肺部豚鼠耳炎诺卡菌感染一例并文献复习_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

余方颖 , 胡权铖 , 刘璐璐 , 方圳鸿 ,  周亮 ,  黄波

遵义医科大学附属医院呼吸与危重症医学科（贵州遵义 563003）;

Corresponding author：

周亮, Email: zhouliang1115@163.com; 黄波, Email: 13985229382@139.com

Keywords：

肺豚鼠耳炎诺卡菌; 重症肺炎; 临床特征; 治疗; 预后

DOI：

10.7507/1671-6205.202112014

Video：

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目的总结肺豚鼠耳炎诺卡菌病的临床特点，以提高诊断和治疗水平。方法回顾性分析1例肺豚鼠耳炎诺卡菌病的发病过程、临床表现、胸部影像学和病原学检查及诊治过程。在PubMed数据库以“pulmonary”和“Nocardia otitidiscaviarum”为检索词进行检索，以“肺豚鼠耳炎诺卡菌”为检索词在中国知网、万方数据库中检索年2016—2021年豚鼠耳炎诺卡菌病病例，并复习相关文献。结果患者女，44岁，因“咳嗽、咳痰及痰中带血伴发热1 d”于2020年7月25日就诊。入院诊断为重症肺炎，既往有支气管扩张病史，影像学检查显示肺部斑片状阴影并空洞，通过痰涂片、痰培养及肺泡灌洗液病原学检查结果提示肺豚鼠耳炎诺卡菌。感染急性期予美罗培南联合去甲万古霉素治疗，后于院外口服复方磺胺甲噁唑治疗3个月，随访1年未复发。结论肺部豚鼠耳炎诺卡菌病临床少见，其临床及影像学等表现无特异性，确诊需依靠病原学检查，首选磺胺类药物治疗。早诊断、早治疗有助于改善肺豚部鼠耳炎诺菌病患者的预后。

Citation： 余方颖, 胡权铖, 刘璐璐, 方圳鸿, 周亮, 黄波. 肺部豚鼠耳炎诺卡菌感染一例并文献复习. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(3): 200-204. doi: 10.7507/1671-6205.202112014 Copy

1.	杨柳, 马迎民. 肺豚鼠耳炎诺卡菌病1例. 中华老年多器官疾病杂志, 2016, 15(9): 697-699.
2.	姜波. 一例由豚鼠耳炎诺卡菌引起的肺诺卡菌病. 医学检验与临床, 2018, 29(9): 2.
3.	刘利华, 李钊, 李晓哲, 等. 豚鼠耳炎诺卡菌合并曲霉感染一例. 中国呼吸与危重监护杂志, 2019, 18(2): 179-181.
4.	沈轶, 张海, 李锋, 等. 豚鼠耳炎诺卡菌肺病一例并文献复习. 国际呼吸杂志, 2020, 40(12): 897-903.
5.	韩天强, 李继东, 陈伟. 播散性肺豚鼠耳炎诺卡菌病1例并文献复习. 临床肺科杂志, 2019, 24(10): 198-200.
6.	董毅娟, 王宇翔. 肺泡灌洗液检出到豚鼠耳炎诺卡菌一例分析报告. 饮食保健, 2020, 7(11): 98-99.
7.	王更芳, 周晓莉, 顾文贤, 等. 肺诺卡菌病一例. 中华病理学杂志, 2019, 48(9): 726-727.
8.	魏孔芳, 贾金虎. 豚鼠耳炎诺卡菌多部位感染致死1例报告. 中国临床医学, 2020, 27(3): 531-533.
9.	周磊, 李海峰, 李略. 肺豚鼠耳炎诺卡菌病一例报告. 现代实用医学, 2020, 32(10): 1292-1293,1304.
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, 2017, 96(13): e6526.
11.	Saksena R, Rynga D, Rajan S, et al. Fatal pulmonary infection by trimethoprim-sulfamethoxazole resistant Nocardia otitidiscaviarum: report of two cases and review. J Infect Dev Ctries, 2020, 14(2): 214-222.
12.	Mahgoub A. Pulmonary nocardiosis caused by Nocardia otitidiscaviarum in an adult asthmatic female patient: the presence of acid-fast branching filaments is always significant. S Afr Med J, 2016, 107(1): 43.
13.	Deepa R, Banu ST, Jayalakshmi G, et al. Pleuropulmonary nocardiosis due to Nocardia otitidiscaviarum in a debilitated host. Indian J Pathol Microbiol, 2016, 59(2): 240-242.
14.	李凤玉, 邓静敏. 肺诺卡菌病诊治的研究进展. 中华临床医师杂志(电子版), 2020, 14(10): 848-852.
15.	Garcia BL, Sibila O, Solanes I, et al. Pulmonary nocardiosis in patients with COPD: characteristics and prognostic factors. Archivos De Bronconeumología, 2012, 48(8): 280-285.
16.	Chacón CF, Vicente R, Ramos F, et al. Nocardia farcinica lung infection in a patient with cystic fibrosis and a lung transplant. Rev Esp Anestesiol Reanim, 2015, 62(3): 161-164.
17.	何靖霓, 李园园, 苏晓丽, 等. 肺皮疽奴卡菌重症肺炎1例并25例病例文献复习. 中国感染控制杂志, 2017, 16(2): 146-150,155.
18.	程振娜, 李刚, 师志云, 等. 诺卡菌感染的临床特点分析. 宁夏医科大学学报, 2017, 39(5): 537-540.
19.	宋秀杰, 路聪哲, 顾珏, 等. 84例肺奴卡菌病文献回顾性分析1979-2011. 临床肺科杂志, 2013, 18(12): 2280-2282.
20.	Usiakimi I, Sittana ES, Latif A. First human infection of Nocardia crassostreae in an immunocompetent patient. Chin Med J (Engl), 2016, 129(1): 114-115.
21.	Huang T, Chen Y, Zhang J, et al. Rapid and accurate diagnosis of brain abscess caused by Nocardia asiatica in combination of Ziehl-Neelsen stain and metagenomics next generation sequencing. Eur J Neurol, 2021, 28(1): 355-357.
22.	Kandi V. Human nocardia infections: a review of pulmonary nocardiosis. Cureus, 2015, 7(8): e304.
23.	Blackmon KN, Ravenel JG, Gomez JM, et al. Pulmonary nocardiosis: computed tomography features at diagnosis. J Thorac Imaging, 2011, 26(3): 224-229.
24.	Mehrian P, Esfandiari E, Karimi MA, et al. Computed tomography features of pulmonary nocardiosis in immunocompromised and immunocompetent patients. Pol J Radiol, 2015, 80(2): 13.
25.	Coussement J, Lebeaux D, van Delden C, et al. Nocardia infection in solid organ transplant recipients: a multicenter European case-control study. Clin Infect Dis, 2016, 63(3): 338-345.
26.	Steinbrink J, Leavens J, Kauffman CA, et al. Manifestations and outcomes of nocardia infections: comparison of immunocompromised and nonimmunocompromised adult patients. Medicine (Baltimore), 2018, 97(40): e12436.
27.	Lederman ER, Crum NF. A case series and focused review of nocardiosis: clinical and microbiologic aspects. Medicine (Baltimore), 2004, 83(5): 300-313.
28.	朱诗应, 戚中田. 16 S rDNA扩增及测序在细菌鉴定与分类中的应用. 微生物与感染, 2013, 8(2): 104-109.
29.	Tremblay J, Thibert L, Alarie I, et al. Nocardiosis in Quebec, Canada, 1988-2008. Clin Microbiol Infect, 2011, 17(5): 690-696.
30.	Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc, 2012, 87(4): 403-407.
31.	柳静文, 吕玮. 播散性奴卡菌病21例临床特征分析. 中国临床医生杂志, 2019, 47(5): 539-541.
32.	Brown-Elliott BA, Brown JM, Conville PS, et al. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev, 2006, 19(2): 259-282.
33.	周佳, 金博, 黄磊, 等. 诺卡菌感染的菌种和药敏试验回顾性分析. 重庆医学, 2018, 47(19): 4.
34.	高春明, 翟惠, 李峰, 等. 38例诺卡菌感染临床特征与药敏分析. 中国医院药学杂志, 2012, 32(5): 2.
35.	Saubolle MA, Sussland D. Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol, 2003, 41(10): 4497-501.
36.	中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.

1. 杨柳, 马迎民. 肺豚鼠耳炎诺卡菌病1例. 中华老年多器官疾病杂志, 2016, 15(9): 697-699.
2. 姜波. 一例由豚鼠耳炎诺卡菌引起的肺诺卡菌病. 医学检验与临床, 2018, 29(9): 2.
3. 刘利华, 李钊, 李晓哲, 等. 豚鼠耳炎诺卡菌合并曲霉感染一例. 中国呼吸与危重监护杂志, 2019, 18(2): 179-181.
4. 沈轶, 张海, 李锋, 等. 豚鼠耳炎诺卡菌肺病一例并文献复习. 国际呼吸杂志, 2020, 40(12): 897-903.
5. 韩天强, 李继东, 陈伟. 播散性肺豚鼠耳炎诺卡菌病1例并文献复习. 临床肺科杂志, 2019, 24(10): 198-200.
6. 董毅娟, 王宇翔. 肺泡灌洗液检出到豚鼠耳炎诺卡菌一例分析报告. 饮食保健, 2020, 7(11): 98-99.
7. 王更芳, 周晓莉, 顾文贤, 等. 肺诺卡菌病一例. 中华病理学杂志, 2019, 48(9): 726-727.
8. 魏孔芳, 贾金虎. 豚鼠耳炎诺卡菌多部位感染致死1例报告. 中国临床医学, 2020, 27(3): 531-533.
9. 周磊, 李海峰, 李略. 肺豚鼠耳炎诺卡菌病一例报告. 现代实用医学, 2020, 32(10): 1292-1293,1304.
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, 2017, 96(13): e6526.
11. Saksena R, Rynga D, Rajan S, et al. Fatal pulmonary infection by trimethoprim-sulfamethoxazole resistant Nocardia otitidiscaviarum: report of two cases and review. J Infect Dev Ctries, 2020, 14(2): 214-222.
12. Mahgoub A. Pulmonary nocardiosis caused by Nocardia otitidiscaviarum in an adult asthmatic female patient: the presence of acid-fast branching filaments is always significant. S Afr Med J, 2016, 107(1): 43.
13. Deepa R, Banu ST, Jayalakshmi G, et al. Pleuropulmonary nocardiosis due to Nocardia otitidiscaviarum in a debilitated host. Indian J Pathol Microbiol, 2016, 59(2): 240-242.
14. 李凤玉, 邓静敏. 肺诺卡菌病诊治的研究进展. 中华临床医师杂志(电子版), 2020, 14(10): 848-852.
15. Garcia BL, Sibila O, Solanes I, et al. Pulmonary nocardiosis in patients with COPD: characteristics and prognostic factors. Archivos De Bronconeumología, 2012, 48(8): 280-285.
16. Chacón CF, Vicente R, Ramos F, et al. Nocardia farcinica lung infection in a patient with cystic fibrosis and a lung transplant. Rev Esp Anestesiol Reanim, 2015, 62(3): 161-164.
17. 何靖霓, 李园园, 苏晓丽, 等. 肺皮疽奴卡菌重症肺炎1例并25例病例文献复习. 中国感染控制杂志, 2017, 16(2): 146-150,155.
18. 程振娜, 李刚, 师志云, 等. 诺卡菌感染的临床特点分析. 宁夏医科大学学报, 2017, 39(5): 537-540.
19. 宋秀杰, 路聪哲, 顾珏, 等. 84例肺奴卡菌病文献回顾性分析1979-2011. 临床肺科杂志, 2013, 18(12): 2280-2282.
20. Usiakimi I, Sittana ES, Latif A. First human infection of Nocardia crassostreae in an immunocompetent patient. Chin Med J (Engl), 2016, 129(1): 114-115.
21. Huang T, Chen Y, Zhang J, et al. Rapid and accurate diagnosis of brain abscess caused by Nocardia asiatica in combination of Ziehl-Neelsen stain and metagenomics next generation sequencing. Eur J Neurol, 2021, 28(1): 355-357.
22. Kandi V. Human nocardia infections: a review of pulmonary nocardiosis. Cureus, 2015, 7(8): e304.
23. Blackmon KN, Ravenel JG, Gomez JM, et al. Pulmonary nocardiosis: computed tomography features at diagnosis. J Thorac Imaging, 2011, 26(3): 224-229.
24. Mehrian P, Esfandiari E, Karimi MA, et al. Computed tomography features of pulmonary nocardiosis in immunocompromised and immunocompetent patients. Pol J Radiol, 2015, 80(2): 13.
25. Coussement J, Lebeaux D, van Delden C, et al. Nocardia infection in solid organ transplant recipients: a multicenter European case-control study. Clin Infect Dis, 2016, 63(3): 338-345.
26. Steinbrink J, Leavens J, Kauffman CA, et al. Manifestations and outcomes of nocardia infections: comparison of immunocompromised and nonimmunocompromised adult patients. Medicine (Baltimore), 2018, 97(40): e12436.
27. Lederman ER, Crum NF. A case series and focused review of nocardiosis: clinical and microbiologic aspects. Medicine (Baltimore), 2004, 83(5): 300-313.
28. 朱诗应, 戚中田. 16 S rDNA扩增及测序在细菌鉴定与分类中的应用. 微生物与感染, 2013, 8(2): 104-109.
29. Tremblay J, Thibert L, Alarie I, et al. Nocardiosis in Quebec, Canada, 1988-2008. Clin Microbiol Infect, 2011, 17(5): 690-696.
30. Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc, 2012, 87(4): 403-407.
31. 柳静文, 吕玮. 播散性奴卡菌病21例临床特征分析. 中国临床医生杂志, 2019, 47(5): 539-541.
32. Brown-Elliott BA, Brown JM, Conville PS, et al. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev, 2006, 19(2): 259-282.
33. 周佳, 金博, 黄磊, 等. 诺卡菌感染的菌种和药敏试验回顾性分析. 重庆医学, 2018, 47(19): 4.
34. 高春明, 翟惠, 李峰, 等. 38例诺卡菌感染临床特征与药敏分析. 中国医院药学杂志, 2012, 32(5): 2.
35. Saubolle MA, Sussland D. Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol, 2003, 41(10): 4497-501.
36. 中华医学会呼吸病学分会. 中国成人社区获得性肺炎诊断和治疗指南(2016年版). 中华结核和呼吸杂志, 2016, 39(4): 253-279.

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