诺卡菌病13例临床分析

 目的 对诺卡菌病的临床特征进行分析，以期为诺卡菌病的诊断治疗提供经验。方法 回顾性分析2016年1月—2020年11月四川省人民医院13例诺卡菌病患者临床资料。结果 13例患者中肺部感染5例，中枢神经系统感染2例，皮肤感染4例，播散性感染及化脓性关节炎各1例。其中12例患有基础疾病，主要有支气管扩张、自身免疫性疾病、糖尿病、高血压。所有患者白细胞、C反应蛋白（CRP）均增高，仅3例检测降钙素原（PCT），均增高。病原学检查结果均为诺卡菌。9例患者单用或联用复方磺胺甲口恶唑，3例患者单独使用左氧氟沙星，1例播散性感染患者使用碳青霉烯类联合利奈唑胺。脑脓肿和皮肤感染采取外科治疗，手术或者清创。12例患者均好转，仅1例化脓性脑膜炎患者加重。结论 诺卡菌病主要有肺部感染、中枢神经系统感染、皮肤感染、播散性感染4类，患支气管扩张或自身免疫性疾病的患者更容易感染。

Clinical features of 13 cases of nocardiosis

Objective To analyze the clinical features of nocardiosis, so as to provide experience for the diagnosis and treatment of nocardiosis. Methods Clinical data of 13 patients with nocardiosis in Sichuan Provincial People's Hospital from January 2016 to November 2020 were analyzed retrospectively. Results Among 13 patients, there were 5 cases of pulmonary infection, 2 cases of central nervous system infection, 4 cases of skin infection, 1 case of disseminated infection and 1 case of suppurative arthritis. 12 patients had underlying diseases, mainly bronchiectasis, autoimmune diseases, diabetes mellitus, and hypertension. All patients had increased leukocytes and C-reactive protein (CRP), only 3 patients detected procalcitonin (PCT), and PCT all decreased. Pathogenic examination results were Nocardia brasiliensis. Nine patients received compound sulfamethoxazole alone or in combination, 3 patients received levofloxacin alone, and 1 patient with disseminated infection received carbapenems combined with linezolid. Brain abscess and skin infection are treated surgically, operation or debridement. All 12 patients improved, and only 1 patient with suppurative meningitis aggravated. Conclusion Nocardiosis mainly includes pulmonary infection, central nervous system infection, skin infection and disseminated infection, patients with bronchiectasis or autoimmune diseases are more likely to be infected.