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严重播散性巴西奴卡菌肺炎伴正常免疫功能:病例报告。

Severe disseminated Nocardia brasiliensis pneumonia with normal immune function: A case report.

机构信息

Department of General Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming City, Yunnan Province, China.

Department of general surgery, Chuxiong Yi Autonomous Prefecture People's Hospital, Lucheng Town, Chuxiong City, Chuxiong Yi Autonomous Prefecture, Yunnan Province, China.

出版信息

Medicine (Baltimore). 2024 Jan 5;103(1):e36402. doi: 10.1097/MD.0000000000036402.

Abstract

RATIONALE

Members of the genus Nocardia brasiliensis are Gram-positive, aerobic bacteria and exist ubiquitously in most environments. In recent years, the incidence of Nocardia brasiliensis has increased significantly and become a global concern. It may be predominantly caused pulmonary infections in immunocompromised hosts. Interestingly, however, we found that it can be present not only on immunocompromised hosts, but also to infect patients with a normal immune system.

PATIENT CONCERNS

We report a very rare case of a 49-year-old immunocompetent man with disseminated Nocardia brasensis pneumonia. He had a fever for 14 days (maximum temperature about 38°C) and a history of mass rupture.

DIAGNOSES

Severe Disseminated Nocardia brasiliensis pneumonia with normal immune function.

INTERVENTIONS

No.

OUTCOMES

The patient was finally diagnosed with Severe Disseminated Nocardia brasiliensis pneumonia and received compound sulfamethoxazole treatment for 4 months.

LESSONS SUBSECTIONS

Our report highlights when cold pus appears in soft tissues such as the lower limbs, neck, nose, scalp, etc, should prompt timely evaluation and biopsy for definitive diagnosis. Be alert to a normally immunocompetent, disseminated Nocardia brasiliensis infection. Early recognition and effective treatment are necessary conditions for successful results. This would allow for better disease prognostication while enabling physicians to develop more effective treatment strategies.

摘要

背景

巴西奴卡菌属成员是革兰阳性需氧菌,广泛存在于大多数环境中。近年来,巴西奴卡菌的发病率显著增加,引起全球关注。它可能主要引起免疫功能低下宿主的肺部感染。然而,有趣的是,我们发现它不仅存在于免疫功能低下的宿主中,还可以感染免疫系统正常的患者。

病例介绍

我们报告了一例非常罕见的免疫功能正常的 49 岁男性播散性巴西奴卡菌肺炎病例。他发热 14 天(最高体温约 38°C),有肿块破裂史。

诊断

免疫功能正常的严重播散性巴西奴卡菌肺炎。

干预措施

无。

治疗结果

最终诊断为严重播散性巴西奴卡菌肺炎,给予复方磺胺甲噁唑治疗 4 个月。

病例启示

当下肢、颈部、鼻部、头皮等软组织出现冷脓肿时,应及时评估和活检以明确诊断。对于免疫功能正常的播散性巴西奴卡菌感染应保持警惕。早期识别和有效治疗是获得良好结果的必要条件,这将有助于更好地预测疾病预后,并使医生能够制定更有效的治疗策略。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/31dd/10766318/cac5d00dc028/medi-103-e36402-g001.jpg

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