肺奴卡菌病6例报道并文献复习

Pulmonary nocardiosis:6 cases report and literature review

目的探讨肺奴卡菌病的临床特点,提高临床医生对肺奴卡菌病的认识及对早期诊断正确率。方法报道2009年8月-2013年11月我院呼吸内科确诊的6例肺奴卡菌病病例资料并回顾相关文献,对病例的基础疾病、临床表现、影像学改变及其治疗方案进行总结。结果 6例肺奴卡菌病患者中,男性4例,女性2例,年龄为40～58岁,合并基础疾病者5例。其中间质性肺炎2例、支气管扩张2例、2型糖尿病2例、陈旧性肺结核1例、未分化结缔组织病1例、寻常型天疱疮1例、肾病综合征1例、皮肌炎1例,有糖皮质激素使用史4例。临床表现以咳嗽、咳痰、发热为主要症状,其他表现有憋气、乏力、胸闷等。6例肺部影像学改变均不具有特异性,多表现为结节灶、肺实变,同时伴有空洞、胸腔积液等。治疗以磺胺类药物为主的联合用药方案,5例好转出院,1例院内死亡。结论肺奴卡菌病是严重的机会致病菌感染性疾病,它多发生于合并有基础疾病以及免疫功能受损的患者,尽早明确诊断是获得良好预后的关键。

Objective To explore the clinical characteristics of nocardiosis, deepen the understanding of this disease and improve its early diagnosis. Methods Six cases with nocardiosis admitted to Chinese PLA General Hospital from August 2009 to November 2013 were reported and the related literatures were reviewed on its risk factors, clinical manifestations, imaging features, diagnosis and treatment. Results Of the six patients, 4 were male and 2 were female with age ranging from 40 to 58. Five cases were complicated with underlying disease, interstitial pneumonia were found in 2 cases, bronchiectasis in 2 cases, diabetes mellitus in 2 cases, obsolete pulmonary tuberculosis in 1 case, UCTD in 1 case, pemphigus vulgaris in 1 case. Four patients had been treated with immunocompromised or glucocorticoids. Cough, expectoration and fever were the main clinical manifestations, others were dyspnea, fatigue and tightness. The imaging features of six cases were similar to most of pulmonary diseases on CT scanning of thorax, such as nodules, consolidation, cavity and pleural fluid. The sulfonamides-based drug therapy was the standard regimen for nocardiosis. Five patients recovered and discharged, and one patient died in hospital. Conclusion Nocardia can cause severe opportunistic infection, especially in immunocompromised patients with major risk factors. Early diagnosis is a critical step toward good prognosis.