免疫功能正常患者播散性放线菌病1例报道并文献复习  

Disseminated actinomycosis in an immunocompetent patient:one case report and literature review

作　　者：范碧君[1] 吴学玲[1] FAN Bijun;WU Xueling(Department of Respiratory Medicine,South Campus,Renji Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 201112,China)

机构地区：[1]上海交通大学医学院附属仁济医院南院呼吸科,上海201112

出　　处：《中国感染与化疗杂志》2020年第6期638-644,共7页Chinese Journal of Infection and Chemotherapy

摘　　要：目的分析龋齿放线菌感染的临床特征、诊断及治疗,以期提高对该病的认识.方法总结分析上海交通大学医学院附属仁济医院南院收治的1例免疫功能正常患者龋齿放线菌感染致肺炎合并化脓性心包炎,并收集文献报道的56例龋齿放线菌感染病例资料.结果龋齿放线菌感染患者男性多于女性,各年龄段均可受影响,57例患者的平均年龄49岁(2~78岁),多有基础疾病或相关诱因.龋齿放线菌感染可累及全身各部位,以胸部较为多见(31/57),同时合并有其他病原体.治疗多为脓液引流联合抗菌药物的应用,以β内酰胺类为主,占77.2%(44/57).总体预后良好,治愈率高达94.7%(54/57).结论龋齿放线菌感染罕见,临床表现无特异性,诊断相对比较困难,多种检测手段联合应用有助于提高诊断效率.治疗以长疗程青霉素类为主,最佳疗程仍不明确,还需进一步研究证实.Objective To analyze the clinical characteristics,diagnosis and treatment of infections caused by Actinomyces odontolyticus,in order to improve the understanding of the disease.Methods A case of pneumonia complicated with suppurative pericarditis due to A.odontolyticus was reported in South Campus,Renji Hospital,Shanghai Jiaotong University School of Medicine.And 56 additional cases reported in the literature were reviewed.Results Infections caused by A.odontolyticus were more common in men.Individual were susceptible to A.odontolyticus at any age.The average age of the 57 patients was 49(range 2-78)years old.Most of the patients had underlying disease or triggering factor.The infection could affect any part of the body.Thoracic actinomycosis was more common(31/57).A.odontolyticus often coexisted with other pathogens.The primary treatment was surgical drainage combined with antimicrobial treatment,mainlyβ-lactams,in 77.2%(44/57)of the cases.The overall clinical cure rate was 94.7%(54/57).Conclusions The infection caused by A.odontolyticus is rarely reported.The clinical manifestations are not specific.The diagnosis is relatively difficult.Comprehensive approach is helpful to improve diagnostic efficiency.Long-term penicillin is the primary treatment.However,the best treatment duration is still not clear.

关 键 词：播散性放线菌病 龋齿放线菌 化脓性心包炎 肺炎 

分 类 号：R519.1[医药卫生—内科学]