甘肃省10例诺卡菌病患者的临床特征

Clinical characteristics of 10 patients with nocardiosis in Gansu Province

摘要:

目的 分析诺卡菌病患者的临床特征，为诺卡菌病的诊疗提供经验。 方法 回顾性分析2017年1月—2021年11月兰州大学第一医院诊断为诺卡菌病住院患者的临床资料。 结果 共收治10例诺卡菌病患者，男性8例，女性2例，平均年龄(59.1±15.4)岁，≥60岁3例，职业类型以农民为主(5例，50.0%)。肺诺卡菌病5例，皮肤诺卡菌病4例，播散性诺卡菌病1例。菌株分型主要为星形诺卡菌(5株)。80.0%患者有基础疾病，主要为支气管扩张症(3例)、长期服用糖皮质激素(3例)。肺诺卡菌病患者均有咳嗽、咳痰，查体均可闻及啰音; 皮肤诺卡菌病主要为病灶处红肿、流脓; 1例脑诺卡菌病系播散性感染，有意识丧失中枢神经系统受累表现。患者C反应蛋白为72.75(39.25~96.74)mg/L，均有所升高。肺部CT检查主要为大小不等的小结节影和斑片影(6例)、双肺多发索条影(4例)、大片磨玻璃阴影(3例)、胸腔积液(3例)。所有患者经积极抗感染治疗，9例好转出院，1例病情加重放弃治疗。 结论 对有肺部基础疾病及抵抗力差的中老年人，常规抗感染治疗效果不佳时，需考虑诺卡菌感染，积极送病原学检查是关键。

Abstract:

Objective To analyze the clinical characteristics of patients with nocardiosis, and provide experience for the diagnosis and treatment of nocardiosis. Methods Clinical data of hospitalized patients with nocardiosis diagnosed in the First Hospital of Lanzhou University between January 2017 and November 2021 were analyzed retrospectively. Results A total of 10 patients with nocardiosis were admitted for treatment, 8 were males and 2 were females, with an average age of (59.1±15.4) years, 3 cases were ≥60 years old. The main occupation of patients was far-mer (n=5, 50.0%). There were 5 cases of pulmonary nocardiosis, 4 cases of cutaneous nocardiosis and 1 case of disseminated nocardiosis. Nocardia asteroides was the main pathogen (n=5). 80.0% of the patients had underlying diseases, mainly bronchiectasis (n=3) and long-term use of glucocorticoids (n=3). Patients with pulmonary nocardiosis had cough and expectoration, rales could be heard during physical examination; cutaneous nocardiosis was mainly swelling and purulent at the focus; one case of cerebral nocardiosis was disseminated infection with loss of consciousness and with central nervous involvement. C-reactive protein in patients was 72.75 (39.25-96.74) mg/L, all increased. Pulmonary CT examination showed small nodule shadow and patch shadow (n=6), multiple cord shadow of both lung (n=4), large ground-glass shadow (n=3) and pleural effusion (n=3). After active anti-infective treatment, 9 patients got well and were discharged, one patient gave up treatment due to aggravation of disease. Conclusion For the middle-aged and elderly people with underlying pulmonary diseases and poor resistance, Nocardia infection should be considered when the effect of routine anti-infective treatment is poor, and the key is to actively perform pathogenic detection.