奴卡氏菌病并文献复习总结

奴卡氏菌病为少见病 ,自１９８０年我国首次报道了奴卡氏菌病以来 ,仍陆续有文献报道［１，２］。最近 ,我科发现奴卡氏菌病１例 ,随着器官移植、肿瘤化疗的广泛开展 ,免疫抑制剂、糖皮质激素应用的增加及获得性免疫缺陷综合症(ＡＩＤＳ)病例增多 ,奴卡氏菌病发病率可能有上升趋势。现将本病例结合奴卡氏菌病的有关文献复习 ,以提高对本病的认识。１临床资料患者女性 ,２６岁 ,农民 ,因发热、咳嗽５个月 ,气急半个月于２０００年６月３０日入院 (住院号３０６５４４)。患者于５个月前无明显诱因下出现发热 (Ｔ≥３９℃ ) ,无寒战 ,伴咳嗽 ,…     

肺奴卡菌感染一例并文献复习

奴卡菌感染并不常见,多发生在免疫功能障碍或合并其他进行性疾病的患者,如长期应用糖皮质类激素、免疫抑制剂、广谱抗生素和2糖尿病等免疫功能低下的患者.肺部是奴卡菌感染最常见部位[1],现将本院呼吸科诊断的一例肺囊肿合并奴卡菌感染患者病历报道并结合文献复习如下.     

奴卡氏菌病3例临床分析

奴卡氏菌病是由奴卡氏菌引起的一种少见但严重的感染 ,通常呈亚急性或慢性化脓性疾病。随着器官移植、肿瘤化疗的广泛开展 ,免疫抑制剂、糖皮质激素应用的增加及艾滋病（ＡＩＤＳ）病例增多 ,奴卡氏菌病发病率可能有上升趋势。最近二年我院发现奴卡氏菌病３例 ,现临床分析如下。１临床资料例１ ,女性 ,２６岁 ,农民 ,因发热、咳嗽５月 ,气急半月 ,于２０００年６月入院。患者５月前无明显诱因下出现发热（Ｔ≥３９℃） ,无寒战 ,伴咳嗽 ,咳少量粘液痰 ,并感乏力、盗汗 ,当地拟诊为肺部感染 ,应用多种抗生素治疗无效 ,半个月前出现气急。入院…     

奴卡菌感染2例并文献复习

正奴卡菌病是奴卡菌属引起的局限或播散性化脓性疾病,可呈急性、亚急性或慢性经过。此病既往罕见。但近年来,随着免疫功能低下、淋巴瘤、艾滋病、接受细胞毒药物化疗或长期大量使用免疫抑制剂等患者的增多,该病发病率较前增加。现就我院2例奴卡菌感染病例报告如下。例1:女,45岁,主因"咳嗽、咳痰4个半月,加重伴发热1天"于2015年9月22入院。患者4个半月     

特发性血小板减少性紫癜伴奴卡菌感染1例

奴卡菌感染主要引起皮肤、皮下和肺部的急、慢性化脓性表现,少数可呈全身性感染.约半数奴卡菌感染患者发病前有免疫功能低下,如患有肿瘤、慢性阻塞性肺病、艾滋病和器官移植,或长期应用激素[1,2].本院收治1例特发性血小板减少性紫癜伴星形奴卡菌感染的患者,报道如下.……     

皮疽奴卡菌感染致右腰部脓肿1例病例报告

皮疽奴卡菌是2019年公布的感染病学名词,又称鼻疽奴卡菌,隶属于奴卡菌属[1 ].1888 年 N O-C A RD首次分离出奴卡菌,其后国内也有临床病例报道[2 ].奴卡菌病临床少见,多见于免疫力低下者,近年有增长趋势[3 ].奴卡菌病由奴卡菌感染所致,该菌通过呼吸道或受损的皮肤入侵,引起肺部、皮肤、中枢系统等感染,肺为主要受累脏器,病理表现为亚急性或慢性化脓性或肉芽肿性病变[4-7 ].国内以星形奴卡菌最为多见,其次为巴西奴卡菌,皮疽奴卡菌感染临床报道极少.2018年,本院收治的1例患者,右侧腰部脓肿分离出1株皮疽奴卡菌,现报道如下.     

肾移植术后肺奴卡菌病两例病例报告并文献复习

<正>奴卡菌病是由奴卡菌引起的一种急性、亚急性或慢性感染性疾病。该病在1890年由Eppinger等首先报导,常见于免疫功能低下患者,尤其是器官移植患者,一旦感染,死亡风险极高[1-2]。现将解放军总医院第三医学中心确诊的肾移植术后发生肺奴卡菌病的2例病例分析报告如下。1临床资料病例1患者男性,48岁。主因"同种异体肾移植术后半年,发热、咳嗽伴乏力、纳差1周"入院。患者因"慢性肾小球肾炎、尿毒症"半年前行同种异体肾移植术,术后常规三联免疫抑制剂(他克莫司+吗     

奴卡菌菌血症合并肺部感染一例并文献复习

奴卡菌是主要存在土壤中的需氧型革兰阳性菌,引起人类致病的主要是星型奴卡菌。奴卡菌病是免疫能力受损患者易感疾病,患病年龄大多在20~50岁,男性多于女性（3：1）,地区之间也存在很大差异。奴卡菌易感人群有：血液系统疾病患者、器官移植患者、人类免疫缺陷患者（HⅣ）、长期使用糖皮质激素或细胞毒性药物的患者[2-3]。近年来,慢性阻塞性肺病（c0PD）患者感染奴卡菌的发病率逐渐增加,COPD的危险因素不亚于HIV或移植患割弘”。COPD患者感染奴卡菌的危险因素有．COPD合并其他疾病（如肿瘤）,基础免疫较低;长期使用糖皮质激素,导致免疫力低下;抗菌药物使用疗程不够。本文笔者将从临床药师的角度,对1例COPD继发奴卡菌菌血症患者的主要治疗方案进行分析。     

奴卡氏菌致全身多发脓肿的诊断学特征分析

目的探讨奴卡氏菌致全身多发脓肿患者的诊断学特征。 方法回顾性分析1例于2017年12月26日在济宁医学院附属医院神经内科就诊的奴卡氏菌感染患者的临床资料,并文献复习。 结果患者临床表现为咳嗽、发热、发作性四肢抽搐伴有头痛,查体见胸壁脓肿破溃,脓液流出;脑脊液检查细胞数8×10⁶/L,蛋白定量1.448g/L,均正常,普通培养未见细菌、真菌及抗酸杆菌;胸部CT见双肺多发空洞及间质改变;颅脑磁共振(MRI)见额叶不均匀异常信号,多发环壁及周围水肿,环壁被强化;胸壁脓液培养3 d后见黄白色菌落,弱抗酸染色及革兰染色见分枝状杆菌,符合奴卡氏菌特点。给予磺胺嘧啶钠、阿莫西林克拉维酸钾抗奴卡氏菌感染治疗后患者症状改善,颅脑MRI示额叶脓肿较前明显吸收。 结论奴卡氏菌致全身多发脓肿患者病程迁延不愈,临床及影像学表现缺乏特异性。常规抗生素治疗欠佳且合并免疫抑制患者,应高度警惕此病并尽快行奴卡氏菌的培养鉴定。     

肺巴西奴卡氏菌病(1例报告及文献复习)

奴卡氏菌属引起的局限性或全身性化脓性疾病,国内已报道16例。大多数病例由星形奴卡氏菌引起。本例是该菌引起肺部感染后血内感染,从血中分离出巴西奴卡氏菌确诊。者男,55岁。因咳嗽、咯浓痰、发热及畏寒1周于1988年3月5日入院。30年前患过“肺炎”,经住院“治愈”。体检:T 39℃、P98、R20,B P 17.3/11.5kPa。神清,体瘦,巩膜轻度黄染,右下肺可闻湿性罗音。心脏听诊无异常。肝右肋下5.5 cm、质软、边钝,轻度压痛。辅助检查:血象:WB C16.5×10~9/L,N82%、L18%、Hb     

Pulmonary ascariasis: two cases in Austria and review of the literature

Ascariasis is the most common helminthic infection, with an estimated worldwide prevalence of 25%. The estimated mortality ranges from 0.8 to 1%. Second stage larvae pass through the intestinal wall and migrate via the portal vein system to the liver and then proceed to the lungs, where they may produce pneumonia and eosinophilia. Symptoms include wheezing, dyspnea, nonproductive cough, hemoptysis, and fever. Two cases of pulmonary ascariasis in Austrian males are reported. Both patients presented with dyspnea, nonproductive cough, fever, and eosinophilia (19 and 26%). One patient additionally had pulmonary infiltrates. Recent travel history was unremarkable in both individuals. Serology for Ascaris was positive twice in both patients, while microscopic examination of stool was negative for helminthic ova. Extensive diagnostic procedures were performed to rule out possible differentials for the patients symptoms. Both patients responded well to antiparasitic treatment with albendazole 400 mg and mebendazole 100 mg q12h for 3 days, respectively. This report highlights the importance of considering parasitic infection in patients presenting with eosinophilia and pulmonary symptoms also in Austria.     

肝移植后肺部细菌合并真菌感染的诊治

背景:肝移植患者因常规服用免疫抑制剂,免疫力低下,极易发生肺部病原微生物感染.目的:回顾分析1例肝移植后突发肺部细菌联合真菌感染患者诊疗经过,总结相关临床治疗经验.方法:1例乙肝肝硬化失代偿期女性患者行同种异体原位肝移植后8个月余突发畏寒高热入院,经实验室检查结合胸部CT检测考虑为细菌引起的肺部感染,给予头孢哌酮钠舒巴坦钠抗菌治疗.结果与结论:治疗后临床症状缓解.1周后复查胸部CT提示:双肺下叶片状渗出较前有所吸收,但背段出现片状"毛玻璃样改变",考虑合并真菌感染,停用头孢哌酮钠舒巴坦钠,改用氟康唑针,治疗1周后行胸部CT:双肺下叶背段渗出较前吸收,出院继续口服氟康唑10d,复查CT:双肺渗出性改变完全吸收.     

Tracheopathia osteochondroplastica

The case of a male, 61 years of age, presenting with occasional hemoptysis and shortness of breath (duration of 1 year) is reported. Congestive heart failure was presumed and supported by chest x-ray and echocardiography. The patient improved with diuretic and angiotensin converting enzyme (ACE) inhibitor therapy, but continued to experience cough and occasional hemoptysis. Bronchoscopy revealed numerous firm nodular projections within the trachea with distribution along the cartilaginous rings. Tracheopathia osteochondroplastica (TPO) was diagnosed. TPO is an uncommon, benign, but slowly progressive disease of unknown etiology. It is characterized by endoluminal projection of cartilaginous and bony nodules arising in the submucosa of the trachea. Involvement may extend to lobar or segmental bronchi. TPO should be considered in cases where cough, dyspnea, persistent pulmonary infection, hoarseness, or recurrent hemoptysis remain after appropriate treatment of other presumptive underlying causes.     

Extracorporeal membrane oxygenation for refractory, life-threatening, and herpes simplex virus 1-induced acute respiratory distress syndrome. Our experience and literature review

We report our first experience of treating an immunocompetent adult patient with acute respiratory distress syndrome (ARDS) due to type 1 herpes simplex (HSV1) pneumonitis, using extracorporeal membrane oxygenation (ECMO). Similar cases reported in literature are reviewed as well. The therapeutic options for this particular complication are discussed. Pneumonia caused by HSV1 is a rare finding in immunocompetent individuals; it occurs more often in immunosuppressed and ventilated patients. It is a severe illness; therefore, early diagnosis and initiation of treatment are imperative. Diagnosis is based on cytologic and histologic findings, viral cultures, or serologic methods. This condition can be reversible; however, often, it can progress into refractory ARDS with limited therapeutic options available. We demonstrate the causative role of HSV1 in refractory ARDS of a previously healthy 18-year-old man who presented to the intensive care unit with acute respiratory distress after a week of flulike syndrome. Due to severe hypoxemia and hypercarbia, the patient required mechanical ventilation and later emergent blood oxygenation with extracorporeal support. For the first time in this condition, we used venovenous ECMO management, to rest the lung, sustain blood oxygenation and end-organ oxygen delivery, and promote potential lung recovery. During ECMO and after our etiologic diagnosis, specific therapy was introduced. After viral negativization, corticosteroid therapy (Meduri protocol) was initiated. Extracorporeal membrane oxygenation allowed us to initiate therapy while maintaining end-organ oxygenation and support the patient until lung recovery. After 18 days of ECMO, our patient recovered completely. Near-normal lung structures and functions were documented on a chest x-ray/computed tomography, thoracic ultrasonography, and pulmonary functional tests at hospital discharge and at a 1-year follow-up. Data suggest that severe pulmonary involvement in HVS1 infection associated with septicemia/shock is a rare but often fatal in immunocompetent adult as well. We suggest that ECMO might be the selected treatment for severe refractory ARDS in this clinical scenario. It seems to be an effective and useful ultimate therapeutic strategy for preventing death and furthermore permitting near-full pulmonary function recovery.     

老年患者由产气荚膜梭菌引起肺部和血流感染的临床和实验室分析及相关文献复习

目的　分析产气荚膜梭菌引起肺部和血流感染的临床和实验室特点,为临床诊治提供依据。方法　报道一例产 气荚膜梭菌引起肺部感染和血流感染的病例,检索产气荚膜梭菌引起的肺部感染、血流感染文献,结合报道回顾性分析 其临床和实验室特点。结果　报道者系并发慢性疾病的老年男性,胸腔积液和血液分离出产气荚膜梭菌,经抗感染和引 流治疗后,临床症状好转。检索到详尽记录的肺部感染或胸腔积液和血流感染文献各29 例和33 例。29 例肺部感染患者中, 男性21 例和女性8 例,26 例患者伴慢性疾病。临床表现相似,前四位的症状和体征为呼吸困难（22 例）、胸痛（15 例）、 发热（15 例）和咳嗽（12 例）。胸腔积液早期一般呈浑浊、黄绿色或者稀薄血性,晚期为脓性、棕褐色伴恶臭。33 例 血流感染患者中,男性22 例和女性11 例,26 例伴慢性疾病,临床表现复杂。除并发白血病患者外,白细胞和中性粒 细胞计数不同程度升高,血红蛋白不同程度下降,乳酸脱氢酶显著升高。结论　产气荚膜梭菌引起肺部感染和血流感染 多发于并发慢性疾病的老年男性,肺部感染或胸腔积液临床表现相似。血流感染临床表现复杂, 分离出产气荚膜梭菌是 确诊的依据之一,临床应结合患者基本情况综合诊治。     

Diagnosis and treatment of community-acquired pneumonia

Patients with community-acquired pneumonia often present with cough, fever, chills, fatigue, dyspnea, rigors, and pleuritic chest pain. When a patient presents with suspected community-acquired pneumonia, the physician should first assess the need for hospitalization using a mortality prediction tool, such as the Pneumonia Severity Index, combined with clinical judgment. Consensus guidelines from several organizations recommend empiric therapy with macrolides, fluoroquinolones, or doxycycline. Patients who are hospitalized should be switched from parenteral antibiotics to oral antibiotics after their symptoms improve, they are afebrile, and they are able to tolerate oral medications. Clinical pathways are important tools to improve care and maximize cost-effectiveness in hospitalized patients.     

肺曲霉病30例临床分析

目的探讨肺曲霉病的临床表现和影像学特点。方法回顾性调查我院2000年1月--2006年4月确诊或拟诊的30例肺曲霉病，并进行分析研究。结果肺曲霉病的症状主要表现为咳嗽及间歇咯血，伴有发热、胸痛等。影像学表现多样，其中曲霉球有特异性X线胸片表现。确诊方法主要靠病理检查，肺曲霉病易误诊为肺结核和肿瘤。结论肺曲霉病的临床表现不典型，缺乏特异性，误诊率高。病理组织活检具有重要的诊断价值。     

肺隔离症的诊断和手术治疗分析

目的：总结肺隔离症的诊治经验。方法：回顾分析8例肺隔离症患者的临床资料,分析其临床表现,诊断及外科治疗。结果：本组8例肺隔离症均为叶内型。最常见症状为反复咳嗽、咳痰,发热、痰中带血、咯血和胸痛。病灶大多位于左肺下叶。术前临床确诊率为37．5％。8例均接受外科手术治疗,手术方式主要为肺叶切除术,异常供血动脉均来源于体循环的降主动脉或腹主动脉。结论：肺隔离症可通过胸部增强CT或MRI检查得以确诊,术前确诊率有待提高。手术切除是治疗肺隔离症的主要手段。     

肝移植后肺部细菌合并真菌感染的诊治

背景：肝移植患者因常规服用免疫抑制剂,免疫力低下,极易发生肺部病原微生物感染。目的：回顾分析1例肝移植后突发肺部细菌联合真菌感染患者诊疗经过,总结相关临床治疗经验。方法：1例乙肝肝硬化失代偿期女性患者行同种异体原位肝移植后8个月余突发畏寒高热入院,经实验室检查结合胸部CT检测考虑为细菌引起的肺部感染,给予头孢哌酮钠舒巴坦钠抗菌治疗。结果与结论：治疗后临床症状缓解。1周后复查胸部CT提示：双肺下叶片状渗出较前有所吸收,但背段出现片状＂毛玻璃样改变＂,考虑合并真菌感染,停用头孢哌酮钠舒巴坦钠,改用氟康唑针,治疗1周后行胸部CT：双肺下叶背段渗出较前吸收,出院继续口服氟康唑10d,复查CT：双肺渗出性改变完全吸收。     

Benign cystic teratoma of the lung

A young man with recurrent cough and hemoptysis was found at thoracotomy to have benign intrapulmonary cystic teratoma. Although benign cystic teratomas are a common mediastinal neoplasm, they rarely occur within the lung parenchyma. Fewer than 30 cases have been reported in the literature. Occasionally, patients present with bronchiectasis, abscess, or pneumonia in addition to cough and hemoptysis. The patient in this report had little evidence of infection and recovered rapidly following surgical excision of the mass.