拟诺卡菌感染1例并文献复习

Nocardiosis:a case report and literature review

目的了解拟诺卡菌感染的临床特征及诊治方案。方法对1例拟诺卡菌所致皮肤感染的患者资料进行分析。以"拟诺卡菌"为主题词检索万方、维普和中国知网数据库,以"Nocardiopsis"为主题词检索PubMed数据库,获取文献报道的拟诺卡菌所致感染的病例,筛选并总结分析病例资料。结果福建医科大学附属泉州第一医院报道的1例病例因鱼刺刺伤左手指出现左臂多发性肿物,诊断为拟诺卡菌所致皮肤感染,经甲氧苄啶-磺胺甲[口恶]唑治疗5个月后基本痊愈。文献检索到7例拟诺卡菌感染患者,包括该院病例共8例,其中皮肤感染4例、播散性感染2例、肺部及鼻感染各1例。4例皮肤感染患者中,3例患者分别被土豆叉、牙签、鱼刺刺伤所致感染。另外4例患者可能因免疫功能低下导致感染。3例皮肤感染患者采用甲氧苄啶-磺胺甲[口恶]唑治疗,最终均治愈;其余5例患者治疗方案不一,1例患者死亡,其余患者均治愈。结论拟诺卡菌可在多种环境中定植,皮肤被刺伤后可致感染。临床诊断需要依赖分子生物学方法进行鉴定。不宜经验性选用头孢菌素进行治疗,建议将甲氧苄啶-磺胺甲[口恶]唑作为拟诺卡菌感染的首选治疗药物。

Objective To understand the clinical characteristics and treatment of nocardiosis.Methods The clinical data of a case of skin infection caused by Nocardia was analyzed.Wanfang,VIP,CNKI,and PubMed databases were searched using“Nocardiopsis”as the search term.The cases of nocardiosis reported at home and abroad were reviewed.Results The patient reported in Quanzhou First Hospital Affiliated to Fujian Medical University had multiple lumps on the left arm due to a fishbone stab,and was diagnosed as skin nocardiosis.After treatment with trimethoprim-sulfamethoxazole for 5 months,the patient largely recovered.Eight cases of nocardiosis,including the one reported here,were reviewed retrospectively.The clinical manifestation included skin infection in 4 cases,disseminated infection in 2 cases,lung infection and nasal infection in one case each.Three of the 4 patients with skin infection got the infection following injury by potato fork,toothpick,and fish bone,respectively.The other 4 patients might be infected due to poor immunity.Three patients with skin infection were cured following treatment with trimethoprim-sulfamethoxazole.The other five patients received different treatments.Finally,one patient died.All the other patients were cured.Conclusions Nocardia can colonize in a variety of environments,and cause infection after skin stabbing.Clinical diagnosis depends on molecular biological methods.It is not advisable to use cephalosporin empirically for treatment of nocardiosis.Trimethoprim-sulfamethoxazole is recommended as the first choice for the treatment of nocardiosis.