中枢神经系统奴卡菌感染诊治分析附一例鼻疽奴卡菌脑脓肿

CNS Nocardia Infection Diagnosis and Treatment and One Case Report of Brain Abscess Nocardia Farcinica

目的:了解中枢神经系统(CNS)奴卡菌感染的临床特点、诊治方法及预后。方法:对青岛大学附属医院收治的1例脑奴卡菌感染病例进行报道,并检索相关文献报道的脑奴卡菌感染共31例,对以上32例进行回顾性分析。结果:32例患者中,22例存在基础疾病,18例有糖皮质激素或免疫抑制剂治疗史。主要临床表现为头痛,发热,恶心、呕吐,口齿不清,意识障碍,肢体功能障碍等。7例接受复方磺胺甲噁唑单药治疗,17例接受复方磺胺甲噁唑联合其他抗生素治疗,8例接受喹诺酮类、氨基糖苷类、β-内酰胺类等联合治疗。23例好转或治愈,9例死亡。结论:免疫功能低下是中枢神经系统奴卡菌病的危险因素;奴卡菌培养阳性是确诊该病的惟一方法;应及早应用磺胺类药物,必要时结合外科手术治疗。

Objective： To investigate the clinical characteristics, diagnosis and treatment of central nervous system（CNS） nocardiosis. Methods： 1 patients in Affiliated Hospital of Qingdao University who were sufferred from brain Nocardia abscess were reported,and searched the literatures with a total of 31 cases, the above 32 patients were analyzed retrospectively. Results： Among the 32 cases of cerebral Nocardia infection patients, 22 cases had underlying diseases, 18 cases with glucocorticoids or immunosuppressive treatment history. The main clinical manifestation of 15 patients was headache, fever, vomit, slurred speech, Unconsciousness, Physical dysfunction. 7 cases were treated with single trimethoprim/sulphamethoxazole, the other patients were given combination treatment, including trimethoprim/sulphamethoxazole, quinolones, aminoglycoside, beta lactam, Linezolid. 9 patients died, the other 23 cases were improved or cured. Conclusions： Immunocompromised is a recognized risk factor for the growth of nocardial brain abscesses. Nocardia positive culture is the only way to diagnose the disease, sulfony amine is the first choice of treatment, if necessary, combined use of other drugs.Poor outcome is mostly found in immunocompromised hosts.