肺星形诺卡菌感染1例

肺诺卡菌病（pulmonary nocardiosis）是较少见的肺部感染性疾病,多发生于免疫功能缺陷或慢性疾病患者。我科曾治疗1例肺星形诺卡菌感染系无明显免疫功能抑制者,现报道如下。     

圣乔治诺卡菌致老年患者肺诺卡菌病1例

肺诺卡菌病影像学检查和临床表现均无特异性,磺胺类、碳青霉烯类、氨基糖苷类、利奈唑胺等多种抗菌药物对该病可能有效[1],体外培养生长非常缓慢,易被其他快生长定植菌覆盖,难于检出,极易被误诊为普通细菌性肺炎,使得病情迁延反复,重则危及生命.     

诺卡氏菌致全身多发感染1例

1病例资料患者,男,64岁,湖北钟祥市人,于2018年1月29日14时因＂间断性咳嗽、咳痰、气短1月余＂入住甘肃省武威市人民医院呼吸科。患者入院前1个月因＂受凉出现阵发性咳嗽,咳少量黄色的黏液痰,无腥臭味,伴多汗、全身乏力,不思饮食,全身关节及肌肉酸困＂于武威十陆医院住院,给予莫西沙星注射液抗感染治疗,但上述症状未见好转,遂就诊于兰州大学某附属医院。     

诺卡菌肺部感染1例

病例资料 患者男,80岁。因“反复咳嗽、咳痰、喘憋20年,加重伴发热1个月”入院。既往有高血压病史。2个月前因患“肾病综合征”一直口服泼尼松和环磷酰胺。入院前曾在外院使用头孢吡肟、阿奇霉素、亚胺培南-西司他丁钠、哌拉西林-他唑巴坦钠、左氧氟沙星和氟康唑等均效果不佳。入院后查血常规示白细胞16．08×10^9／L,中性粒细胞0．966,淋巴细胞0．019。胸部CT检查示双肺炎并胸腔积液（图1）。     

肺星形诺卡菌病继发血流感染1例

患者女,61岁,农民。10余天前受凉后发热,伴畏寒、寒战,胸闷气短,体温38～39．5℃,在当地应用清开灵、青霉素等治疗不佳,转至我院血液科。既往有免疫性全血细胞减少症,混合性贫血。入院体检：体温38．8℃,心率90次／min,呼吸20次／min,血压130／80mmHg,神志清楚,贫血貌,皮肤无结节、溃疡、脓肿;肺呼吸音低,腹软,四肢活动自如。     

播散性诺卡菌病合并肺曲霉感染1例

诺卡菌病通常发生在激素或其他免疫抑制剂使用后、血液系统恶性肿瘤、HIV感染、器官移植术后[1]。肺部感染是其最常见的表现,也可出现播散性感染。肺曲霉病有相近的易感因素,如过敏状态(哮喘)、气道疾病(支气管扩张、囊性纤维化)、慢性肺疾病(结核、结节病)或免疫功能缺陷[2]。由于二者在临床及影像学表现上具有相似性,早期鉴别的同时也应考虑混合感染的可能。现回顾性分析1例混合感染病例,总结其临床特点及诊治过程,以期为临床工作者提供参考。     

皮肤诺卡菌病1例

原发性皮肤诺卡菌感染在临床上比较罕见,主要表现为皮肤脓疱、脓皮病、脓肿、溃疡、肉芽肿或蜂窝织炎,主要由巴西诺卡菌感染所致 [1].本文报道1例由巴西诺卡菌合并荒尾诺卡菌感染所致的原发性皮肤感染病例,以供临床参考.     

肺诺卡菌病1例

诺卡菌病(nocardiosis)是由诺卡菌感染所致的急慢性化脓性疾病。多见于各种原因所致的机体免疫抑制状态下发生。我们曾遇1例肺诺卡菌病系无明显免疫机能抑制。现报道如下。     

诺卡菌腹膜炎1例

诺卡菌（Nocadia,前称奴卡菌）是需氧放线菌,原分类将其归入真菌,现代分类为细菌。诺卡菌病（nocardiosis）是一种急性或慢性化脓性或肉芽肿性病变。病原菌多由外伤进入皮肤或经呼吸道吸入引起感染,常见于因各种原因所致的机体免疫功能低下患者。诺卡菌病临床通常表现为肺诺卡菌病、皮肤原发性诺卡菌病或脑诺卡菌病。我们收治1例诺卡菌所致腹膜炎,现报道如下。     

皮疽诺卡菌致多发脑脓肿1例并文献复习

目的 分析皮疽诺卡菌累及中枢神经系统的临床特征、诊断及治疗,以期提高对该疾病的认识,精准抗感染治疗。方法 报告清华大学附属北京清华长庚医院感染性疾病科收治的1例皮疽诺卡菌感染致多发脑脓肿的病例,并以“Nocardia farcinica”为关键词检索PubMed 1967年1月1日—2022年9月18日的英文文献共433篇,分别以“皮疽奴卡菌”“皮疽诺卡菌”“鼻疽奴卡菌”“鼻疽诺卡菌”为关键词在万方数据库、维普数据库检索1999年10月1日—2022年9月18日的中文文献,共153篇,收集并分析总结70例皮疽诺卡菌中枢神经系统感染的病例资料。结果 该院这例患者以“头痛伴意识障碍”入院,入院后脑脊液宏基因组二代测序(mNGS)提示为皮疽诺卡菌,以复方磺胺甲唑为主联合美罗培南、莫西沙星、阿米卡星为治疗方案,治疗1个月病灶吸收,院外口服复方磺胺甲唑、莫西沙星,总疗程为1年。文献70例皮疽诺卡菌中枢神经系统感染患者男性51例,占72.8%,平均年龄(58.6±15.3)岁,57.1%患者有糖皮质激素使用史,57.1%患者同时合并其他脏器播散,80.0%(56例)的患者通过传统细菌培养明确病原学...     

预防老年患者肺部多重耐药菌感染的研究

目的 探讨循证护理对控制院内多重耐药菌肺部感染的作用.方法 将2009年1～12月住院的242例老年患者,以病区为单位分为循证组(126例)和对照组(116例),循证组采用预防肺部感染的循证护理措施,对照组实施传统护理.进行回顾性调查和监测院内总感染率及肺部多重耐药菌感染率的变化.结果 实施循证护理病区的多重耐药菌肺部感染率显著下降,P＜0.05,差异有显著性意义.结论 循证护理能有效预防老年患者多重耐药菌院内肺部感染,提高患者的生存质量,降低死亡率和医疗费用.     

Treatment of Nocardia asteroides infection with trimethoprim-sulfamethoxazole.

Although sulfonamide therapy has reduced the case fatality rate in infection due to Nocardia asteroides from nearly 100% to 25% to 45% there remains a need for a still more effective chemotherapeutic regimen. We describe three cases of serious infection due to N asteroides treated successfully with trimethoprim-sulfamethoxazole (TMP-SMX) and review an additional 15 cases from the world literature. Trimethoprim and sulfamethoxazole exhibit a synergistic interaction in vitro against N asteroides, and the agent reaches antibacterial concentrations in blood, lung, and the central nervous system. Clinical results have been satisfactory in the limited number of patients treated to date.     

Nocardia infection in the acquired immunodeficiency syndrome

A case of Nocardia asteroides pneumonia in a patient with the acquired immunodeficiency syndrome who was intolerant of sulfadiazine is described. On cefuroxime, the patient had a complete resolution of his Nocardia pneumonia. Disk-diffusion and broth microdilution antibiotic susceptibility testing (MIC less than or equal to 2 micrograms/ml) strongly supported the use of cefuroxime as treatment in this patient. Susceptibility testing with newer cephalosporins should be considered for all significant Nocardia isolates.     

Drug-resistant Nocardia asteroides infection in a patient with acquired immunodeficiency syndrome

We have reported what we believe to be the first case of disseminated infection due to a multiply drug resistant strain of Nocardia asteroides in a patient with the acquired immunodeficiency syndrome and concomitant disseminated histoplasmosis. This strain of the organism fits a pattern of susceptibility that is rare among N asteroides isolates in general and has been called the type 5 pattern, described as a resistance to broad spectrum cephalosporins, ciprofloxacin, and all aminoglycosides except amikacin. The recognition of disease due to this group of organisms is especially important in patients with AIDS because sulfonamides, considered the drugs of choice for treatment of N asteroides infection, are associated with a high incidence of adverse effects in these patients.     

Nocardia elegans infection involving purulent arthritis in humans

Nocardia elegans infection in humans is rare and is predominantly associated with pulmonary infections. We describe the first case of N. elegans infection associated with purulent arthritis in humans. The patient was a 66-year-old woman without underlying disease. She had swelling in her left ankle that was increasing in size, but it did not cause the patient substantial pain. Punctual discharge was collected for Gram staining and Kinyoun's acid-fast staining. The results of microscopic findings were suggestive of the genus Nocardia. The 16S rRNA sequence of the isolate was completely identical (100%) with that of N. elegans, indicating that the isolate was N. elegans. All the previously reported 4 cases of N. elegans infection in humans were associated with respiratory infections; we present the first case of the infection involving purulent arthritis.     

Nocardia cyriacigeorgica infection in a patient with pulmonary sequestration: A case report

BACKGROUND Nocardia cyriacigeorgica (N. cyriacigeorgica) infection is uncommon in clinical practice. Pulmonary sequestration complicated with N. cyriacigeorgica has not been reported in the literature. Here, we present a case of pulmonary se-questration complicated with N. cyriacigeorgica infection in an immunocom-petent woman.CASE SUMMARYA 37-year-old woman complaining of a recurrent cough was admitted to our hospital. Pulmonary sequestration in the lower lobe of the left lung was diagnosed by enhanced computed tomography. Bronchoalveolar lavage fluid was then collected, which showed gram positive bacilli with weakly positive modified acid-fast staining. The pathogen was identified as N. cyriacigeorgica after bacterial culture and mass spectrometry analysis. The patient was diagnosed with pulmonary sequestration complicated with N. cyriacigeorgica infection, and her symptoms quickly improved following anti-infective therapy.CONCLUSIONNocardiosis is considered to be an opportunistic infection. This is the first report of pulmonary sequestration complicated with N. cyriacigeorgica infection in a patient with normal immunity.