诺卡菌病34例临床分析及文献复习

Clinical Analysis of 34 Cases of Nocardiosis and Literature Review

目的对诺卡菌病的临床特征进行分析总结,为临床诺卡菌病的诊治提供更多经验,减少误诊。方法回顾性分析2016年1月-2022年12月复旦大学附属华山医院34例诺卡菌病患者的临床资料。结果17例为播散性诺卡菌感染,17例为单一部位感染:9例为肺部感染,6例为皮肤感染,2例为肌肉感染。其中26例因基础疾病曾使用免疫抑制剂。一般炎性指标稍升高,细胞免疫指标下降,其中播散性感染组与单一部位感染组比较,白细胞、C反应蛋白和CD8^(+)T淋巴细胞更低。影像学表现多为结节、肿块和胸腔积液。培养和二代测序是诊断的重要方法。大多数明确诊断后正规治疗预后较好,部分合并颅内感染者预后较差。结论诺卡菌病可累及全身多个系统,临床表现无特异性,易误诊,使用免疫抑制剂或免疫低下的中老年患者若出现慢性发热伴有全身以结节或肿块为表现的病灶,需警惕感染诺卡菌的可能。需积极寻找病原学依据,并结合感染部位、严重程度和药敏综合制定治疗方案。

Objective The clinical characteristics of Nocardiosis were analyzed and summarized to provide more experience for the diagnosis and treatment of clinical Nocardiosis and reduce misdiagnosis.Method The clinical data of 34 patients with Nocardia from January 2016 to December 2022 in Huashan Hospital affiliated with Fudan University were retrospectively analyzed.Result 17 cases had disseminated Nocardia infection,and 17 cases were infected with individual sites:9 cases were pulmonary,6 cases were skin,2 cases were muscle.Among them,26 had used immunosuppressants for underlying diseases.The general inflammatory indicators were slightly increased,and the cellular immune indicators were decreased.The disseminated infection group had less CD8^(+)T lymphocytes,white blood cells,and C-reactive protein than the single site infection group.Imaging findings mostly showed nodules,masses and pleural effusion.Culture and sequencing are important diagnostic methods.After a definite diagnosis,most patients had a better prognosis after normal treatment,but the prognosis of some patients with intracranial infection is poor.Conclusion Nocardiosis can affect multiple systems of the body,with non-specific clinical manifestations and easy to be misdiagnosed.Patients who are middle-aged or older,use immunosuppressive medications,or have hypoimmunity should be aware that a nocardiosis infection may be the cause of a persistent fever and systemic lesions that appear as nodules or masses.Therefore,it is necessary to actively seek the etiological basis and formulate a comprehensive treatment plan combining the infection site,severity and drug sensitivity.