如何诊治继发性肺结核合并肺奴卡菌病_West China Medical Journal

Authors：

樊涛 ¹ , 张宇 ² , 戴仲秋 ³ ,  陈雪融 ⁴

1. ;
2. ;
3. ;
4. ;

Corresponding author：

陈雪融, Email: 384481688@qq.com

Keywords：

肺奴卡菌病; 奴卡菌; 肺结核; 免疫受损; 磺胺

DOI：

10.7507/1002-0179.201807110

Video：

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该文报道了一例患有痛风、糖尿病等多种疾病的高龄男性患者，院外诊断涂阳敏感肺结核并给予抗结核治疗，但呼吸困难症状加重、肺部影像学未改善。多学科讨论认为患者系免疫受损宿主，不排除合并细菌、真菌及特殊病原体感染，因此选择敏感抗生素治疗并合用奥司他韦和磺胺覆盖病毒及卡氏孢子菌、奴卡菌等病原体。痰菌延长培养发现皮疽奴卡菌生长，证实患者系肺结核合并肺奴卡菌病，经上述治疗患者呼吸衰竭好转。

Citation： 樊涛, 张宇, 戴仲秋, 陈雪融. 如何诊治继发性肺结核合并肺奴卡菌病. West China Medical Journal, 2018, 33(8): 1042-1045. doi: 10.7507/1002-0179.201807110 Copy

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1. Kandi V. Human nocardia infections: a review of pulmonary nocardiosis. Cureus, 2015, 7(8): e304.
2. 贾练, 刘丹, 梁宗安, 等. 肺奴卡菌病的临床特征与诊治分析. 西部医学, 2016, 28(1): 40-44.
3. 方春晓, 孙博, 季颖群, 等. 肺奴卡菌病并脓胸一例及文献复习. 中国呼吸与危重监护杂志, 2013, 12(2): 197-198.
4. Boubaker K, Gargah T, Abderrahim E, et al. Mycobacterium tuberculosis infection following kidney transplantation. Biomed Res Int, 2013, 5: 347103.
5. Lerner PI. Nocardiosis. Clin Infect Dis, 1996, 22(6): 891-903.
6. Li S, Song XY, Zhao YY, et al. Clinical analysis of pulmonary nocardiosis in patients with autoimmune disease. Medicine (Baltimore), 2015, 94(39): e1561.
7. Aliye A, Jacobo K, Tan-Lucien H, et al. Pulmonary Nocardiosis after lung transplantation CT findings in 7 patients and review of the literature. J Thorae Imaging, 2007, 22(2): 143-148.
8. Khadka P, Basnet RB, Rijal BP, et al. Pulmonary nocardiosis masquerading renascence of tuberculosis in an immunocompetent host: a case report from Nepal. BMC Res Notes, 2018, 11(1): 488.
9. Saubolle MA, Sussland D. Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol, 2003, 41(10): 4497-4501.
10. Liu C, Feng M, Zhu J, et al. Severe pneumonia due to Nocardia otitidiscaviarum identified by mass spectroscopy in a cotton farmer: a case report and literature review. Medicine (Baltimore), 2017, 96(13): e6526.

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如何诊治继发性肺结核合并肺奴卡菌病

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