军团菌感染继发机化性肺炎一例并文献回顾  

Legionella infection causes secondary organic pneumonia: A case report and literature review

作　　者：熊鑫[1] 赵惠敏[1] 吴文杰[1] 杨霁[1] 薛兵[1] Xiong Xin;Zhao Huimin;Wu Wenjie;Yang Ji;Xue Bing(Department of Respiratory Medicine, Beijing ChuiYangLiu Hospital, Beijing 100022, China)

机构地区：[1]北京市垂杨柳医院呼吸内科,100022

出　　处：《国际呼吸杂志》2019年第15期1135-1140,共6页International Journal of Respiration

摘　　要：目的探讨军团菌感染导致的继发性机化性肺炎(SOP)的临床特征。方法通过对1例军团菌感染导致的SOP的临床资料、影像表现、治疗过程进行分析,结合相关文献复习,对该病的临床特点、治疗及预后进行总结。以"军团菌,机化性肺炎"为检索词,检索万方数据库,以"legionella AND organizing pneumonia"为检索词,检索PubMed数据库。结果患者男,56岁,主因"间断发热9 d,腹泻3 d,加重伴咳嗽2 d"于北京市垂杨柳医院呼吸内科就诊。表现为发热、腹泻、咳嗽、咳痰,院外误诊为呼吸道感染、肠炎,影像表现为大叶实变伴磨玻璃影,入院后考虑诊断军团菌肺炎。给予抗感染、补液、支持治疗效果不佳,出现呼吸困难,血氧下降,由经皮肺穿刺病理诊断为机化性肺炎,加用糖皮质激素治疗后好转。随访2个月后病灶完全吸收,随访2年无复发。共检索到文献3篇,均为外文文献,1篇为闭塞性细支气管炎伴机化性肺炎(BOOP)。回顾性分析发现1例军团菌感染的SOP;1篇为经肺活检证实的个案报道;1篇为军团菌导致SOP的CT研究。结论继发于军团菌肺炎的SOP研究极少,影像学表现与军团菌肺炎相似,其最具特征的表现为胸膜下分布的磨玻璃影和实变伴或不伴支气管充气征。临床遇到抗感染治疗效果不佳的军团菌肺炎时应考虑到SOP可能,可完善肺穿刺检查确诊,短期的激素治疗效果好,预后较好。Objective To investigate the clinical characteristics of secondary pneumonia (SOP) caused by legionella infection. Methods A case of SOP caused by legionella infection was analyzed with the clinical data, imaging manifestations and treatment process to describe its clinical characteristics, treatment and prognosis of the disease.A systematic literature review was performed for similar published cases in Wanfang, PubMed databases, using the key words " legionella AND organizing pneumonia". Results The patient was a 56 years-old man, admitted to the respiratory department of Beijing ChuiYangLiu Hospital for treatment due to intermittent fever for 9 days, diarrhea for 3 days and aggravation with cough for 2 days.The manifestations were fever, diarrhea, cough and sputum cough, respiratory tract infection, enteritis and pneumonia were misdiagnosed outside the hospital, and the imaging manifestations were large leaf consolidation with ground glass shadow.Legionella infection was considered after admission.The effect of anti-infection, fluid rehydration and supportive treatment was not good, with respiratory difficulties and decreased blood oxygen.The patient was diagnosed as organic pneumonia by percutaneous lung puncture pathology, and improved after glucocorticoid therapy.The lesions were completely absorbed after 2 months of follow-up, and there was no recurrence after 2 years of follow-up.By literature review, we found 3 foreign articles.One of them was SOP of legionella infection found in a retrospective analysis of BOOP.1 case report confirmed by lung biopsy;1 CT study of legionella causing SOP. Conclusions There are few SOP studies secondary to legionella infection, and the imaging manifestations are similar to legionella infection.The distribution of ground glass and consolidation under the pleura with or without bronchial inflation is the most characteristic.SOP should be taken into account in the clinical treatment of legionella infection with poor anti-infection treatment effect, which can improve the diagno

关 键 词：肺炎 感染 军团病 糖皮质激素 误诊 

分 类 号：R563.1[医药卫生—呼吸系统]