14例肺奴卡菌病临床特征

Clinical characteristics of 14 cases of pulmonary nocardiosis

目的分析肺奴卡菌病临床特点和诊治方法,提高对肺奴卡菌病的诊治意识。方法对2012年1月-2019年12月解放军总医院海南医院14例肺奴卡菌病住院患者临床资料进行回顾性分析,结合国内外文献,进行临床特点分析。结果14例肺奴卡菌病患者均为原发肺奴卡菌感染,既往体健者7例,7例患有基础疾病;14例患者中表现为咳嗽、咳痰12例(85.7%),发热4例(28.6%),咯血2例(14.3%),气促2例(14.3%),胸痛2例(14.3%);肺CT影像主要表现为实变、斑片影、结节等;14例肺奴卡菌病患者,3例患者炎症指标中白细胞计数、中性粒细胞占比升高,7例患者C-反应蛋白水平升高,1例患者降钙素原水平升高;通过痰培养、肺穿刺组织、高通量基因测序等方法对奴卡菌感染进行诊断;治疗上以磺胺类药物为基础单药或联合治疗好转。结论以肺为首发免疫正常肺奴卡菌病病例并不少见,临床表现类似于常见社区获得性肺炎,容易出现误诊、漏诊,痰弱抗酸染色、支气管灌洗、组织病理可帮助诊断,高通量基因测序可以快速帮助提高确诊率,磺胺甲噁唑/甲氧苄啶对于肺奴卡菌病疗效较好,耐药少,少数合并基础疾病病例需联合治疗,尽早明确诊断对预后良好。

OBJECTIVE To investigate the clinical characteristics and treatment measures of pulmonary nocardiosis so as to raise the awareness of diagnosis and treatment of pulmonary nocardiosis.METHODS The clinical data of 14 patients with pulmonary nocardiosis who were hospitalized in Hainan Hospital of PLA General Hospital from Jan 2012 to Dec 2019 were retrospectively analyzed,and the clinical characteristics were analyzed in combination with domestic and foreign literatures.RESULTS All of the 14 patients with pulmonary nocardiosis were primary pulmonary novozyme infection,7 cases were previously healthy,7 had underlying diseases.Among the 14 patients,12(85.7%)had cough and expectoration,4(28.6%)had fever,2(14.3%)had hemoptysis,and 2(14.3%)had chest pain.Consolidation,patchy shadow and nodule were the major lung CT imaging manifestations.3 of 14 patients with pulmonary nocardiosis had the elevated levels of white blood cell and neutrophils,7 patients had the elevated level of C-reactive protein(CRP),and 1 patient had elevated level of procalcitonin(PCT).The Nocardia infection was diagnosed by means of sputum culture,lung puncture tissue and high-throughput gene sequencing.The treatment was improved with sulfonamine-based monotherapy or combination therapy.CONCLUSION The pulmonary nocardiosis patients with starting normal immunity are common,and the clinical manifestations are similar to community-acquired pneumonia,it is likely to lead to misdiagnosis and missed diagnosis,phlegm weak acid dye and bronchial lavage.The histopathologic examination may facilitate the diagnosis,the high-throughput gene sequencing can quickly help to improve the diagnosis rate.Sulfamethoxazole-trimethoprim can achieve remarkable effect on treatment of the pulmonary nocardiosis and is less drug-resistant,a few cases who are complicated with underlying diseases need the joint treatment,and early diagnosis is favorable for the treatment.