomycosis. Pulmonary actinomycosis can increase FDG uptake on18F-FDG PET scan and can mimic lung cancer. Accurate diagnosis is generally made by histopathological examination of lung biopsy or surgical samples. High-dose intravenous penicillin therapy is preferred for pulmonary actinomycosis followed by prolonged oral antibiotics for 6 to 12 months. Surgical intervention may be necessary for refractory hemoptysis or patients who do not respond to antibiotic therapy.Conclusions Pulmonary actinomycosis is a rare disease. Symptoms of pulmonary actinomycosis are atypical. This patient is the first reported case of actinomyces with positive blood cultures.

关 键 词：放线菌病 肺 血培养 

分 类 号：R519.1[医药卫生—内科学]