摘要
目的总结通过肺穿刺或肺活检组织标本检出诺卡菌的肺部感染患者的临床特征、影像学特点、实验室检查方法与治疗结局。方法回顾性分析中日友好医院从2018年10月至2022年3月间收集的3105份肺组织中检出9例诺卡菌感染病例的临床资料,实验室肺组织培养方法及治疗转归,并对相关文献进行总结分析。结果9例诺卡菌感染肺组织病例中主要临床症状为发热、咳嗽、咳痰、胸闷等。其中1例患者咯血,4例患者既往身体健康,2例患者肺移植术后,1例患者长期使用激素。所有患者经CT引导进行肺穿刺或支气管镜下肺活检术得到的肺组织,经常规平皿培养、BACTEC MGIT BD960和(或)BD真菌/分枝杆菌瓶培养后分离诺卡菌,应用抗菌药物甲氧苄啶-磺胺甲噁唑、阿米卡星、利奈唑胺等治疗后,9例患者中有8例病情临床好转。结论诺卡菌可致肺组织感染,行病理学检查结果阳性率较低,临床医生应认识到肺组织送检微生物学培养的重要性,需要结合临床表现考虑微生物实验室诺卡菌感染的可能性,以提高诺卡菌检出率。
Objective To summarize the clinical features,imaging features,laboratory examination methods,and treatment outcomes of Nocardia pulmonary infection detected by lung puncture or lung biopsy.Methods Among lung tissue samples,9 were Nocardia-positive,and the clinical data,laboratory culture methods of lung tissue,and treatment outcomes of 9 Nocardia-positive cases detected in China-Japan Friendship Hospital from December 2018 to March 2022 were retrospectively analyzed,and the relevant literature was reviewed and summarized.Results The main clinical symptoms of 9 Nocardia infection cases were fever,cough,phlegm,chest tightness,and hemoptysis in 1 case.Four patients were previously healthy,2 patients after lung transplantation,and 1 patient was in a state of immunodeficiency after long-term use of hormones.The lung tissues of 9 patients obtained by CT-guided lung puncture or bronchoscope-guided lung biopsy were all found to be Nocardia after culture.After treatment with antibiotics such as trimethoprim-sulfamethoxazole,amikacin,and linezolid,8 of the 9 patients showed improvement.Conclusion Nocardia can cause lung tissue infection,and the positive rate of the pathological test is low.Clinicians should realize the importance of microbial culture in lung tissue examination,and it is necessary to combine clinical manifestations to consider the possibility of Nocardia infection in microbiology laboratories to improve the detection rate of Nocardia.
作者
胡晏宁
范艳艳
武永莉
王清扬
向丽丽
鲁炳怀
HU Yanning;FAN Yanyan;WU Yongli;WANG Qingyang;XIANG Lili;LU Binghuai(China-Japan Friendship School of Clinical Medicine,Peking University,Beijing 100029,China;Laboratory of Clinical Microbiology and Infectious Diseases,Department of Respiratory and Critical Care Medicine,China-Japan Friendship Hospital,Beijing 100029,China;Graduate School of Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Department of Laboratory Medicine,Chongqing Shapingba District Chenjiaqiao Hospital/Affiliated Hospital of Chongqing Medical and Pharmaceutical College,Chongqing 400000,China)
出处
《国际检验医学杂志》
CAS
2023年第14期1732-1736,1742,共6页
International Journal of Laboratory Medicine
基金
首都卫生发展科研专项(首发2020-2-4062)。
关键词
诺卡菌
肺炎
肺组织感染
组织培养
Nocardia
pneumonia
lung tissue infection
tissue culture
