Yang H Q, Shi H Z, Tong Z H
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2017 Aug 12;40(8):588-591. doi: 10.3760/cma.j.issn.1001-0939.2017.08.009.
To evaluate the clinical features, chest radiological manifestations, microbiological examination and treatments of nocardial disease. A retrospective study was conducted to analyze the data of patients with nocardial infection admitted to Beijing Chaoyang Hospital from January 2010 to January 2016. The 13 patients, 6 males and 7 females, aged (51±17) years. Twelve cases were diagnosed with pulmonary nocardiosis, and 1 with disseminated nocardial infection. Most of these patients had complications: autoimmune diseases in 3 (2 with autoimmune hemolytic anemia and 1 with systemic lupus erythematosus), and bronchiectasis in 6 patients. The most common symptoms were cough, expectoration and fever. The main manifestations of CT scans included nodules or masses, bronchiectasis, ground glass opacity, cavity and pleural thickening. Six cases were confirmed by sputum smear microscopy, 4 by bronchoalveolar lavage, 2 by percutaneous lung biopsy and 1 by renal abscess puncture. After diagnosis, antibiotics such as Co-trimoxazole, amikacin, cephalosporins, imipenem, minomycin, or linezolid were used, and the 13 patients were all cured and discharged. Pulmonary nocardiosis was the most common clinical presentation of nocardial infection. Cough, expectoration and fever were the most common symptoms. The main findings of CT scans were nodules or masses, bronchiectasis, ground glass opacity, cavity and pleural thickening. The diagnosis of nocardiosis was not easy because of the non-specific clinical presentations and difficult culture of nocardia spp. Thus, high clinical suspicion of nocardiosis is necessary for earlier diagnosis and treatment.
评估诺卡菌病的临床特征、胸部影像学表现、微生物学检查及治疗情况。进行一项回顾性研究，分析2010年1月至2016年1月在北京朝阳医院收治的诺卡菌感染患者的数据。13例患者，男性6例，女性7例，年龄（51±17）岁。12例诊断为肺诺卡菌病，1例为播散性诺卡菌感染。这些患者大多有并发症：3例患有自身免疫性疾病（2例自身免疫性溶血性贫血，1例系统性红斑狼疮），6例患有支气管扩张。最常见的症状为咳嗽、咳痰和发热。CT扫描的主要表现包括结节或肿块、支气管扩张、磨玻璃影、空洞及胸膜增厚。6例经痰涂片镜检确诊，4例经支气管肺泡灌洗确诊，2例经经皮肺穿刺活检确诊，1例经肾脓肿穿刺确诊。确诊后使用复方磺胺甲恶唑、阿米卡星、头孢菌素、亚胺培南、米诺环素或利奈唑胺等抗生素治疗，13例患者均治愈出院。肺诺卡菌病是诺卡菌感染最常见的临床表现。咳嗽、咳痰和发热是最常见的症状。CT扫描的主要表现为结节或肿块、支气管扩张、磨玻璃影、空洞及胸膜增厚。由于临床表现不特异且诺卡菌属培养困难，诺卡菌病的诊断并不容易。因此，高度怀疑诺卡菌病对于早期诊断和治疗很有必要。
