皮疽诺卡菌导致中枢神经系统感染一例  

Nocardia dermatosis causes central nervous system infection in one case

作　　者：张亚楠 张永亮 赵萌 郑立恒[1] 陈颜强[1] Zhang Yanan;Zhang Yongliang;Zhao Meng;Zheng Liheng;Chen Yanqiang(Department of Neurology,the Hebei Chest Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省胸科医院,石家庄050000 [2]河北医科大学第二医院

出　　处：《脑与神经疾病杂志》2024年第7期444-448,共5页Journal of Brain and Nervous Diseases

基　　金：河北省中医药管理局课题项目(2021149)。

摘　　要：目的分析河北省胸科医院神经内科收治的1例皮疽诺卡菌导致中枢神经系统感染患者的临床资料,为临床医师提供参考。方法本文报道1例由皮疽诺卡菌引起的脑脓肿病历,该患者早期主要表现为发热伴头痛,后期表现为意识障碍伴抽搐。患者先后曾住院3次,于2019年7月6日就诊于河北省胸科医院,通过脑脊液二代基因测序中发现病原体为皮疽诺卡菌,肺泡灌洗液培养发现诺卡菌,实施靶向复方磺胺甲噁唑治疗,症状未见缓解,后期合并了肺部念珠菌感染,并死于急性呼吸窘迫综合征。结果患者通过二代基因测序检测为诺卡菌,同时肺泡灌洗液发现该菌,并给予靶向抗生素治疗,后因急性呼吸窘迫症死亡。结论诺卡菌病临床表现无特异性,易被误诊。二代基因测序是一种无需培养的快速检测方法,可用于直接鉴定临床标本中的微生物;皮疽诺卡菌感染中枢神经系统的诊断以及鉴别诊断有更重要的意义。Objective To summarize clinical experience and study relevant literature by analyzing the cases of central nervous system infection caused by the rare bacterium Nocardia dermis admitted to our department.Methods We reported a rare case of brain abscess caused by Nocardia dermatoseri.The patient presented with headache in the early stage and disturbance of consciousness with convulsions in the later stage.The patient's history is complex:he has been hospitalized for three times and was admitted to our hospital on July 6,2019.Finally,Nocardia was found in cerebrospinal fluid by metagenomic next-generation sequencing;Nocardia was suspected in Broncho-alveolar Lavage Fluid,targeted antibiotic therapy was implemented,symptoms were not relieved,and pulmonary fungal infection was later combined and died of acute respiratory distress syndrome.Results Patient was suspected nocardiosis by metagenomic next-generation sequencing,bronchoalveolar lavage fluid were cultured with Nocardia.Then patient was treated with targeted antibiotics,and died of acute respiratory distress.Conclusion Through this case report,the clinical manifestations of nocardiosis are non-specific and easy to be misdiagnosed,and metagenomic next-generation sequencing is a rapid method without culture,which can be used to directly identify all microorganisms in clinical specimens.This case has more important significance for the diagnosis and differential diagnosis of the central nervous system of Nocardia dermatosis infection,and provides experience for clinicians to diagnose and treat.

关 键 词：皮疽诺卡菌 中枢神经系统感染 结核菌 二代基因测序 

分 类 号：R51[医药卫生—内科学]