肺奴卡菌病七例报告并文献复习

目的 分析肺奴卡菌病的临床表现、影像学和实验室检查特点.方法 回顾性分析2012年1月至2014年4月广州医科大学附属第一医院收治的7例肺奴卡菌病患者的临床资料,包括病史、症状及体征、影像学和实验室检查资料、病原学特点和诊治情况.结果 肺奴卡菌病患者7例中,既往体健者2例、有基础疾病者5例,有应用免疫抑制剂或糖皮质激素治疗病史者2例.临床症状表现为咳嗽7例、咳痰7例、发热4例、气促3例、胸痛1例、咯血1例、消瘦1例.胸部高分辨率CT检查表现为单个或多发结节影3例,实变影3例,肺部肿块影1例,其中伴有空洞3例、纵膈淋巴结肿大2例、胸腔积液3例.7例肺奴卡菌病患者中,检出巴西奴卡菌3株,星形奴卡菌1株,未分型奴卡菌3株.多数患者磺胺类药物治疗有效.结论 肺奴卡菌病患者多有基础疾病,临床表现无特异性,影像学检查以肺部单个或多发结节影及实变影多见,磺胺类药物对多数患者治疗有效.     

奴卡菌肺炎4例临床病理学观察

目的 探讨奴卡菌肺炎的临床病理特征、诊断、鉴别诊断及预后。方法 收集4例奴卡菌肺炎临床资料，采用手工特殊染色、PMseq-DNA感染病原微生物高通量基因检测等方法进行分析，并复习相关文献。结果 4例患者年龄54～84岁，平均66.5岁；均有基础疾病、发热，多数患者有咳嗽、咳痰症状。4例患者影像学表现为胸腔积液2例、空洞2例、结节或肿块4例；血常规示白细胞计数多数明显升高，而血液中降钙素原仅轻度升高。4例患者中3例有泥土接触史，4例患者肺部活检组织主要表现为化脓性病变。特殊染色：病变部位的奴卡菌Gram染色可见分支菌丝细长，呈断裂竹节样；特殊染色抗酸、PAS及六胺银染色结果阴性，弱抗酸染色结果阳性。病原微生物高通量基因检测有奴卡菌。结论 奴卡菌肺炎以肺部化脓性病变为显著特征，特殊染色的弱抗酸可见阳性分支细长菌丝，病原微生物高通量基因检测有奴卡菌是重要的鉴别点。     

慢性播散型组织胞浆菌病2例

 目的 提高临床医生对慢性播散性组织胞浆菌病的认识和诊治水平,以便减少误诊,改善预后。方法 根据北京协和医院1980年~2012年诊断慢性组织胞浆菌病的2例临床和随诊资料,结合文献对该病的临床表现、组织病理学特点、诊断、治疗及预后进行分析。结果 2例患者均病程较长、首发症状缺乏特异性,多系统受累,无特殊疾病史。其中1例有消化道、肺和双肾上腺受累,另1例为肺和腹膜受累。早期均被误诊,确诊均依靠组织病理,抗真菌治疗效果好,未见复发。结论 慢性组织胞浆菌病少见且临床表现不特异,确诊依赖于典型的病理形态和特殊染色,积极治疗预后好。     

卡介菌多糖核酸联合重组人干扰素α-2b乳膏治疗面部扁平疣的临床观察

目的探讨卡介菌多糖核酸联合重组人干扰素α-2b乳膏治疗面部扁平疣的临床疗效。方法 83例面部扁平疣患者,年龄20～43岁,平均32.8岁,男28例,女55例,随机分为2组:治疗组隔日1次肌注卡介菌多糖核酸注射液1ml;每天清洁患处后使用重组干扰素α-2b乳膏,每日涂抹患处4次;对照组给予肌注卡介菌多糖核酸注射液1ml,隔日1次。8周后对疗效进行观察判定。结果治疗组有效率79.55%,对照组有效率56.41%。结论卡介菌多糖核酸联合重组人干扰素α-2b乳膏治疗面部扁平疣的临床疗效显著,治疗过程中无严重不良反应,值得临床推广。     

背部皮肤软组织放线菌病一例并文献回顾

目的探讨皮肤软组织放线菌病的临床表现、诊断、鉴别诊断及治疗，提高创面外科医师对皮肤软组织放线菌病的认识。 方法报道1例背部皮肤软组织放线菌病的诊治经过，分别以"放线菌、放线菌感染、皮肤、软组织"及"actinomycosis，cutaneous，soft tissue"为检索词检索中国知网和PubMed的相关文献并进行分析。 结果与所检索20篇文献相比，本例皮肤放线菌病的临床表现、鉴别诊断及治疗既典型又具自身特点。本例患者入院时并未表现出明显皮肤肿物，但皮下感染组织内多个窦道，伴较多土褐色脓液流出较为典型。本例患者入院第9天才培养出放线菌，但无论是术中肉眼观察、细菌培养还是组织病理学检查均未见典型"硫磺颗粒"。本例患者查体、术中所见及辅助检查结果和气性坏疽的临床表现高度相似，因此最初曾高度怀疑产气荚膜梭菌感染，但多次细菌培养及涂片均未提示产气荚膜梭菌感染。治疗主要包括全身状态的调整、手术清创及抗生素的应用。 结论原发于皮肤软组织的放线菌病较少见，临床表现多样，即便有相对典型特征，也并无特异性，诊断需综合考虑并鉴别诊断。皮肤软组织放线菌感染发病率低，不易诊断，需引起创面外科医师的注意，及早对本病作出诊断及治疗。     

卡介菌多糖核酸治疗慢性荨麻疹的疗效观察

目的 观察卡介菌多糖核酸联合左西替利嗪治疗慢性荨麻疹的临床疗效及安全性.方法 将98例慢性荨麻疹患者随机分为2组,治疗组:采用卡介菌多糖核酸注射液肌肉注射0.7毫克,每周2次,连续治疗12周,同时口服左西替利嗪5毫克,每日1次,连续4周.对照组:单独口服左西替利嗪5毫克,每日1次,连续4周.结果 4周后观察疗效,治疗组有效率为73.5%,对照组为51.0%(P＜0.05),12周后治疗组有效率为75.5%,对照组为34.7%,两组比照差异有显著性(P＜0.01).结论卡介菌多糖核酸联合左西替利嗪治疗慢性荨麻疹疗效确切.     

卡介菌多糖核酸治疗慢性荨麻疹临床效果研究

目的探讨卡介菌多糖核酸治疗慢性荨麻疹的临床效果。方法选择2012年1月~2013年12月我院收治的100例慢性荨麻疹患者,将其随机均分为两组。对照组50例,给予氯雷他定进行口服,10mg/d;观察组50例,口服氯雷他定10mg/d的基础上选择卡介菌多糖核酸注射液0.5mg进行肌肉注射,隔1d 1次,1疗程要进行15次治疗。评价对比两组患者的临床效果,以及观察组的不良反应和复发率。结果经过治疗,对照组患者的总有效率为44.0%,观察组患者的总有效率为84.0%,差异显著<0.05,具有统计学意义。观察组患者均未出现不良反应,通过随访发现其复发率为20.0%,但与治疗前相比症状减轻,经再次治疗均康复结论慢性荨麻疹的治疗中卡介菌多糖核酸注射液具有良好的临床效果。     

卡介菌多糖核酸治疗儿童反复呼吸道感染

目的 探讨应用卡介菌多糖注射液治疗儿童反复呼吸道感染的临床疗效.方法 选择100例符合诊断标准的患儿,随机分为治疗组和对照组,两组均给与抗感染及对症治疗,治疗组加用卡介菌多糖核酸1ml/次,隔日肌内注射1次,18次为一疗程.两组均随访半年.结果 治疗组总有效率90%,对照组总有效率60%,两组差异有显著性意义.结论 卡介菌多糖核酸治疗儿童反复呼吸道感染疗效好,方法简单,费用低,值得临床推广.     

皮瓣移植结合封闭式负压引流修复下肢皮肤及软组织缺损

背景：各种创伤引起的下肢皮肤及软组织缺损十分常见,常伴有严重的血运破坏和创面感染,患肢感染率高,不易愈合。 目的：系统回顾关于下肢皮肤及软组织感染性缺损治疗的相关文献,结合华中科技大学同济医学院附属普爱医院治疗的下肢皮肤及软组织感染性缺损23例患者治疗效果,探讨皮瓣移植结合封闭式负压引流治疗感染性下肢皮肤及软组织缺损的适应症、方法及临床应用价值。 方法：文章选取2004年8月至2011年11月在华中科技大学同济医学院附属普爱医院治疗的下肢皮肤及软组织感染性缺损患者共23例,男15例,女8例;年龄17-56岁,平均31.4岁。对23例下肢皮肤及软组织感染性缺损患者采用皮瓣移植结合负压封闭引流治疗,随访时间为4-15个月,平均7.3个月,观察临床效果。同时检索下肢皮肤及软组织感染性缺损治疗的相关文献,找出治疗对象相似、疗效评价标准相同的病例进行比较。 结果与结论：23例下肢皮肤及软组织感染性缺损患者伤口感染菌中革兰阳性菌占52.2%,革兰阴性菌占47.8%,多重耐药菌占43.5%,应用封闭式负压吸引技术处理后,创面感染得到有效的控制,创面肉芽组织生长良好,通过皮瓣移植修复创面均痊愈。结果显示,皮瓣移植结合封闭式负压引流治疗感染性下肢皮肤及软组织缺损,可缩短创面愈合时间。     

艾滋病与非艾滋病病例合并卡氏肺孢子菌肺炎的临床特征对比研究

目的:比较艾滋病相关性卡氏肺孢子菌肺炎与非艾滋病相关性卡氏肺孢子菌肺炎的临床特征及辅助检查,以提高临床医师诊疗水平。方法:收集2018年1月至2021年7月在某三甲医院确诊的卡氏肺孢子菌肺炎17例,按照不同基础疾病将病例分为艾滋病组（7例）与非艾滋病组（10例）,比较两组病例的人口学特征、临床表现、实验室检查、病原学以...     

Nocardia infections: clinical and biological aspects]

The nocardiosis is an infection caused by a bacterial pathogen agent, Nocardia, belonging to the Actinomycetales order. They are Gram-positive, strictly aerobic bacteria. Members of the genus Nocardia are ubiquitous. They are frequently isolated from soil, water, air dusts. The mode of contamination occurs by inhalation or by cutaneous or ocular traumatic lesion. Clinically, nocardiosis is essentially characterized by pulmonary diseases. Others secondary localizations are described, such as in the central nervous system. Nocardia can be responsible for important cutaneous, subcutaneous and lymphocutaneous manifestations. In the same way, some extrapulmonary diseases and spread nocardiosis are more rarely observed. Several factors seem to favour the development of Nocardia. The immunocompromised patients, particularly those with organ transplant and the patients treated with immunosuppressor treatments, offer strong predispositions to this opportunistic disease. The nocardiosis is nevertheless observed in healthy persons. In front of polymorphic and specific-less clinical manifestations, large phenotypic heterogeneity, and resistance profiles to specific antibiotics, a correct diagnosis for Nocardia species is necessary to apply an adequate treatment. The techniques of identification based on the chemotaxonomic analysis and the susceptibility to different inhibitors are efficient for the identification of genus and species. However, because of the slow growth rate of Nocardia, the reading of these tests can require several weeks of incubation. With the intention of the rapid identification of genus and species, the molecular techniques (PCR-RFLP) seem to be efficient. The technique of RAPD allows an efficient molecular typing, which will give a better knowledge concerning transmission, ecological niches and epidemic reservoirs.     

Sporotrichoid pattern of cutaneous nocardiasis due to Nocardia asteroids

Cutaneous nocardiosis is a rare disease, only a few cases of which have been reported from the world as well as in India. This infection, when in the lymphocutaneous form, may clinically resemble sporotrichosis, hence causing a diagnostic dilemma. Here, we report a case of primary cutaneous, sporotrichoid pattern of cutaneous nocardiosis caused by Nocardia asteroides in immunocompetent host. The patient was a 32-year-old farmer, with no predisposing factors, who presented with cutaneous nocardiosis. The diagnosis was confirmed by culture of the biopsy, after which the patient was treated successfully with antibacterial agents.     

Nocardia otitidiscaviarum,cutaneous infection in a patient receiving long-term corticosteroid treatment

A 62-year-old man, under long-term corticosteroid therapy for pigeon breeder's disease, was admitted to endocrinology disease department for cutaneous abscess on back, limbs and scalp. Culture of various bacteriological samples (cutaneous abscess, blood culture) isolated Nocardia otitidiscaviarum. The patient was treated by trimethoprime-sulfametoxazole during several weeks with abscess disappearance. Our laboratory quickly identificatied a bacteria belonging to the Nocardia genus, with simple technique, later confirmed by a specialized laboratory (Pr. Boiron Claude Bernard University Lyon I) with identification of Nocardia otitidiscaviarum. The proof of pulmonary nocardiosis could not be established despite the existente of several risk factors. Prognosis is poor for immunocompromised patients, but the secondary cutaneous dissemination phase presented a favourable evolution under antibiotic therapy.     

Clinical experiences of pulmonary and bloodstream nocardiosis in two tertiary care hospitals in northern Taiwan, 2000-2004.

BACKGROUND AND PURPOSE: Nocardia is an uncommon pathogen in humans, and most patients with nocardiosis are immunocompromised, with variable etiologies. To understand the incidence, clinical characteristics, treatment and outcome of pulmonary and bloodstream nocardiosis, we conducted a retrospective study in two tertiary care hospitals in northern Taiwan. METHODS: We reviewed laboratory culture reports and clinical records of 29 adult patients with lower respiratory tract or bloodstream nocardiosis (21 and 8 patients, respectively) in two tertiary care hospitals, over a period of 5 years. The risk factors, clinical manifestations, response to therapy, outcome and recurrence rate were compared between these two groups. RESULTS: The most common underlying conditions in pulmonary nocardiosis were chronic lung disease and long-term steroid usage. For nocardemia, underlying malignancy and steroid administration are common. Fourteen of 21 patients with pulmonary nocardiosis ever transferred to an intensive care unit and 9 of them had concomitant infection. In patients with and without coexisting isolates during hospital course, the mean days from admission to specific therapy for nocardiosis were 26.4 and 11.9 days, respectively. Patients with nocardemia showed great variation in clinical manifestations and disease severity; central venous catheter implantation was noted in 6 of them. Only one patient with nocardemia had documented recurrence. Twenty four patients were treated with antimicrobials (trimethoprim-sulfamethoxazole, 83%; imipenem or meropenem, 25%). Treatment failure occurred in 7 of 20 patients treated with trimethoprim-sulfamethoxazole alone or in combination. CONCLUSIONS: Pulmonary or disseminated nocardiosis is rare but may be fatal as an opportunistic infection in an immunocompromised host with chronic lung disease, underlying malignancy or long-term steroid usage. The significance of primary nocardemia needs careful evaluation. Concomitant infection was the probable predisposing factor for intensive care unit admission for pulmonary nocardiosis in our study (p=0.019) and might obscure the isolation of nocardiae organisms and delay effective treatment. For critical patients with nocardiae infection, initial therapy with a combination antimicrobial regimen is recommended.     

Reactive cutaneous cytophagocytosis in nocardiosis

Cutaneous nocardiosis, which usually manifests in the form of pustules, abscesses, or subcutaneous nodules, is occasionally found in immunocompromised patients. A 59-yr-old Korean man with myasthenia gravis and thymoma developed nodular skin lesions on his trunk. Histopathologically, abscess formation with a dense infiltrate of neutrophils and many cytophagic histiocytes were observed. Numerous filamentous organisms, which turned out to be Nocardia asteroides by culture, were also found. After sulfamethoxazole-trimethoprim therapy, all of the skin lesions rapidly decreased in size, with a marked diminution of the number of cytophagic histiocytes, and cleared up within four months. On reporting a case of cutaneous nocardiosis showing unusual histopathologic findings, we considered that reactive conditions should be included in the differential diagnosis of the cutaneous cytophagocytosis, and that nocardiosis could be one of the diseases showing reactive cytophagocytosis.     

Nocardia brasiliensis primary pulmonary nocardiosis with subcutaneous involvement in an immunocompetent patient

This is a report of an unusual case of Nocardia brasiliensis causing primary pulmonary nocardiosis with disseminated subcutaneous lesions in an immunocompetent patient. This case highlights the importance of considering nocardiosis as a differential diagnosis in patients with pulmonary and cutaneous lesions and the need for vigorous management for complete cure.     

Nocardia and human nocardiosis

Nocardia spp. are pathogens commonly found in soil worldwide, and they cause mostly opportunistic infections in humans and animals, complicating both immunodepressive states and primary diseases. Nocardiosis is difficult to proper microbiological and clinical diagnosis because of its non-specific symptoms, which manifest as the cutaneous and sub-cutaneous infections, lung symptoms and the dissemination through the bloodstream to other organs. General characteristics of Nocardia, human nocardiosis as well as the microbiological diagnostics routine and treatment are discussed.     

Pulmonary nocardiosis in fine‐needle aspiration cytology smears: Report of four cases

Nocardia has been recognized as a significant opportunistic pathogen in organ transplant patients; however, it is an uncommon pathogen in immunocompetent patients. It may mimic other infectious diseases both clinically and radiologically. We report four cases of pulmonary nocardiosis in three immunocompromised and one immunocompetent patients on fine‐needle aspiration cytology (FNAC). Two patients presented with lung consolidation while two had cavitatory lesions. FNAC smears showed inflammatory cells composed of polymorphs and histiocytes along with necrosis. Occasional epithelioid cell granuloma was seen in one case. Modified Ziehl–Neelsen (ZN) stain was performed which highlighted long slender filamentous branching organisms conforming to the morphology of Nocardia. Thus, a suspicion for nocardiosis should be kept while assessing cytologic material especially in immunocompromised individuals. The diagnosis can be confirmed by special stains and culture studies; however, a high index of clinical suspicion is required so that appropriate culture media can be used for high diagnostic yield. FNAC is of help in providing immediate and accurate diagnosis of nocardiosis, thus helping in appropriate medical management. Diagn. Cytopathol. 2016;44:347–350. © 2016 Wiley Periodicals, Inc.     

Nocardia nova as the causative agent in spondylodiscitis and psoas abscess

We describe here the first case of Nocardia nova spondylodiscitis accompanied by a psoas abscess due to spreading from pulmonary nocardiosis. Nocardia was cultured from all affected sites. After 1 year of an appropriate antimicrobial therapy and a surgical drainage of the abscess that was required, the patient's clinical condition had improved.     

Nocardial infection in patients infected with the human immunodeficiency virus

During the period 1981–2000, we diagnosed eight cases of HIV– Nocardia co-infection (0.38% of AIDS cases). Six were males, and the mean age was 28.6 years. The most common risk factor for HIV infection was intravenous drug abuse. Most patients were severely immunodepressed at the time of diagnosis (mean CD4⁺ count, 35 cells/µL). The clinical forms of nocardiosis seen were pulmonary infection in three, skin or soft tissue infection in three, disseminated in one, and pulmonary colonization in one. Most patients were given sulfonamides, and a clinical response was observed in six of seven treated patients. However, two patients with pulmonary disease died from progressive infection. Although its incidence is very low among AIDS patients, nocardiosis is associated with high morbidity and mortality among HIV-infected individuals.