放线菌与诺卡菌所致感染性皮肤肉芽肿的鉴别诊断及治疗

Differential diagnosis and treatment of infectious cutaneous granuloma caused by Actinomyces and Nocardia

感染性肉芽肿是一类慢性增生性炎症。放线菌和诺卡菌所致感染性肉芽肿实属少见,但两者临床症状、体征相似,易误诊或漏诊。本文报道1例放线菌与1例诺卡菌所致皮肤感染性肉芽肿,通过皮肤组织病理学检查、细菌培养、生化鉴定及细菌分子生物学检测,最终明确诊断。进一步分析2种感染的病因学、流行病学、临床表现、诊断和鉴别诊断及治疗,并结合最新研究进展,可帮助临床医师更好地认识放线菌属细菌所致感染性皮肤肉芽肿,以便于及时诊断、及时治疗。这2种感染有很多相似之处,也有各自特点,需临床医师求同存异,仔细鉴别;还需与其他感染性肉芽肿如皮肤结核、孢子丝菌病或着色芽生菌病等鉴别诊断。

Infections granuloma is a kind of chronic hyperplastic inflammation which is rarely caused by Actinomyces and Nocardia .As clinical symptoms and physical examination results of infectious granuloma caused by Actinomyces and Nocardia are similar ,it is easily to lead to misdiagnosis or missed diagnosis .Here we presented a case of infectious granuloma caused by Actinomyces and a case of infectious granuloma caused by Nocardia . The final diagnosis was confirmed by pathological examination , bacterial culture and identification ,and gene sequencing . We also summarized the etiology , epidemiology , clinical features , differential diagnosis ,treatment and recent advances in these two infections ,which could help to make the correct diagnosis without delay and choose the optimal treatment . There two infections have many similarities ,and we need to distinguish them for proper therapy . The differential diagnosis with other granulomatous infections ,such as tuberculosis ,cutaneous sporotrichosis or chromoblastomycosis was also discussed .