慢性阻塞性肺疾病合并奴卡菌感染三例临床及影像学分析

Clinical Characteristics and Radiological Analysis of Chronic Obstructive Pulmonary Disease Complicated with Pulmonary Nocardiosis Infection:a Report of Three Cases

目的了解慢性阻塞性肺疾病合并肺奴卡菌感染的临床特征、影像学特点、临床诊治和预后。方法选取2017年3月-2018年9月浙江衢化医院收治的3例确诊为慢性阻塞性肺疾病合并肺奴卡菌感染的病例进行总结及文献复习。结果3例慢性阻塞性肺疾病合并肺奴卡菌感染患者主要症状包括发热、咳嗽、咳黄浓痰;影像学表现为结节或肿块、空洞、实变和胸腔积液。确诊手段主要是痰培养,治疗药物以复方磺胺甲噁唑治疗为基础,可以联合其他抗生素。3例患者均痊愈或好转。结论结构性肺病是肺奴卡菌感染的基础,临床表现和影像学特点无特异性,奴卡菌病原菌培养阳性是主要的确诊途径,治疗药物以磺胺甲噁唑为主,酌情联合其他用药。

Objective To investigate the clinical and radiological characteristics of chronic obstructive pulmonary disease(COPD)complicated with pulmonary nocardiosis infection and its diagnosis and treatment and prognosis.Methods The clinical data of three patients with COPD complicated with pulmonary nocardiosis infection who were admitted to Zhejiang Quhua Hospital from March 2017 to September 2018 were analyzed and reported retrospectively and the literature were reviewed.Results Cardinal symptoms of three patients included fever,cough,and coughing up yellow mucus.Computer tomography scan of chest showed nodules or masses,cavities,pleural effusion and consolidation.The most precise diagnosis method is mainly sputum culture.On the basis of Compound Sulphamethoxazole,the patients were treated with other antibiotics.All three patients were cured or in the improved condition.Conclusion Structural pulmonary disease is the basis of pulmonary nocardia infection with non-specific clinical and radiological manifestations.The positive culture of nocardia pathogen is the mainly way of diagnosing the disease.Compound Sulphamethoxazole is the basic choice of treatment in combination with other drugs according to patient's condition.