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肺奴卡菌病的临床特征与诊治分析
Clinical characteristics,diagnosis and treatment of pulmonary nocardiosis
【摘要】 目的了解肺奴卡菌病的临床特征、影像学特点、临床诊治和预后。方法对四川大学华西医院2012年1月~2015年8月收治的2例确诊肺奴卡菌感染病例进行总结,并检索国内同期万方数据库和中国期刊全文数据库具有完整资料的肺奴卡菌感染病例48例,共50例进行回顾性分析。结果 50例奴卡菌感染病例中,健康者6例,44例有基础疾病病例中大多数为免疫功能低下者、曾使用糖皮质激素或免疫抑制剂者。常见症状包括咳嗽、咯痰、发热,影像学表现为结节或肿块、空洞、胸腔积液、实变。确诊手段主要包括痰培养及体液奴卡菌培养。治疗药物以复方磺胺甲恶唑治疗为基础,多和碳青霉烯类、喹诺酮类、氨基糖苷类、利奈唑胺、三代头孢等联合治疗。痊愈或好转42例(84%),无效1例(2%),死亡7例(14%)。结论免疫功能低下是肺奴卡菌感染的基础,临床表现无特异性,奴卡菌病原菌培养阳性是唯一确诊途径,治疗药物以复方磺胺甲恶唑为主,酌情联合用药。
【Abstract】 Objective To investigate the clinical and radiological characteristics,diagnosis,treatment and prognosis of pulmonary nocardiosis.Methods The clinical data of 2patients with pulmonary nocardiosis admitted to West China Hospital of Sichuan University from January 2012 to August 2015 were reported and the domestic literatrue in the same period with a total of 48 cases were reviewed.The above 50 patients were retrospectively analyzed.Results Among the50 cases of pulmonary nocardia infection patients,6cases were healthy subjects.There were 44 cases with basic disease with poor immune function,use of coaticosteroids or imunosuppressants.Common symptoms of 50 patients included cough,expectoration and fever.Computer tomography scan of chest showed nodules or masses,cavitary,pleural effusion,and consolidation.The most precise diagnosis methods mainly included sputum cultivation and body fluids cultivation.On the basis of Trimethoprim sulphamethoxazole,the patients were treated with carbapenem,quinolone and aminogly-coside,linezolid and the third-generation cephalosporin.There were 42cases(84%)were improved and cured,1cases(2%)was invalid and 7cases(14%)died.Conclusion Poor immune function is the basic of pulmonary nocardia infection with no characteristic clinical manifestations.Nocardia positive culture is the only way for diagnosis of disease.MP-SMX is the basic choice of treatment,in combination with other drugs according to patient’s condition.
【Key words】 Pulmonary nocardiosis; Clinical characteristics; Diagnosis; Treatment;
- 【文献出处】 西部医学 ,Medical Journal of West China , 编辑部邮箱 ,2016年01期
- 【分类号】R563.1
- 【被引频次】22
- 【下载频次】667