21例肺诺卡菌病临床特征及耐药性分析

Analysis of strain distribution,clinical characteristics and antimicrobial susceptibility in 21 cases pulmonary nocardiosis

目的了解肺诺卡菌的菌种分布、感染特征及菌种耐药情况,为肺诺卡菌病的诊断和治疗提供依据。方法回顾性分析2021年1月至2023年12月在安徽省胸科医院确诊为肺诺卡菌病患者的临床资料,分析诺卡菌菌种分布、临床特点及耐药情况。结果21例肺诺卡菌病确诊患者共鉴定出诺卡菌22株,其中1例有合并感染。菌种包括盖尔森基兴诺卡菌7株(31.8%)、皮疽诺卡菌4株(18.2%)、脓肿诺卡菌2株(9.1%)、豚鼠耳炎诺卡菌2株(9.1%)、星型诺卡菌、华莱士诺卡菌、亚洲诺卡菌和南非诺卡菌各1株(4.5%),另有3株(13.6%)未能鉴别种属。患者平均年龄60.8岁,男女性别比为1∶1.1,症状主要表现为咳嗽/咳痰(85.7%)、胸闷(38.1%)、咯血(28.6%)等;胸部CT主要表现为支气管扩张(57.1%)及斑片状影(57.1%)等;气管镜可直观清晰展示气管内黏液、糜烂或血凝块等典型病变特征。11例药物敏感试验结果显示诺卡菌对利奈唑胺、阿米卡星敏感。结论肺诺卡菌病多为中老年患者,男女比例相当,感染菌种主要为盖尔森基兴诺卡菌,对利奈唑胺、阿米卡星敏感。患者临床表现不具备特异性,CT及电子支气管镜下表现具有一定的辅助诊断价值。

Objective To understand the distribution of strains of Nocardia pseudomallei,infection characteristics and strain resistance of Nocardia pseudomallei,and to provide a basis for the diagnosis and treatment of pulmonary nocardiosis.Method Clinical data of patients diagnosed with pulmonary nocardiosis in Anhui Chest Hospital from January 2021 to December 2023 were retrospectively analysed to analyse the distribution of Nocardia strains,clinical characteristics and drug resistance.Result A total of 22 strains of Nocardia were identified in 21 patients with confirmed pulmonary nocardiosis,including one case with co-infection.The strains included 7 strains(31.8%)of Nocardia gelsenkirchen,4 strains(18.2%)of Nocardia dermatoglycans,2 strains(9.1%)of Nocardia abscessus,2 strains(9.1%)of Nocardia guinea-pig otitis,and 1 strain(4.5%)of each of Nocardia asteroidea,Nocardia Wallace,Nocardia asiatica and Nocardia africanica,and 3 strains(13.6%)could not be identified to the species genus.The average age of the patients was 60.8 years old,and the sex ratio was 1:1.1.Symptoms mainly included cough/sputum(85.7%),chest tightness(38.1%),hemoptysis(28.6%),etc.Chest CT mainly showed bronchial dilatation(57.1%)and plaque(57.1%),etc.Bronchoscopy could visualize and clearly show the typical characteristics of the lesions such as mucus,vesiculocytes,or blood clots in the trachea.The results of drug sensitivity test in 11 cases showed that Nocardia was sensitive to linezolid and amikacin.Conclusion Pulmonary nocardiosis is mostly in middle-aged and elderly patients,with equal proportion of men and women,and the infecting strain is mainly Nocardia gelsenkirchen,which is sensitive to linezolid and amikacin.The clinical manifestations of the patients were not specific,and CT and electronic bronchoscopic manifestations had certain auxiliary diagnostic value.