肺移植受者诺卡菌感染5例临床分析

Clinical analysis ofnocardia infection in lung transplant recipient:a report of five cases

目的分析肺移植术后诺卡菌感染的临床表现、影像学特点,提高该疾病的诊治水平。方法回顾性分析2018年1月至2019年12月在广州医科大学附属第一医院确诊诺卡菌感染的5例肺移植受者的基本资料、临床表现、实验室检查、影像学特点及治疗方案,并结合相关文献进行总结。5例肺移植受者中男性4例,女性1例,中位年龄66岁(26~69岁),单肺移植3例,双肺移植2例,确诊诺卡菌病距肺移植手术的中位时间为术后6个月(5~19个月)。临床症状主要表现为发热、咳嗽、咳黄痰、气促。实验室检查发现淋巴细胞下降,C反应蛋白明显升高、降钙素原轻度升高,并合并低蛋白血症、贫血。胸部高分辨率CT检查表现为多发结节、实变影,可伴空洞及胸腔积液。结果5例肺移植受者中,2例为肺部感染合并血流感染,3例为单纯肺部感染,鉴定出皮疽诺卡菌5株。根据药敏选择两种药物联合用药治疗,经治疗后5例受者均好转出院,随访1年以上,1例受者死亡,4例治愈。结论肺移植受者诺卡菌感染主要发生在术后1年以内,临床表现无特异性,胸部影像学表现为多发结节及实变影,治疗上需根据药敏早期、联合、足疗程用药。

Objective To explore the clinical manifestations and imaging features of nocardia infection(NI)after lung transplantation and boost the diagnosis and treatment of NI.Methods From January 2018 to December 2019,basic profiles,clinical manifestations,laboratory examinations,imaging features and treatment outcomes of 5 lung transplant recipients with a diagnosis of NF were retrospectively analyzed and summarized with the relevant literatures.There were 4 males and 1 female with a median age of 66(26-69)years.3 patients were single-lung transplantation,2 patients were bilateral-lung transplantation.The median time from an initial diagnosis of NI to lung transplant surgery was 6(5-19)months.Common symptoms included fever,cough with yellow phlegm and shortness of breath.Laboratory findings showed lymphopenia,significantly high C-reactive protein levels,a slight elevation of procalcitonin,hypoproteinemia and anemia.The major manifestations of high-resolution computed tomography(CT)included multiple nodules,consolidation,cavitation and pleural effusion.Results Five strains of N.farcinica were identified from bloodstream infection(n=2)and pulmonary infection(n=3).After with a combined therapy of two sensitive agents,all patients improved and were discharged from hospital.During follow-ups,one patient died and the remainders were cured.Conclusions Nocardia infection occurs in lung transplant recipients mostly within 1 year post-operation.There are non-specific symptoms and imaging features of multiple nodules and consolidation.Combination therapy of sensitive agents is indicated for lung transplant recipients with NI.