15例奴卡菌病的临床分析

Clinical analysis of 15 cases of Nocardiosis

目的分析奴卡菌感染病例的临床资料,提高临床医生对奴卡菌病的认识及早期诊断。方法回顾分析该院2015-2019年确诊的15例奴卡菌感染患者的基础疾病、临床表现、影像学特点、病理学检查结果、实验室检查结果、病原学特点、治疗与预后等。结果15例奴卡菌感染患者中,肺部感染11例,足菌肿2例,脑脓肿1例,皮肤感染1例。合并基础疾病或有移植手术史患者11例,免疫功能正常患者4例。肺部感染患者影像学表现有斑片状密度增高影、空洞形成、结节影、毛玻璃影、支气管扩张、胸腔积液等。用16 S rRNA通过PCR扩增和基因序列分析对15株奴卡菌鉴定分型,其中,盖尔森基兴奴卡菌6株,化脓奴卡菌3株,豚鼠耳炎奴卡菌2株,巴西奴卡菌2株,北京奴卡菌1株,鼻疽奴卡菌1株。15例患者中单用磺胺类药物治疗4例,以磺胺类药物为基础联合其他药物治疗7例,其他药物单独或联合治疗4例。所有患者中,14例患者治疗好转,1例患者死亡。结论奴卡菌病多发生于合并有基础疾病及免疫功能受损的患者,但免疫功能正常患者也可感染奴卡菌。临床标本直接涂片染色对奴卡菌的早期诊断具有重要意义。磺胺类药物仍为奴卡菌感染的首选药物,且临床效果显著。

Objective To analyze the clinical data of patients with Nocardiosis,and to improve the understanding and early diagnosis of Nocardiosis.Methods Totally 15 cases of Nocardia infection confirmed in the hospital from 2015 to 2019 were retrospectively analyzed.The underlying diseases,clinical manifestations,imaging changes,pathological examination,laboratory examination,etiological characteristics,treatment and prognosis were analyzed.Results Among the 15 cases of Nocardia infection,11 cases were pulmonary infection,2 cases were podophyta,1 case was brain abscess and 1 case was skin infection.There were 11 patients with underlying diseases or transplantation history and 4 patients with normal immune function.The imaging findings of pulmonary infection patients include patchy,cavity,nodular focus,ground glass shadow,bronchiectasis,pleural effusion,etc.Fifteen strains of Nocardia were identified by 16 S rRNA PCR amplification and gene sequence analysis.Among them,6 strains were Nocardia gelsenkii,3 strains were Nocardia pyogenes,2 strains were Nocardia caviae,2 strains were Nocardia brasiliensis,1 strain was Nocardia pekinensis and 1 strain was Nocardia mallei.Among the 15 cases,4 cases were treated with sulfonamides alone,7 cases were treated with sulfonamides combined with other drugs,4 cases were treated with other drugs alone or in combination.In all patients,14 patients improved after treatment,and 1 patient died.Conclusion Nocardiosis often occurs in patients with underlying diseases and impaired immune function,but patients with normal immune function can also be infected with Nocardia.Direct smear staining of clinical specimens is of great significance for the early diagnosis of Nocardia.Sulfonamides are still the first choice of drugs for Nocardia infection,and the clinical effect is significant.