1例皮肤巴西奴卡菌感染报道并文献复习

One case of nocardiosis and literature review

目的总结奴卡菌感染的临床表现、诊治方法及预后。方法报道本院2015年收治的1例皮肤奴卡菌感染，同时检索、温习了同期国内文献报道的29例，行回顾性分析。结果在全部30例（16例来源于中平能化医疗集团总医院检验科何理，王梭等在2011年发表于中华医学感染学杂志的《奴卡菌感染16例诊治分析》，13例来源于广西人民医院检验科陈杏春等在2012年发表于中华医院感染学杂志的《13例患者奴卡菌感染临床资料分析》）奴卡菌感染病例中，有22例肺部感染病例，均合并有基础疾病史（矽肺8例、矽肺合并COPD例、糖尿病8例、类风湿性关节炎5例）；8例皮肤感染病例；另外还有5例合并有基础疾病（糖尿病3例、类风湿性关节炎2例），3例应用肾上腺糖皮质激素病例。结论奴卡菌感染是外源性、机会性感染。奴卡菌不仅是免疫抑制患者的条件致病菌，也可发生在有免疫力的健康患者。由于奴卡菌感染病例症状常不典型，奴卡菌病易漏诊。病理检查是确诊奴卡菌病的唯一方法。一旦确诊，应及早使用磺胺类药物或其他敏感药物治疗，而皮下软组织感染予外科辅助治疗。

Objective To summarize the clinical manifestations, diagnosis, treatment, and prognosis of nocardiosis. Methods One case of narcotics infection treated at our hospital in 2015 was reported. At the same time, 29 cases of domestic reports were reviewed and retrospectively analyzed. Results In all the 30 cases of nocardiosis, 22 cases had pulmonary infection and all associated with basic diseases （8 cases had silicosis, 1 case silicosis complicated with COPD, 8 cases diabetes mellitus, and 5 cases rheumatoid arthritis）. 8 cases had skin infection; another 5 cases had basic diseases （3 cases had diabetes and 2 cases rheumatoid arthritis）; 3 cases took adrenal glucocorticoid. Conelusion Nocardiosis is exogenous and opportunistic infection. Nocardia is not only a conditional pathogen in immunosuppressive patients but also in healthy persons with immunity. The symptoms of nocardia infection are atypical. Nocardiosis is easy to be misdiagnosed. Pathological examination is the only way to diagnose nocardiosis. Once diagnosed, sulfa drugs or other sensitive drug treatment should be used as soon as possible and subcutaneous soil tissue infection should be treated surgically.