甘肃省10例诺卡菌病患者的临床特征

目的 分析诺卡菌病患者的临床特征,为诺卡菌病的诊疗提供经验。方法 回顾性分析2017年1月—2021年11月兰州大学第一医院诊断为诺卡菌病住院患者的临床资料。结果 共收治10例诺卡菌病患者,男性8例,女性2例,平均年龄(59.1±15.4)岁,≥60岁3例,职业类型以农民为主(5例,50.0%)。肺诺卡菌病5例,皮肤诺卡菌病4例,播散性诺卡菌病1例。菌株分型主要为星形诺卡菌(5株)。80.0%患者有基础疾病,主要为支气管扩张症(3例)、长期服用糖皮质激素(3例)。肺诺卡菌病患者均有咳嗽、咳痰,查体均可闻及啰音;皮肤诺卡菌病主要为病灶处红肿、流脓;1例脑诺卡菌病系播散性感染,有意识丧失中枢神经系统受累表现。患者C反应蛋白为72.75(39.25～96.74)mg/L,均有所升高。肺部CT检查主要为大小不等的小结节影和斑片影(6例)、双肺多发索条影(4例)、大片磨玻璃阴影(3例)、胸腔积液(3例)。所有患者经积极抗感染治疗,9例好转出院,1例病情加重放弃治疗。结论 对有肺部基础疾病及抵抗力差的中老年人,常规抗感染治疗效果不佳时,需考虑诺卡菌感染,积极送病原学检查是关键。     

原发性皮肤奴卡菌病一例

患者,男,72岁。右侧手背、前臂结节伴肿痛3天。组织病理学:(右侧前臂)表皮缺失,真皮可见大片坏死组织,大量中性粒细胞、淋巴细胞及少许多核巨细胞浸润。右侧前臂分泌物细菌培养示:星形奴卡菌生长。诊断为原发性(淋巴型)皮肤奴卡菌病。给予哌拉西林钠舒巴坦钠,夫西地酸乳膏,红光照射治疗后逐渐好转。     

Relationship between the duration of trimethoprim/sulfamethoxazole treatment and the clinical outcome of pulmonary nocardiosis

Background

Despite treatment, pulmonary nocardiosis, which is a rare opportunistic disease caused by Nocardia species, has poor clinical outcomes including recurrence and death. Currently, the treatment regimen and duration for pulmonary nocardiosis are not fully understood. The present study aimed to clarify the factors related to the clinical outcome of pulmonary nocardiosis.

奴卡氏菌性脑脓肿的临床特点(附1例报告)

目的探讨奴卡氏菌性脑脓肿的临床特点。方法回顾性分析1例奴卡氏菌性脑脓肿患者的临床资料。结果本例患者急性起病,以发现右肩肿块后继发头痛、左侧肢体无力为主要症状。既往有"特发性血小板减少性紫癜"病史,长期口服激素、免疫抑制剂治疗。头颅MRI示右侧脑干及左侧顶叶可见圆形占位;增强后呈环形强化。右肩肿块穿刺脓液培养示奴卡氏菌。结论奴卡氏菌性脑脓肿患者死亡率高,要重视病原学诊断与长期特异性抗感染治疗,必要时需结合手术治疗。     

免疫功能正常的肺奴卡菌病3例临床分析

目的 探讨免疫功能正常的肺奴卡菌病的临床特点,以提高对该病的认识和诊治水平.方法 报告3例免疫功能正常的肺奴卡菌病的临床资料并进行临床分析.结果 3例免疫功能正常的肺奴卡菌病患者均为农民.临床表现为慢性病程、发热、咳嗽、咳痰、呼吸困难、体形消瘦、精神疲惫等.实验室检查示中性粒细胞数升高、乳酸脱氢酶升高、血沉增快、血清白蛋白减少、T淋巴细胞亚群正常.胸部CT表现无特异性.2例依据痰中查见奴卡菌,1例依据肺组织病理确诊.明确诊断后均给予复方磺胺甲噁唑联合其他抗生素治疗,治疗有效.结论 免疫功能正常的肺奴卡菌病呈慢性肺部感染性疾病表现,不易血行播散,T淋巴细胞亚群正常,临床上易被误诊为肺结核等感染性疾病,病原学及病理诊断可以帮助诊断,治疗方案为复方磺胺甲噁唑联合其他抗生素.     

Primary cutaneous nocardiosis caused by Nocardia takedensis with pulmonary dissemination in an immunosuppressed patient

We present a remarkable case of primary cutaneous nocardiosis with pulmonary dissemination due to Nocardia takedensis in a 76‐year‐old man suffering from marginal zone lymphoma and hypogammaglobulinaemia. We also discuss an alternative treatment to trimethoprim‐sulfamethoxazole, which could be contraindicated due to haematological and cutaneous toxicities. This case report is of interest due to the emergence of cutaneous nocardiosis in dermatology.     

Nocardiosis in renal transplant recipients in Kuwait

BACKGROUND.: Nocardiosis has emerged as an important bacterial disease amongrenal transplant recipients, leading to considerable morbidityand mortality. Apart from the increasing problem of resistancein pathogenic nocardiae, the spectrum of species causing diseasehas enlarged in recent years. There are no published reportson nocardiosis from Middle-East countries. METHODS.: A retrospective review of case records of 513 renal transplantrecipients between January 1989 and January 1995 was done inthe transplant unit of our hospital. Information was collectedon clinical details, type of donor, immunosuppressive therapy,prophylaxis, and outcome. Isolation of Nocardia species fromappropriate clinical specimens was the sole criterion for diagnosis. RESULTS.: Nocardiosis was diagnosed in six recipients with a disease incidenceof 1.2%. Four patients had received unrelated kidneys. Co-morbidconditions were diabetes mellitus (3), viral hepatitis (2) andneutropenia (1). Clinical manifestations included deep-seatedskin abscesses and pulmonary disease in three each. Cerebralabscess and meningitis were found in two patients with pulmonarydisease. Pathogens were Nocardia asteroides in four and N. otitidiscaviarum and N. farcinica in one each. In contrast to invitro susceptibility results, clinical response was differentin that five patients who received trimethoprim-sulphamethoxazole(TMP-SMX) alone (2) or in combination with cefuroxime (3) respondedwell. CONCLUSION.: The study stresses a high index of suspicion for nocardiosisin susceptible hosts who present with cutaneous abscess, pulmonaryinfiltrative lesions, and cerebral manifestations. TMP-SMX incombination with cefuroxime seems to be a highly effective therapy.It does not appear mandatory to reduce or discontinue immunosuppressivetherapy during treatment of nocardiosis.     

A novel case of nocardiosis with skin lesion due to Nocardia araoensis

Nocardiosis is caused by gram-positive aerobic actinomycetes that live in soil and are known to be responsible for opportunistic infections. The condition mostly affects the lung, brain or skin. Here, we present a 24-year-old Japanese woman who had had systemic lupus erythematosus since the age of 20 years, and lupus nephritis since the age of 23 years. She developed cutaneous lymph duct-type nocardiosis due to Nocardia araoensis while on immunosuppressant therapy. The patient had cutaneous findings from the right inguinal region to the right lower thigh and did not have lesions on the rest of the body. Minocycline and co-trimoxazole were co-administrated, and her condition improved. To our knowledge, this is the first case in which N. araoensis was detected by analysis on rRNA base sequence in skin lesions.