皮肤型奴卡菌病二例并文献分析

目的探讨皮肤型奴卡菌感染的临床表现、诊断、治疗及预后，提高对奴卡菌的认识。 方法选取2016年6月至2017年5月解放军总医院第四医学中心烧伤整形科收治的皮肤型奴卡菌病患者2例，患者入院后积极进行外科清创，清创术后行负压封闭引流治疗，细菌培养结果明确为奴卡菌后，使用敏感抗生素结合口服复方磺胺甲口恶唑治疗。分析患者的临床资料、治疗过程，并结合检索、查阅奴卡菌相关文献，对奴卡菌病进行系统性陈述。 结果2例患者最终均治愈。皮肤型奴卡菌病临床表现及影像学检查无特异性，易误诊。 结论皮肤型奴卡菌病少见，病原菌培养为奴卡菌是诊断本病的主要依据，伴有脓肿需行外科手术切开引流，并结合磺胺类药物治疗。

Two cases of cutaneous nocardiosis and literature analysis

ObjectiveTo investigate the clinical manifestation, diagnosis, treatment and prognosis of cutaneous Nocardia infection, and improve the knowledge of Nocardia. MethodsTwo cases of cutaneous nocardiosis were selected from June 2016 to May 2017 in Department of Burns and Plastic Surgery, Fourth Medical Center of PLA General Hospital. Two patients were treated with surgical debridement after admission. After debridement, they were treated with negative pressure sealing drainage. When the bacterial culture was confirmed as Nocardia, sensitive antibiotics were used in combination with oral sulfamethoxazole. The clinical data and treatment process of the patients were analyzed, and the related literature of nocardiosis was searched and consulted to make a systematic statement of nocardiosis. ResultsTwo patients were cured. The clinical manifestations and radiographic examination of cutaneous nocardiosis were not specific and easy to be misdiagnosed. ConclusionsIt is a rare disease that the pathogen culture as Nocardia is the main basis for the diagnosis of the disease. Cutaneous nocardiosis with abscess should be treated with surgical incision and drainage, combining with sulfanilamide.