膜性肾病并发诺卡菌感染一例报告并文献复习  

Membranous nephropathy complicated by Nocardia infection:1 case report and literature review

作　　者：王雪严 苏晓丽[1] Wang Xueyan;Su Xiaoli(Department of Respiratory Medicine,National Key Clinical Specialty,Branch of National Clinical Research Center for Respiratory Disease,Xiangya Hospital,Central South University,Center of Respiratory Medicine,Xiangya Hospital,Central South University,Clinical Research Center for Respiratory Diseases in Hunan Province,Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease,National Clinical Research Center for Geriatric Disorders,Xiangya Hospital,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院呼吸内科,国家呼吸系统疾病临床医学研究中心分中心,中南大学湘雅医院呼吸中心,湖南省呼吸疾病临床研究中心,呼吸疾病智能诊疗技术湖南省工程研究中心,国家老年疾病临床医学研究中心(湘雅医院),长沙410008

出　　处：《中国医师杂志》2022年第4期573-576,581,共5页Journal of Chinese Physician

摘　　要：目的探讨膜性肾病并发诺卡菌感染的临床特点、诊断及治疗,提高对诺卡菌感染的认识。方法回顾性分析在中南大学湘雅医院呼吸内科住院的1例膜性肾病并发诺卡菌感染患者的临床资料,以"诺卡菌""膜性肾病"为关键词,对知网、万方数据库,以"Nocardiosis""Menbranous nephropathy"为关键词对pubmed数据库进行检索,总结膜性肾病并发诺卡菌感染患者的临床特征和诊疗要点。结果本例患者为47岁中年男性,因"咳嗽、咳痰2个月,发现左下肢包块20 d"收入中南大学湘雅医院呼吸内科治疗,肺部CT示右侧胸膜可见多发结节及胸腔积液改变,痰涂片示革兰阳性杆菌,左下肢包块穿刺液涂片示革兰阳性杆菌(分枝状),住院后先后予以复方磺胺甲恶唑、美罗培南、左氧氟沙星抗感染后患者咳嗽咳痰明显好转,左下肢包块基本吸收,随访2个月后胸腔积液、左下肢包块吸收完全。文献检索共收集4篇文献,包括本例共6例,其中皮疽诺卡菌3例,豚鼠耳炎诺卡菌1例,星形诺卡菌1例,未分类1例。结论皮疽诺卡菌虽在膜性肾病患者中少见,但极易引起全身播散性感染。因此,在免疫力低下患者中,应注意诺卡菌感染的发生。在确诊诺卡菌感染前,应经验性运用复方磺胺甲恶唑。对于磺胺类耐药菌株,可换用利奈唑胺等药物进行抗感染治疗。Objective To investigate the clinical features,diagnosis and treatment of membranous nephropathy complicated with Nocardia infection,and to improve the understanding of Nocardia infection.Methods The clinical data of a patient with membranous nephropathy complicated by Nocardia infection who were hospitalized in the department of respiratory medicine,Xiangya Hospital of Central South University were retrospectively analyzed.Using"Nocardiosis"and"membranous nephropathy"on China National Knowledge Internet(CNKI)and Wanfang databases,and using"Nocardiosis"and"menbranous nephropathy"as keywords to search the pubmed database to summarize the clinical characteristics and diagnosis and treatment points of patients with membranous nephropathy complicated by Nocardia infection.Results This patient is a 47-year-old middle-aged male.He was admitted to the respiratory medicine department in Xiangya Hospital of Central South University due to"coughing and expectoration of sputum for 2 months,and a mass in the left lower extremity was found for 20 days".Lung computed tomography(CT)showed that multiple nodules and changes in pleural effusion were seen in the right pleura.The sputum smear showed Gram-positive bacilli,and the smear of the mass puncture fluid of the left lower extremity showed Gram-positive bacilli(branched).After treatment with compound sulfamethoxazole,meropenem and levofloxacin successively,the phlegm was obviously improved,and the mass in the left lower extremity was basically absorbed.After 2 months of follow-up,the pleural effusion and the mass in the left lower extremity were completely absorbed.A total of 4 literatures were collected in the literature search,including 6 cases of this case,including 3 cases(50%)of Nocardia anthracis,1 case(16.7%)of Nocardia otitis in guinea pigs,and 1 case of Nocardia stellariformis(16.7%).1 case(16.7%)was not classified.Conclusions Although Nocardia anthracis is rare in patients with membranous nephropathy,it can easily cause systemic disseminated infection.Therefore,in im

关 键 词：肾病 膜性 诺卡菌感染 

分 类 号：R692[医药卫生—泌尿科学] R446.5[医药卫生—外科学]