11例诺卡菌感染患者的临床特征分析  

Analysis of clinical characteristics of 11 patients with Nocardia infection

作　　者：谢艳斌 卢文婷 XIE Yanbin;LU Wenting(Laboratory Department,Guangxi Liugang Medical Co.,Ltd.Hospital,Liuzhou 545002,China)

机构地区：[1]广西柳钢医疗有限公司医院检验科,广西柳州545002

出　　处：《临床医学研究与实践》2024年第25期110-113,共4页Clinical Research and Practice

摘　　要：目的分析诺卡菌感染患者的临床特征,为诺卡菌病的诊治提供参考依据。方法回顾性收集并分析2018年9月至2023年7月在本院确诊为诺卡菌感染患者的临床资料。结果11例诺卡菌感染患者中,男性6例,女性5例;平均年龄(67.0±12.0)岁;平均住院天数(13.3±10.8)d。所有患者均伴有基础疾病,合并心脑血管疾病(72.7%)、慢性肺部疾病(45.5%)、低蛋白血症(45.5%)。11例诺卡菌感染患者出现发热(63.6%),咳嗽、咳痰(54.5%),胸闷、气促、胸痛、乏力(均为27.3%)等临床特征。胸部影像学检查可见斑片状密度影(72.7%),结节状、索条状密度影、胸腔积液(均为27.3%)等特征。实验室检查可发现白细胞计数(WBC)(45.5%)、中性粒细胞(N)比率(90.9%)及C-反应蛋白(CRP)、降钙素原(PCT)(均为63.6%)水平升高,清蛋白(ALB)水平(72.7%)降低。11例菌株,鉴定到诺卡菌属6例(54.5%),圣乔治诺卡菌3例(27.3%),豚鼠耳炎诺卡菌、新泻诺卡菌各1例(均为9.1%)。8例患者采用以甲氧苄啶-磺胺甲噁唑(TMP-SMZ)为基础,单独使用或联合用药;2例患者单独使用头孢哌酮/舒巴坦。治疗好转共9例(81.8%),放弃1例(9.1%),死亡1例(9.1%)。结论诺卡菌感染的临床表现缺乏特异性,容易误诊,及早开展病原学检测,有助于诺卡菌病的诊疗。TMP-SMZ可作为诺卡菌治疗的首选药物,单独或联合治疗,患者预后良好。Objective To analyze the clinical characteristics of patients with Nocardia infection,and to provide references for the diagnosis and treatment of nocardiosis.Methods The clinical data of patients diagnosed with Nocardia infection in our hospital from September 2018 to July 2023 were retrospectively collected and analyzed.Results Among the 11 patients with Nocardia infection,6 were male and 5 were female.The mean age was(67.0±12.0)years;the average hospital stay was(13.3±10.8)d.All patients were accompanied by underlying diseases,combined with cardiovascular and cerebrovascular diseases(72.7%),chronic lung diseases(45.5%)and hypoproteinemia(45.5%).Eleven patients with Nocardia infection had clinical features such as fever(63.6%),cough and expectoration(54.5%),chest tightness,shortness of breath,chest pain and fatigue(both 27.3%).Chest imaging examination showed patchy density shadow(72.7%),nodular,cord-like density shadow,pleural effusion(both 27.3%)and other characteristics.Laboratory tests showed that white blood cell count(WBC)(45.5%),neutrophil(N)ratio(90.9%)and C-reactive protein(CRP),procalcitonin(PCT)(both 63.6%)levels increased,and albumin(ALB)level(72.7%)decreased.Among the 11 strains,6 strains of Nocardia(54.5%),3 strains of Nocardia st.George(27.3%),1 strain of Nocardia caviae otitis media and 1 strain of Nocardia neodiarrhea were identified(both 9.1%).Eight patients were treated with trimethoprim-sulfamethoxazole(TMP-SMZ)alone or in combination;two patients were treated with cefoperazone/sulbactam alone.A total of 9 cases improved(81.8%),1 case abandoned(9.1%),and 1 case died(9.1%).Conclusion The clinical manifestations of Nocardia infection are lack of specificity and easy to be misdiagnosed.Early etiological detection is helpful for the diagnosis and treatment of nocardiosis.TMP-SMZ can be used as the preferred drug for the treatment of Nocardia,single or combined treatment has a good prognosis for patients.

关 键 词：诺卡菌感染 诺卡菌病 药物治疗 预后 

分 类 号：R446.5[医药卫生—诊断学]