支气管扩张合并甜味诺卡菌、结核分枝杆菌和烟曲霉感染1例

Bronchiectasis complicated with Nocardia amamiensis,Mycobacterium tuberculosis and Aspergillus fumigatus infection:a case report

患者女,61岁,因“反复咳嗽4年,加重伴发热6 d”于2023年5月4日收入深圳市中医院。胸部CT示支气管扩张伴肺部感染;痰涂片显微镜检查提示诺卡菌可能,痰真菌培养检出烟曲霉;抗诺卡菌及抗烟曲霉治疗数天后,炎症指标有所下降,但仍有低热。行支气管肺泡灌洗液培养和宏基因组测序,检出甜味诺卡菌、结核分枝杆菌及烟曲霉3种可疑致病菌,经抗感染治疗,病情好转。对于混合感染的诊断,多种检验方法相结合,可以提高病原菌的正确诊断率,从而更好地指导临床治疗。

An elderly female patient was admitted to Shenzhen Traditional Chinese Medicine Hospital on May 4,2023,due to recurrent cough for 4 years and aggravation with fever for 6 days.Chest CT showed bronchiectasis with pulmonary infection.Sputum smear microscopy indicated the possibility of Nocardia,and sputum fungal culture revealed Aspergillus fumigatus.After several days of anti-Nocardia and anti-Aspergillus fumigatus treatment,the patient′s inflammatory index decreased but she still had a low-grade fever.Effective communication between the laboratory and clinicians facilitated the culture of bronchoalveolar lavage fluid and the detection of metagenomic next-generation sequencing.The patient made progress after receiving anti-infection treatment for three suspected pathogenic bacteria-Nocardia amamiensis,Mycobacterium tuberculosis,and Aspergillus fumigatus-detected by the above methods.For the diagnosis of coinfection,the combination of multiple methods can improve the accuracy of pathogen identification,thereby better guiding clinical treatment.