1例乔治教堂诺卡菌引发肺诺卡菌病的实验室诊断思考

肺诺卡菌感染临床症状常不典型,病影像学检查和临床表现均无特异性,若诊治不及时,病死率会比较高,病原学诊断是确诊该病的重要依据。乔治教堂诺卡菌是常见的人类诺卡菌病原体,革兰阳性需氧杆菌,其形态独特,具有弱抗酸性,但是酒精可脱色,且生长缓慢。2020年10月发现1例乔治教堂诺卡菌引发肺诺卡菌病,通过涂片革兰染色发现大量呈90°分枝甚至缠绕成团丝状的革兰染色阳性杆菌,弱抗酸染色为阳性,现对该病例的实验室诊断进行分析,以提高对该病的认识。

Reflections on laboratory diagnosis of a case of pulmonary nocardiosis caused by Nocardia cyriacigeorgica

The clinical symptoms of pulmonary Nocardia infection are often atypical, and the imaging examination and clinical manifestations are not specific. If the diagnosis and treatment are not timely, the mortality is relatively high. The etiological diagnosis is an important basis for the diagnosis of the disease. Nocardia cyriacigeorgica is a common human Nocardia pathogen, Gram-positive aerobic bacilli, which has a unique form and is weakly acid resistant, but alcohol can be decolorized and grows slowly. In October 2020, a case of nocardiosis caused by Nocardia cyriacigeorgica was found. A large number of Gram-positive bacilli with 90° branches or even tangled into filaments were found by Gram staining on smears, and weak acid-fast staining was positive. Now the laboratory diagnosis of this case is analyzed in order to improve the understanding of the disease.