诺卡菌感染的临床特点分析

Clinical Characteristics of Nocardia Infection

目的对诺卡菌感染的临床特征进行分析。方法回顾性分析2012年1月到2016年6月宁夏医科大学总医院20例诊断为诺卡菌感染患者的临床资料,对其临床表现、实验室检查、影像学表现等进行分析,并对其特征进行总结。结果 20例患者中男、女性各10例,平均年龄为49岁;肺部感染占80%(16/20),主要表现为发热、咳嗽、咳痰、胸痛;3例为皮肤感染,表现为局部红肿、疼痛;2例为中枢神经系统感染,主要表现为头痛、恶心、发热。70%的患者有基础疾病,其中糖尿病最多见,占25%,其次为高血压、冠心病,各占15%;2例长期口服激素及免疫抑制剂。患者影像学表现无特异性。阳性标本中,痰液最多见,占45%,其次为脓液,占15%;实验室检查主要为淋巴细胞比例降低、中性粒细胞比例升高及血沉增加。收集的17株诺卡菌,包含三个诺卡菌种,分别为盖尔森基兴诺卡菌、鼻疽诺卡菌、豚鼠耳炎诺卡菌,各占58.8%、23.5%、17.7%。患者好转率为90%,两例转归不明。结论诺卡菌感染临床表现缺乏特异性,容易误诊,应提高医务工作者对该病的认识,避免延误治疗,提高治愈率。

Objective To improve early diagnosis and cure rate of nocardiosis and toreduce the rate of misdiagnosis or missed diagnosis.MethodsThe clinical features,laboratory data and imaging findings of 20 patients with nocardiosis were analyzed. These patients were hospitalized in General Hospital of Ningxia Medical University from January 2012 to June 2016.ResultsThe 20 patients included 10 men and 10 women with a mean age of 49 years. Pulmonary infection accounted for 80%（16/20）and main clinical symptoms included fever,cough,sputum and chest pain. 3 cases were cutaneous nocardiosis with the performance such as local redness and swelling,pain. 22 cases was central nervous system infection and the main clinical symptoms were headache,nausea and fever. 70% of the patients had underlying diseases and the most common type was diabetes,accounting for 25%,followed by high blood pressure and coronary heart disease,each accounted for 15%. 2 patients were infected due to the long-term oral hormone and immunosuppressive agents and the imaging findings of the patients showed no statistical significance. Among the positive specimens,the sputum accounted for 45%,followed by fester,accounting for 15%. Laboratory results mainly showed that the proportion of neutrophils and erythrocyte sedimentation rate increased while the proportion of lymphocytes decreased. A total of 17 isolates of Nocardia were collected,including 58.8% strains of Nocardiacyriacigeorigica,23.5% strains of Nocardia farcinica,and 17.% strains of Nocardia otitidiscaviarum. 90% of the patients were improved.ConclusionThe incidence of Nocardia infection has been increasing in recent years. lack of specific clinical manifestations make the infection easily misdiagnosed. We should raise awareness of this disease,avoid delaying treatment and improve the cure rate.