播散性诺卡菌病1例并文献复习  

Case report and literature review of disseminated nocardiosis

作　　者：彭玲[1] 孔晋亮[2] 卢桦崧[2] 蔡双启[2] 巫艳彬[2] 曾能永[2] 

机构地区：[1]柳州市柳铁中心医院呼吸内科,545007 [2]广西医科大学第一附属医院呼吸内科,南宁530021

出　　处：《国际呼吸杂志》2015年第21期1626-1629,共4页International Journal of Respiration

基　　金：国家自然科学基金项目（81260663）

摘　　要：目的加深对播散性诺卡菌病的认识，提高临床诊疗水平。方法分析2014年8月广西医科大学第一附属医院呼吸内科收治的1例肾病综合征患者全身播散的诺卡菌病病例的临床表现、影像学、实验室检查、诊治过程，并进行文献复习。结果该病临床表现及影像学检查无特异性，播散至脑部时早期可无中枢神经系统症状，患者多伴有免疫功能低下，诊断主要依据细菌学检查。结论播散性诺卡菌病是罕见但致命的机会性感染。细菌培养和鉴定是诊断该病的金标准。机体免疫力低下的患者，出现发热、咳嗽、胸痛等呼吸道症状，血象增高，胸部影像学表现实变影、结节影、肿块影、胸腔积液等，尤其合并皮下脓肿时，需警惕播散性诺卡菌病的可能，即使无中枢神经系统症状，也应重视颅内播散的可能。早期充分治疗可以改善预后。Objective To improve the diagnosis and treatment of the disseminated nocardiosis. Methods The clinical features, radiological findings,laboratory testing and treatment were presented in one case diagnosed with disseminated nocardiosis in a patient with nephrotic syndrome, and the related literatures were reviewed. Results The disease was lack of specific clinical feature and radiological findings, also could be lack of central nervous system symptoms when the brain was involved. The patient was often immunosuppressed. The most precise diagnosis could be provided by bacteriology examination. Conclusions Disseminated nocardiosis was a rare but severe opportunistic infection. Bacterial culture and identification was the gold standard for diagnosis of this disease. For immunosuppressed patients,nocardia infections should be considered when they had fever, cough, and chest pain and other respiratory symptoms, leukocytosis, and the chest radiology showed consolidations, nodules, mass and pleural effusions, especially accompanied with subcutaneous abscess. Although without symptoms of central nervous system（CNS）,we should pay attention to the possibility of CNS involvement of the nocardiosis. Early and sufficient treatment may improve the prognosis.

关 键 词：诺卡菌 播散性诺卡菌病 肺诺卡菌病 

分 类 号：R560.4[医药卫生—呼吸系统]