奴卡氏菌致全身多发脓肿的诊断学特征分析  

Analysis of the diagnostic characteristics of multiple abscesses caused by Nocardia

作　　者：郑培兵 李晓哲[2] 冯勋刚[3] Zheng Peibing;Li Xiaozhe;Feng Xungang(Jining Medical University, Jining 272067, China;Department of Clinical Laboratory, Jining 272029, China;Department of Neurology,Affiliated Hospital of Jining Medical University, Jining 272029, China)

机构地区：[1]济宁医学院,在读研究生272067 [2]济宁医学院附属医院检验科,272029 [3]济宁医学院附属医院神经内科,272029

出　　处：《中华诊断学电子杂志》2019年第2期109-113,共5页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：国家自然科学基金(81771360);山东省自然科学基金(ZR2017LH034)

摘　　要：目的探讨奴卡氏菌致全身多发脓肿患者的诊断学特征。方法回顾性分析1例于2017年12月26日在济宁医学院附属医院神经内科就诊的奴卡氏菌感染患者的临床资料,并文献复习。结果患者临床表现为咳嗽、发热、发作性四肢抽搐伴有头痛,查体见胸壁脓肿破溃,脓液流出;脑脊液检查细胞数8×10~6/L,蛋白定量1.448g/L,均正常,普通培养未见细菌、真菌及抗酸杆菌;胸部CT见双肺多发空洞及间质改变;颅脑磁共振(MRI)见额叶不均匀异常信号,多发环壁及周围水肿,环壁被强化;胸壁脓液培养3 d后见黄白色菌落,弱抗酸染色及革兰染色见分枝状杆菌,符合奴卡氏菌特点。给予磺胺嘧啶钠、阿莫西林克拉维酸钾抗奴卡氏菌感染治疗后患者症状改善,颅脑MRI示额叶脓肿较前明显吸收。结论奴卡氏菌致全身多发脓肿患者病程迁延不愈,临床及影像学表现缺乏特异性。常规抗生素治疗欠佳且合并免疫抑制患者,应高度警惕此病并尽快行奴卡氏菌的培养鉴定。Objective To explore the diagnostic features of patients with multiple abscesses caused by Nocardia. Methods The clinical data of one patient infected with Nocardia in Neurology Department of Affiliated Hospital of Jining Medical University on December 26, 2017 was retrospectively studied and the relevant literatures were reviewed. Results The patient was mainly presented with cough, fever, paroxysmal limb convulsion accompanied by headache, physical examination showed collapsed abscess on the chest wall and the pus flowed out. The number of cerebrospinal fluid cells was 8×10^ 6/L, protein level in the cerebrospinal fluid was 1.448 g/L, and none of bacteria, fungi and acid-fast bacilli was observed in the general culture. The chest CT showed multiple cavities and interstitial changes in both lungs. The brain magnetic resonance imaging (MRI) showed abnormal signals with multiple ringlike walls and surrounding edema, of which the ringlike walls were enhanced. After a culture of chest wall pus for 3 days, yellow-white colonies were observed and mycobacteria in line with the characteristics of Nocardia were identified by the weak acid-fast staining and Gram-staining. After the treatment of sodium sulfadiazine and amoxicillin- clavulanate, the patient recovered with clinical improvement and the brain MRI showed significantly absorbed frontal abscess. Conclusions The patients with multiple abscesses caused by Nocardia have prolonged disease progression and lack specificity in clinical and imaging findings. The patients with immunosuppressive status and poor response to general antibiotic treatment should be considered as the Nocardia infection and the culture of Nocardia should be performed as soon as possible.

关 键 词：奴卡氏菌 脓肿 诊断 

分 类 号：R519.1[医药卫生—内科学]