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播散性诺卡菌病11例临床分析
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Abstract:
目的：分析播散性诺卡菌病(DN)临床特点，为诊疗提供经验。方法：回顾性分析广西医科大学第一附属医院2010年1月~2022年11月确诊的11例DN患者的临床资料。结果：(1) 男9例，女2例，中位年龄53岁，>45岁者9例(81.8%)；7例有职业接触史，8例有基础疾病。(2) 受累部位包括肺(10/11)、中枢神经系统(7/11)、皮肤(6/11)和血液系统(2/11)。(3) 累及肺部者主要症状为咳嗽(10/10)、咳脓痰(8/10)、胸痛(4/10)、咯血(1/10)，胸部CT表现为结节(7/10)、斑片影(7/10)、团块影(2/10)、胸腔积液(7/10)、空洞(5/10)，支气管镜下为化脓性炎症(6/7)；累及中枢神经系统者出现意识障碍、头晕头痛(3/7)，部分呈隐匿性(4/7)，头颅CT可见低密度灶(6/7)，头颅MRI可见环形强化的异常信号灶(3/3)；累及皮肤者表现为脓疱、脓肿、结节和溃疡。(4) 病原学结果均为诺卡菌阳性，采用甲氧苄啶–磺胺甲噁唑(TMP-SMZ)等抗菌药物的多药联合全身抗感染治疗及局部处理，8例好转，2例恶化，1例死亡。结论：DN多见于中老年男性，常有职业接触史和基础疾病，临床表现与感染部位相关，主要为发热和相应部位的化脓性感染表现，伴高血象、PCT和炎症指标升高，较常累及肺部、中枢神经系统和皮肤，应注意部分中枢神经系统受累者症状隐匿；确诊依靠病原学获得诺卡菌阳性结果；治疗首选TMP-SMZ联合多种抗生素全身抗感染治疗及局部脓肿处理。
Objective: To an-alyze the clinical characteristics of disseminated nocardiosis (DN), so as to provide experience for diagnosis and treatment. Methods: From January 2010 to November 2022, Clinical data of 11 pa-tients with DN diagnosed in the First Affiliated Hospital of Guangxi Medical University were retro-spectively analyzed. Results: (1) 9 were males and 2 were females, the median age was 53 years and >45 years in 9 cases (81.8%). 7 cases had occupational contact history and 8 cases had under-lying diseases. (2) Affected sites include lung (10/11), central nervous system (7/11), skin (6/11), and blood system (2/11). (3) The main symptoms of lung involvement were cough (10/10), puru-lent sputum (8/10), chest pain (4/10), and hemoptysis (1/10). Chest CT were nodules (7/10), patch shadow (7/10), mass shadow (2/10), pleural effusion (7/10), and cavity (5/10), Suppurative in-flammation under bronchoscope (6/7). Consciousness disturbance, dizziness and headache (3/7) in patients with central nervous system involvement, and some of them are occult (4/7). Skull CT showed low-density foci (6/7), and head MRI showed abnormal signal foci with ring intensification (3/3). Skin involvement is characterized by pustules, abscesses, nodules, and ulcers. (4) The etio-logical results were all positive for Nocardia. After multi-drug combined systemic anti-infection treatment and local treatments with antibacterial agents such as trimethoprim-sulfamethoxazole (TMP-SMZ), 8 cases were improved, 2 cases worsened, and 1 case died. Conclusion: DN is more common in middle-aged and elderly men with a history of occupational contact and underlying dis-eases, and its clinical manifestations are related to the site of infection, mainly fever and suppura-tive infection of the corresponding site, accompanied by high blood image, PCT and elevated in-flammatory indicators. It is more often involved in the lungs, central nervous system
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