15例肺诺卡菌病的临床特征

Clinical characteristics of 15 patients with pulmonary nocardiosis

目的 分析肺诺卡菌病患者的临床特征。方法 回顾性分析某院2019年9月-2022年12月经宏基因组学二代测序技术(mNGS)确诊为肺诺卡菌病患者的临床资料,分析总结其临床特征。结果 15例肺诺卡菌病患者中,男性14例,女性1例,年龄36~83岁。14例患者合并有基础疾病,其中3例患者长期使用免疫抑制剂或糖皮质激素。单纯肺诺卡菌病11例,两个部位同时受侵犯的4例,其中在肺诺卡菌病基础上播散至血液2例、肝脏1例、中枢神经系统1例。咳嗽、咳痰是最常见症状(73.33%),可出现中性粒细胞百分比、C反应蛋白和降钙素原升高,CD4+T细胞计数和清蛋白降低。胸部影像学表现为单侧肺部病变多见,多发生在右肺,主要表现为空洞、斑片影、支气管扩张、结节影、树芽征和实变影。15例患者中仅用磺胺类治疗1例,在磺胺类基础上联合其他抗菌药物治疗12例,其他抗菌药物联合治疗2例。14例患者治疗好转,1例患者死亡。结论 肺诺卡菌病好发于合并基础疾病和免疫功能低下的患者,临床特征不典型,容易误诊,对患者标本进行mNGS检测能快速、准确诊断。早期、足量、足疗程给予磺胺类药物为基础的联合治疗,一般预后良好。

Objective To analyze the clinical characteristics of patients with pulmonary nocardiosis(PN).Methods Clinical data of patients with PN diagnosed by metagenomic next-generation sequencing(mNGS)in a hospital from September 2019 to December 2022 were retrospectively analyzed,and patients’clinical characteristics were analyzed and summarized.Results Among the 15 patients with PN,14 were males and 1 was female,aged 36-83 years old.14 patients had underlying diseases,3 of whom used immunosuppressants or glucocorticoids chronically.11 cases were simple PN,and two sites were simutaneously invaded in 4 cases,2 of whom spread to the blood,1 case to the liver,and 1 case to the central nervous system on the basis of PN.Cough and expectoration were the most common symptoms(73.33%).The percentage of neutrophils,C-reactive protein and procalcitonin increased,CD4+T cell count and albumin decreased.Chest imaging showed that unilateral lung lesions were more common,mostly occurred in the right lung in the form of cavities,patchy shadows,bronchiectasis,nodular shadow,tree-in-bud sign,and consolidation shadow.Among the 15 patients,only 1 was treated with sulfonamides,12 were treated with sulfonamides combined with other antimicrobial agents,and 2 were treated with other antimicrobial combination.14 patients improved after treatment,and 1 patient died.Conclusion PN often occurs in patients with underlying diseases and compromised immunity.With atypical clinical characteristics,it is prone to be misdiagnosed.mNGS can diagnose promptly and accurately.Early,adequate,and full-course sulfonamide-based antimicrobial combination treatment generally results in good prognosis.