特殊皮肤表现的奴卡菌病1例及文献回顾

Nocardiosis with special skin manifestations:a case report with literature reviews

目的探讨皮肤奴卡菌病的临床特征、诊断和治疗。方法临床诊断1例特殊皮肤表现的奴卡菌病,进行文献回顾。结果 22例患者中,健康者14例,8例有基础疾病者都有使用糖皮质激素或使用免疫抑制剂者。常见临床表现:脓肿、溃疡、包块、肿块可伴有发热、乏力等全身症状。感染途径:外伤3例,来源于肺部3例,医源性注射2例,感染途径不明14例。22例患者均通过组织培养确诊,治疗主要为单用磺胺类药物或联合其他药物治疗或联合外科切开引流治疗。结论皮肤奴卡菌病可能更多见于免疫功能正常者,临床表现无特异性,多数找不到明确的感染途径,其中医源性注射也是其感染途径之一,病原菌培养为主要确诊手段,治疗以磺胺类药物为主或联合手术切开引流。

Objective To investigate the clinical features,diagnosis and treatment of cutaneous nocardiosis.Methods One case of nocardiosis with special skin manifestations is reported with literature review.Results Of the 22 patients,14 were healthy and 8 had underlying diseases with a history of glucocorticoids or immunosuppressants.Common clinical manifestations include abscess,ulcer,lump with fever,fatigue or other systemic symptoms.Infection pathway are 3 cases of trauma,3 cases from lung,2 cases of iatrogenic injection,and 14 cases of unknown infection.All 22 patients were diagnosed by tissue culture.Treatment strategies are single sulfonamides,or combination with other drugs,or combination with surgical incision and drainage.Conclusion Cutaneous nocardiosis is commonly seen in the immune functioned with untypical clinical manifestations.A clear infection route cannot be found,and iatrogenic injection is also one of the ways of infection.The pathogenic bacteria culture was the main diagnostic method,and the treatment was treated with sulfonamides or combined surgical incision drainage.