支气管扩张症合并肺诺卡菌病二例并文献复习
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摘要
目的提高对支气管扩张症合并肺诺卡菌病的认识。方法对2例支气管扩张症合并肺诺卡菌病患者的临床资料进行分析,并结合文献复习。结果患者均为女性,务农,年龄分别为55和62岁,基础疾病均为支气管扩张症,例1还合并龋齿和2型糖尿病,例2合并胃食管反流病。患者临床表现均为发热、咳嗽和咳痰,外周血白细胞升高。例1还伴有呼吸困难和类白血病反应。胸部影像学表现均为肺部实变影,例1为双肺病变,伴坏死和空洞;例2为单肺病变,无坏死空洞。患者痰涂片抗酸染色和弱抗酸染色均阳性,例1痰培养为豚鼠耳炎诺卡菌,例2痰培养阴性。例1药敏试验显示头孢曲松、亚胺培南和美罗培南等耐药,复方磺胺甲恶唑(SMZ/TMP)、阿米卡星和莫西沙星等敏感。例1予SMZ/TMP+莫西沙星+阿米卡星联合治疗6个月,例2予SMZ/TMP单药治疗3个月。两例患者均临床治愈。共检出相关文献共6篇,中文4篇,英文2篇,均为个案报道,共7例患者。结论支气管扩张症是肺诺卡菌病的危险因素之一,需根据药敏试验结果和病情的严重程度选择治疗方案,支气管扩张症合并肺诺卡菌病患者预后相对良好。
Objective To describe the clinical characteristics of pulmonary nocardiosis associated with bronchiectasis and to evaluate the methods of diagnosis and treatment. Methods Clinical data of two patients with pulmonary nocardiosis and bronchiectasis were analyzed and the literature on the subject were reviewed. Results Two female patients with bronchiectasis were respectively 55 and 62 years old, both of them presented with fever, cough,expectoration, and leukocytosis. Case 1 also complicated with respiratory failure and leukemoid reaction. Chest CT showed bilateral pulmonary multi-patchy consolidations with cavities in case 1 and unilateral pulmonary local consolidation without cavities in case 2. Sputum smears on modified Ziehl-Neelsen staining of both patients showed typical Nocardia hyphe. Sputum culture of case 1 showed Nocardia otitidiscaviarum, which was sensitive to sulfamethoxazole/trimethoprim(SMZ/TMP), amikacin and moxifloxacin while resistant to ceftriaxone, imipenem and meropenem. Sputum culture of case 2 was negative. Case 1 was treated with SMZ/TMP + moxifloxacin + amikacin for6 months, and case 2 treated with SMZ/TMP for 3 months. Both patients were clinically cured. Six case reports including7 patients were searched, including 4 Chinese reports and 2 English reports. Most of them were reported individually.Conclusions Bronchiectasis is a risk factor for pulmonary nocardiosis, and the treatment of nocardiosis should accord with drug susceptibilities and severities of diseases. The prognoses of patients with pulmonary nocardiosis and bronchiectasis are relatively good.
Objective To describe the clinical characteristics of pulmonary nocardiosis associated with bronchiectasis and to evaluate the methods of diagnosis and treatment. Methods Clinical data of two patients with pulmonary nocardiosis and bronchiectasis were analyzed and the literature on the subject were reviewed. Results Two female patients with bronchiectasis were respectively 55 and 62 years old, both of them presented with fever, cough,expectoration, and leukocytosis. Case 1 also complicated with respiratory failure and leukemoid reaction. Chest CT showed bilateral pulmonary multi-patchy consolidations with cavities in case 1 and unilateral pulmonary local consolidation without cavities in case 2. Sputum smears on modified Ziehl-Neelsen staining of both patients showed typical Nocardia hyphe. Sputum culture of case 1 showed Nocardia otitidiscaviarum, which was sensitive to sulfamethoxazole/trimethoprim(SMZ/TMP), amikacin and moxifloxacin while resistant to ceftriaxone, imipenem and meropenem. Sputum culture of case 2 was negative. Case 1 was treated with SMZ/TMP + moxifloxacin + amikacin for6 months, and case 2 treated with SMZ/TMP for 3 months. Both patients were clinically cured. Six case reports including7 patients were searched, including 4 Chinese reports and 2 English reports. Most of them were reported individually.Conclusions Bronchiectasis is a risk factor for pulmonary nocardiosis, and the treatment of nocardiosis should accord with drug susceptibilities and severities of diseases. The prognoses of patients with pulmonary nocardiosis and bronchiectasis are relatively good.
引文
1 Kandi V. Human nocardia infections:a review of pulmonary nocardiosis. Cureus,2015, 7(8):e304.
2 Pintado V, Gomez-Mampaso E, Fortun J, et al. Infection with nocardia species:clinical spectrum of disease and species distribution in Madrid, Spain, 1978-2001. Infection, 2002, 30(6):338-340.
3 Chen J, Zhou H, Xu P, et al. Clinical and radiographic characteristics of pulmonary nocardiosis:clues to earlier diagnosis.PLoS One, 2014, 9(3):e90724.
4 Fujita T, Ikari J, Watanabe A, et al. Clinical characteristics of pulmonary nocardiosis in immunocompetent patients. J Infect Chemother, 2016, 22(11):738-743.
5 Lumb R, Greville H, Martin J, et al. Nocardia asteroides isolated from three patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis, 2002, 21(3):230-233.
6 Ferrer A, Llorenc V, Codina G, et al. Nocardiosis and bronchiectasis. An uncommon association?. Enferm Infect Microbiol Clin, 2005, 23(2):62-66.
7 Sadamatsu H, Takahashi K, Tashiro H, et al. Successful treatment of pulmonary nocardiosis with fluoroquinolone in bronchial asthma and bronchiectasis. Respirol Case Rep, 2017, 5(3):e00229.
8 Aide MA, Loureno SS, Marchiori E, et al. Pulmonary nocardiosisin a patient with chronic obstructive pulmonary disease and bronchiectasis. J Bras Pneumol, 2008, 34(11):985-988.
9陈蕾,顾云峰,上官宗校,等.肺支气管扩张合并盖尔森基兴奴卡菌感染一例并文献复习.中华临床感染病杂志,2015, 8(4):350-352.
10柯会星,赵洪涛,孙铁英.老年人支气管扩张症合并肺奴卡菌感染一例.中华老年医学杂志,2003, 22(2):122.
11仝金斋,黄炎明,梁丽萍.支气管扩张合并肺奴卡菌感染临床分析.临床肺科杂志,2012,17(8):1545-1551.
12杨春霞,王珊珊,王鹏,等.支气管扩张老年男性北京奴卡菌肺部感染一例.中华内科杂志,2016, 55(1):45-46.
13 Martinez R, Reyes S, Menendez R. Pulmonary nocardiosis:risk factors, clinical features, diagnosis and prognosis. Curr Opin Pulm Med, 2008, 14(3):219-27.
14黄慧,陆志伟,徐作军.诺卡菌感染26例临床特点分析.中华结核和呼吸杂志,2010, 33(9):651-655.
15张媛,张媛媛,万康林,等.诺卡菌的培养和染色特征研究.中国人兽共患病学报,2012, 28(3):230-236.
2 Pintado V, Gomez-Mampaso E, Fortun J, et al. Infection with nocardia species:clinical spectrum of disease and species distribution in Madrid, Spain, 1978-2001. Infection, 2002, 30(6):338-340.
3 Chen J, Zhou H, Xu P, et al. Clinical and radiographic characteristics of pulmonary nocardiosis:clues to earlier diagnosis.PLoS One, 2014, 9(3):e90724.
4 Fujita T, Ikari J, Watanabe A, et al. Clinical characteristics of pulmonary nocardiosis in immunocompetent patients. J Infect Chemother, 2016, 22(11):738-743.
5 Lumb R, Greville H, Martin J, et al. Nocardia asteroides isolated from three patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis, 2002, 21(3):230-233.
6 Ferrer A, Llorenc V, Codina G, et al. Nocardiosis and bronchiectasis. An uncommon association?. Enferm Infect Microbiol Clin, 2005, 23(2):62-66.
7 Sadamatsu H, Takahashi K, Tashiro H, et al. Successful treatment of pulmonary nocardiosis with fluoroquinolone in bronchial asthma and bronchiectasis. Respirol Case Rep, 2017, 5(3):e00229.
8 Aide MA, Loureno SS, Marchiori E, et al. Pulmonary nocardiosisin a patient with chronic obstructive pulmonary disease and bronchiectasis. J Bras Pneumol, 2008, 34(11):985-988.
9陈蕾,顾云峰,上官宗校,等.肺支气管扩张合并盖尔森基兴奴卡菌感染一例并文献复习.中华临床感染病杂志,2015, 8(4):350-352.
10柯会星,赵洪涛,孙铁英.老年人支气管扩张症合并肺奴卡菌感染一例.中华老年医学杂志,2003, 22(2):122.
11仝金斋,黄炎明,梁丽萍.支气管扩张合并肺奴卡菌感染临床分析.临床肺科杂志,2012,17(8):1545-1551.
12杨春霞,王珊珊,王鹏,等.支气管扩张老年男性北京奴卡菌肺部感染一例.中华内科杂志,2016, 55(1):45-46.
13 Martinez R, Reyes S, Menendez R. Pulmonary nocardiosis:risk factors, clinical features, diagnosis and prognosis. Curr Opin Pulm Med, 2008, 14(3):219-27.
14黄慧,陆志伟,徐作军.诺卡菌感染26例临床特点分析.中华结核和呼吸杂志,2010, 33(9):651-655.
15张媛,张媛媛,万康林,等.诺卡菌的培养和染色特征研究.中国人兽共患病学报,2012, 28(3):230-236.