奴卡菌病12例临床特征分析

Clinical characteristics of 12 cases of nocardiosis

目的探讨奴卡菌病的易感因素、临床表现、治疗及预后情况,为临床医师早期诊断及治疗提供帮助。方法收集天津市第一中心医院2013年9月-2018年9月确诊为奴卡菌病患者的临床资料,回顾性分析奴卡菌病的易感因素、临床表现、影像学特点、治疗及预后。结果共收集奴卡菌病患者12例,其中11例(91.67%)合并基础疾病,9例(75.00%)应用糖皮质激素和(或)免疫抑制剂;临床表现以发热、咳嗽、咳痰最常见;影像学以团块、结节、空洞常见;12例奴卡菌病患者中以单纯肺奴卡菌感染为主,标本来源主要为痰液标本,培养类型中星形奴卡菌7例(58.33%);12例中5例(41.67%)合并真菌感染。治疗以磺胺类药物和利奈唑胺为主,免疫抑制患者合并真菌感染预后差。结论奴卡菌好发于免疫抑制人群,易合并真菌感染,临床表现缺乏特异性,容易误诊及漏诊。

OBJECTIVE To explore the predisposing factors, clinical manifestations, treatment outcomes and prognosis of nocardiosis so as to provide guidance for early diagnosis and treatment. METHODS The clinical data were collected from the patients who were diagnosed with nocardiosis in Tianjin First Central Hospital from Sep 2013 to Sep 2018.The predisposing factors, clinical manifestations, imaging characteristics and treatment outcomes of nocardiosis were retrospectively analyzed. RESULTS Of totally 12 patients with nocardiosis, 11(91.67%) were complicated with underlying diseases, 9(75.00%) were treated with glucocorticoids or immunosuppressors.Fever, cough and expectoration were the most common clinical manifestations.Clumps, nodules and cavities were the major imaging characteristics.The patients with pulmonary Nocardia infection were dominant among the patients with nocardiosis.The sputum specimens were the major specimens source, and there were 7(58.33%) cases of Nocardia asteroids. Five of 12 patients were complicated with fungal infection.The patients were mainly treated with sulfonamides and linezolid, and the patients who were treated with immunosuppressors and complicated with fungal infection had unfavorable treatment outcomes. CONCLUSION The immunocompromised population tends to have nocardiosis, which is more likely to be complicated with fungal infection;there was no specific clinical manifestations for nocardiosis, which may lead to misdiagnosis and missed diagnosis.