摘要
目的分析播散性奴卡菌病的临床特点和误诊原因。方法回顾性分析2015年6月26日入住首都医科大学附属北京安贞医院的l例播散性奴卡菌病患者的临床诊断、治疗及误诊过程，并进行相关文献复习。结果患者既往有肺结核病史，胸部CT提示左侧大量胸腔积液，腺苷脱氢酶（ADA）62．6～76．4U／L，经抗结核治疗后症状缓解，但缓解后又再次复发。伤口分泌物、痰、胸腔积液涂片及血、便培养检出奴卡菌，菌种鉴定为鼻疽奴卡菌，并通过药物敏感试验诊断为播散性奴卡菌病。检索文献复习可知，胸腔积液中ADA含量较高的患者易误诊为结核性胸膜炎。结论奴卡菌病患者既往有肺结核病史且胸腔积液中ADA含量较高，且缺乏特异性的临床和影像学表现，容易误诊为肺结核复发。
Objective To analyze causes of misdiagnosis and clinical features of disseminated nocardiosis. Methods One case of patient with disseminated nocardiosis who was admitted in Beijing Anzhen Hospital, Capital Medical University on June 26, 2015 was analyzed. Clinical diagnosis and misdiagnosis, and treatment was analyzed based on literature review. Results The patient had a history of tuberculosis ; chest CT showed left lung patchy shadows and pleural effusion; adenosine dehydrogenase （ADA） was 62.6-76.4 U/L. The patient＇s symptoms were relieved after anti-tuberculosis therapy and recurred. A large number of gram-positive nocardia were detected in wound secretion, sputum, pleural effusion, blood and faeces samples. Conclusion Pulmonary nocardiosis has no specific clinical and imaging manifestations; patients with tuberculosis history and high ADA in oleural effusion can be easily misdiaznosed of tuberculous.
出处
《中国医药》
2017年第8期1157-1160,共4页
China Medicine
基金
北京市卫生和计划生育委员会科研专项（首发2016-2-1052）
关键词
播散性奴卡菌病
误诊
结核
Disseminated nocardiosis
Misdiagnosis
Tuberculosis
