Zhang Y, Shao C, Sun Y X, Xu K, Li J, Huang H, Xu Z J
International Medical Service Department, Peking Union Medical College Hospital, Beijing 100730, China.
Department of Respiratory Medicine, Peking Union Medical College Hospital, Beijing 100730, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Aug 12;43(8):665-669. doi: 10.3760/cma.j.cn112147-20200523-00627.
To describe the clinical features and prognosis of pulmonary actinomycosis in a tertiary Chinese hospital. We conducted a retrospective analysis of 32 patients diagnosed with pulmonary actinomycosis between January 2013 and December 2019. General characteristics, clinical manifestations, lab data, chest CT imaging, treatment and follow-up information were reviewed and analyzed. This study consisted of 19 males and 13 females, with a mean age of (58±12) years, ranging from 16 to 76 years. There were 26 cases with co-morbidities. Among them, there were 16 cases with pulmonary co-morbidity. Sixteen cases had a smoking history. Eight cases, 5 men and 3 women, with a mean age of (48±8) years, ranging from 41 to 58 years, received thoracic surgery for diagnosis. The remaining 24 cases who did not receive thoracic surgery consisted of 14 males and 8 females, with a mean age of (54±14)years, ranging from 16 to 76 years. Cough (25cases), expectoration (21 cases) and fever (16 cases) were the common clinical manifestations. The erythrocyte sedimentation rate (ESR) ranged from 2 to 114 mm/1 h, with a mean value of (28±31) mm/1 h. The ESR was elevated (>20 mm/1 h) in 15 cases. The C-reactive protein (CRP) ranged from 1 to 116 mg/L, with a mean value of (28±45) mg/L. The CRP was elevated (>8 mg/L) in 16 cases. Localized air-space consolidation (18 cases), pulmonary mass or nodules (16 cases) were the common chest CT manifestations. When compared with non-surgical cases, fever was the sole characteristic that was less common in cases with thoracic surgery (1 case in surgical group 11 cases in non-surgical group, 0.05). . was found in 7 cases (87.5%) who received thoracic surgery, in 16 (61.5%) specimens collected through bronchoscopy and in 10 (55.6%) sputum samples of good quality. All of our enrolled cases were administrated with oral antibiotics, and 14 cases were prescribed with intravenous antibiotics initially. Among them, 27 cases were administrated with more than one antibiotic. Penicillin, ampicillin and amoxillin were prescribed for 25 cases. Finally, 30 cases showed improvement or cure in our hospital. Pulmonary actinomycosis tended to develop in aged patients with co-morbidities. Cough, expectoration, fever and localized air-space consolidation were the common clinical and radiological manifestations, respectively. Actinomyces spp. could be found more easily in the surgically resected tissues than other specimens. The prognosis of our enrolled cases was good after treatment with combined antibiotics.
描述一家中国三级医院中肺放线菌病的临床特征及预后。我们对2013年1月至2019年12月间确诊为肺放线菌病的32例患者进行了回顾性分析。对患者的一般特征、临床表现、实验室数据、胸部CT影像、治疗及随访信息进行了回顾与分析。本研究包括19例男性和13例女性，平均年龄为（58±12）岁，年龄范围为16至76岁。26例患者有合并症。其中，有16例合并肺部疾病。16例有吸烟史。8例患者（5例男性和3例女性）平均年龄为（48±8）岁，年龄范围为41至58岁，接受了胸外科手术以明确诊断。其余24例未接受胸外科手术的患者包括14例男性和8例女性，平均年龄为（54±14）岁，年龄范围为16至76岁。咳嗽（25例）、咳痰（21例）和发热（16例）是常见的临床表现。红细胞沉降率（ESR）范围为2至114mm/1h，平均值为（28±31）mm/1h。15例患者的ESR升高（>20mm/1h）。C反应蛋白（CRP）范围为1至116mg/L，平均值为（28±45）mg/L。16例患者的CRP升高（>8mg/L）。局限性气腔实变（18例）、肺部肿块或结节（16例）是常见的胸部CT表现。与非手术病例相比，发热是胸外科手术病例中唯一较少见的特征（手术组1例，非手术组11例，P<0.05）。在接受胸外科手术的7例患者（87.5%）、通过支气管镜采集的16份标本（61.5%）以及10份质量良好的痰标本（55.6%）中发现了放线菌。我们纳入的所有病例均接受口服抗生素治疗，14例患者最初接受静脉抗生素治疗。其中，27例患者使用了一种以上抗生素。25例患者使用了青霉素、氨苄青霉素和阿莫西林。最后，30例患者在我院病情好转或治愈。肺放线菌病倾向于在有合并症的老年患者中发生。咳嗽、咳痰、发热和局限性气腔实变分别是常见的临床和影像学表现。与其他标本相比，在手术切除的组织中更容易发现放线菌属。我们纳入病例经联合抗生素治疗后的预后良好。
