侵袭性肺曲霉病合并肺奴卡菌病1例并文献复习  

Co-infection of pulmonary aspergillosis and nocardiosis:A case report and literature review

作　　者：段智梅[1] 毛丹 徐轶 曹江涛[1] 崔俊昌[1] Duan Zhi-Mei;Mao Dan;Xu Yi;Cao Jiang-Tao;Cui Jun-Chang(Department of Respiratory and Critical Care Medicine,the First Medical Center of Chinese PLA General Hospital,Beijing 100853,China;Department of Critical Care Medicine,the 968th Hospital of PLA Joint Logistics Support Force,Jinzhou,Liaoning 121000,China)

机构地区：[1]解放军总医院第一医学中心呼吸与危重症医学科,北京100853 [2]解放军联勤保障部队第968医院重症医学科,辽宁锦州121000

出　　处：《解放军医学杂志》2021年第4期348-353,共6页Medical Journal of Chinese People's Liberation Army

基　　金：国家重点研发计划“重大慢性非传染性疾病防控研究”2016年度专项(2016YFC1304301)。

摘　　要：目的总结侵袭性肺曲霉病合并肺奴卡菌病的临床特点,提高对该疾病的诊治水平。方法报告1例侵袭性肺曲霉病合并肺奴卡菌病例。检索万方数据库、中国期刊全文数据库、PubMed、Web of Science和Embase数据库,结合文献报告综合分析该类患者的临床特点及诊治过程。结果本例患者为男性,66岁,基础疾病为肾病综合征,长期应用激素等免疫抑制剂治疗。临床表现为咳嗽、咳黄痰、发热;胸部CT显示双肺多发结节空洞影;痰中发现曲霉及奴卡菌。明确诊断为“侵袭性肺曲霉病合并肺奴卡菌病”,给予针对性抗感染治疗后痊愈。综合文献并本例患者,24例中男16例,女8例;除1例为溺水后感染外,其余23例均合并免疫功能受损。所有患者均接受针对曲霉和肺奴卡菌的抗感染治疗,6例死亡。结论侵袭性肺曲霉病患者可能合并肺奴卡菌病,且易发生于免疫抑制的患者,临床诊治时须注意鉴别诊断。早期诊断和治疗可能对改善预后有积极意义。Objective To summarize the clinical characteristics of patients suffering from invasive pulmonary aspergillosis(IPA)associated with pulmonary nocardiosis(PN)for improving the level in diagnosis and treatment of the disease.Methods The clinical characteristics,diagnosis and treatment of one patient diagnosed with IPA and PN in the First Medical Center of Chinese PLA General Hospital in January 2017 were reported.Wanfang,CNKI,PubMed,Web of Science and Embase databases were searched,and the clinical characteristics and diagnosis and treatment process of patients with IPA and PN were analyzed together with this patient.Results This patient was a 66-year-old male.His underlying disease was nephrotic syndrome,and long-term treatment with hormones and other immunosuppressive agents.The clinical manifestations were cough,yellow sputum,fever.Chest CT showed multiple nodules in both lungs.Aspergillus and Nocardia were found in the sputum.The patient was clearly diagnosed as"invasive pulmonary aspergillosis combined with pulmonary nocardiosis".After targeted anti-infective treatment,the patient recovered.Combined with the literature,a total of 24 cases of patient,including 16 males and 8 females,were analyzed;except for one patient who was infected after drowning,the other 23 patients had immunological impairment;all the patients received antiinfective treatment against Aspergillus and Nocardia,and a total of 6 deaths.Conclusions Patients with IPA may be associated with PN,and it is prone to occur in immunosuppressed patients.Attention should be paid to differential diagnosis during clinical diagnosis and treatment.Early diagnosis and treatment may have a positive effect on improving the prognosis.

关 键 词：侵袭性肺曲霉病 肺奴卡菌病 免疫抑制 

分 类 号：R563.9[医药卫生—呼吸系统] R379.6[医药卫生—内科学]