皮疽奴卡菌肺部感染3例报道并文献复习  

Three cases of pulmonary infection caused by Nocardia farcinica and literature review

作　　者：陈玉[1] 杨强[1] 畅怡[1] 张霖[1] 鲁俊锋[2] 聂秀红[1] Chen Yu;Yang Qiang;Chang Yi;Zhang Lin;Lu Junfeng;Nie Xiuhong(Department of Pulmonary and Critical Care Medicine,Xuan-wu Hospital,Capital MedicalUniversity,Beijing 100053,China;Department of International Medical,Beijing YouanHospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学宣武医院呼吸与危重病医学科,北京100053 [2]首都医科大学附属北京佑安医院国际医疗部,北京100069

出　　处：《国际呼吸杂志》2019年第10期744-748,共5页International Journal of Respiration

基　　金：北京市医院管理局“青苗”计划专项项目(QML20151602).

摘　　要：目的提高对皮疽奴卡菌肺部感染的临床特点、影像特征、治疗及预后的认识及诊治水平。方法报道就诊于首都医科大学宣武医院并确诊为皮疽奴卡菌肺部感染的3例病例,结合相关文献进行讨论。结果3例患者中,2例存在结缔组织病并使用激素及免疫抑制剂,1例既往体健。2例相对年轻患者为慢性病程,高龄患者表现为2周内进行性加重的急性病程。3例患者均有咳嗽、咳痰,2例伴有发热。3例患者的CT均表现为双肺多发斑片状或团片状渗出影,2例可见厚壁空洞。3例患者给予复方磺胺甲噁唑为基础的联合治疗,症状均缓解。结论皮疽奴卡菌肺部感染患者大多存在免疫缺陷。临床特征和影像缺乏特异性,易被误诊为结核或真菌感染。给予复方磺胺甲噁唑为基础的联合治疗,大多患者预后良好。Objective To improve the understanding of clinical features,imaging features,treatment and prognosis of pulmonary infection caused by Nocardia farcinica and the level of diagnosis and treatment.Methods Three cases of pulmonary infection caused by Nocardia farcinica diagnosed and treated in Xuanwu Hospital,Capital Medical University were reported and disscussed in combination with relevant literatures.Results Of the three patients,two had connective tissue disease and used glucocorticoid and immunosuppressive agents and one was previously healthy.The two relatively young patients presented with chronic course and one elderly patient presented with progressive exacerbation of acute course within 2 weeks.All the three patients had cough and expectoration with two cases accompanied by fever.CT scan of the three patients showed multiple plaques or patchy exudation in the lungs with thick-walled cavities in two cases.Three patients were given trimethoprim-sulfamethoxazole based combination therapy and the symptoms were relieved.Conclusions Most patients with pulmonary infection caused by Nocardia farcinica have immunodeficiency.Clinical features and imaging lack specificity.Pulmonary nocardiosis caused by Noca rdia farcinica is easy to be misdiagnosed as tuberculosis or fun gal infection.Most of the patients with compound sulfamethoxazole based combination therapy have good prognosis.

关 键 词：肺炎 化脓 皮疽奴卡菌 

分 类 号：R563.1[医药卫生—呼吸系统]