脓肿诺卡菌致免疫功能正常者支气管感染并文献复习  

Bronchial infection in patients with normal immune function caused by Nocardia abscess and literature review

作　　者：李强 董珍珍 肖志忠 LI Qiang;DONG Zhenzhen;XIAO Zhizhong(Department of Laboratory Medicine,Beijing Huairou Hospital,Beijing,101400,China;Beijing Huairou Center for Disease Control and Prevention,Beijing,101400,China)

机构地区：[1]北京怀柔医院检验科,北京101400 [2]北京市怀柔区疾病预防控制中心,北京101400

出　　处：《当代医学》2024年第19期25-28,共4页Contemporary Medicine

摘　　要：目的分析脓肿诺卡菌感染临床特点及诊治要点。方法总结分析北京怀柔医院收治的1例脓肿诺卡菌所致免疫功能正常患者支气管感染的临床诊疗过程。以“脓肿诺卡菌”为中文主题词检索万方数据知识服务平台(万方)和中国知识基础设施工程(知网)数据库,以“Nocardia abscessus”为主题词检索PubMed数据库,检索1900至2023年公开发表的脓肿诺卡菌所致感染的病例报道。结果本研究病例女,30岁,有肺不张既往史,急性病程,以间断咳嗽、脓痰、发热为主要表现,经痰培养及支气管肺泡灌洗液病原微生物宏基因组检测鉴定明确诊断为脓肿诺卡菌感染。予以甲氧苄啶-磺胺甲恶唑、亚胺培南联合用药治疗后痊愈。纳入合格文献10篇,结合此例报道,共有11例脓肿诺卡菌感染患者,其中肺部感染6例,颅内感染3例,全身播散感染2例;以甲氧苄啶-磺胺甲恶唑治愈9例,利奈唑胺治愈1例,亚胺培南治疗死亡1例。结论脓肿诺卡菌感染可发生于免疫功能正常者,建议将甲氧苄啶-磺胺甲恶唑作为首选治疗药物并联合使用其他抗生素。Objective To analyze the clinical characteristics,diagnosis and treatment of Nocardia abscess infection.Methods To summarize and analyze the clinical treatment of bronchial infection in a patient with normal immune function caused by Nocardia abscess in Beijing Huairou Hospital.A PubMed database was searched for cases of infection caused by Nocardia abscessus between 1900 and 2023 in Data Knowledge Service Plantporm(Wanfang)and China National Knowledge Infrastructure(CNKI)with"Nocardia abscessus"as the Chinese theme word.Results A 30-year-old female patient in this study had a history of atelectasis and an acute course of disease,the main manifestations were intermittent cough,purulent sputum and fever,she was diagnosed as Nocardia abscessus infection by sputum culture and metagenomic detection of pathogenic microorganisms in bronchoalveolar lavage fluid.He was cured after treatment with trimethoprim-sulfamethoxazole and imipenem.A total of 10 qualified literatures were included,combined with this case report,there were 11 patients with Nocardia abscess infection,including 6 cases of pulmonary infection,3 cases of intracranial infection and 2 cases of systemic disseminated infection;9 cases were cured by trimethoprim-sulfamethoxazole,1 case was cured by linezolid,and 1 case died of imipenem.Conclusion Nocardia abscess infection can also occur in people with normal immune function,trimethoprim-sulfamethoxazole is recommended as the first choice and is used in combination with other antibiotics for the treatment of Nocardia abscess infections.

关 键 词：脓肿诺卡菌 支气管扩张 联合用药 甲氧苄啶-磺胺甲恶唑 

分 类 号：R562.2[医药卫生—呼吸系统]