播散性肺豚鼠耳炎奴卡菌病1例并文献复习

Disseminated pulmonary nocardiosis caused by nocardia otitidiscaviarum:A case report and literature review

本文报道了1例播散性肺豚鼠耳炎奴卡菌病的起病过程、临床表现、影像表现、诊断和治疗经过、预后。在中国知网、万方数据库以"肺豚鼠耳炎奴卡菌"为检索词进行检索,以"pulmonary"和"Nocardia otitidiscaviarum"为检索词在PubMed数据库检索近5年肺豚鼠耳炎奴卡菌病病例,并复习国内外相关文献。通过总结肺豚鼠耳炎奴卡菌病的临床特点,提高临床医师对该病的诊治水平。患者男,59岁,因"胸闷、气喘7 d"入院,入院诊断社区获得性肺炎、呼吸衰竭。痰培养及肺泡灌洗液高通量基因测序提示肺豚鼠耳炎奴卡菌,影像表现为肺实变伴有液化坏死,合并右大腿软组织感染伴脓肿形成,考虑播散性肺豚鼠耳炎奴卡菌病。入院后积极治疗病情明显好转,随访半年未复发。肺豚鼠耳炎奴卡菌病临床少见,临床表现和肺部影像改变无特异性,病原学检查是诊断的金标准,复方磺胺甲恶唑是首选的经验性用药。重症豚鼠耳炎奴卡菌肺炎临床少见而且预后较差,病死率高,早期诊断、精准治疗有助于改善患者预后。

This paper reported the onset process,clinical manifestations,imaging features,diagnosis and treatment process,and prognosis of a case of disseminated pulmonary nocardiosis caused by nocardia otitidiscaviarum.In the China National Knowledge Infrastructure and Wanfang Database,we searched for cases of pulmonary nocardiosis caused by nocardia otitidiscaviarum in the past 5 years using the search term"pulmonary nocardia otitidiscaviarum",and then using the search term"pulmonary"and"Nocardia otitidiscaviarum"we searched in PubMed.We reviewed relevant literature domestically and internationally.By summarizing the clinical characteristics of pulmonary nocardiosis caused by nocardia otitidiscaviarum,we aim to improve the diagnosis and treatment of this disease.A 59-year-old male patient was admitted due to"chest tightness and asthma for 7 days"and was diagnosed with community acquired pneumonia,with respiratory failure upon admission.Sputum culture and high-throughput gene sequencing of alveolar lavage fluid suggested pulmonary nocardia otitidiscaviarum.Imaging manifestation is lung consolidation accompanied by liquefaction necrosis.The patient also showed right thigh soft tissue infection and abscess formation,suggesting disseminated pulmonary nocardiosis caused by nocardia otitidiscaviarum.After admission,active treatment improved the patient's condition significantly,with no recurrence after a follow-up of six months.Pulmonary nocardiosis caused by nocardia otitidiscaviarum is rare in clinical practice,with no specific clinical manifestations and lung imaging changes.Etiological examination is the gold standard for diagnosis,and compound sulfamethoxazole is the preferred empirical medication.Severe pulmonary nocardiosis caused by nocardia otitidiscaviarum is rarely seen in clinical practice,with poor prognosis and high mortality rate.Early diagnosis and precise treatment can help improve patient prognosis.