新型冠状病毒感染继发诺卡菌病合并活动性肺结核一例并文献复习_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

任洁 ¹ , 汤荣 ² , 杨锴 ³ , 谢国钢 ¹ ,  丁凤鸣 ¹ , 张旻 ¹

1. ;
2. ;
3. ;

Corresponding author：

丁凤鸣, Email: fmding81@163.com

Keywords：

诺卡菌病; 结核分枝杆菌; 新型冠状病毒感染; 发热

DOI：

10.7507/1671-6205.202401060

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目的分析新型冠状病毒感染继发诺卡菌病合并活动性肺结核患者的临床特征，提高临床医师对诺卡菌病的认识。方法回顾性分析1例新型冠状病毒感染患者继发诺卡菌病合并活动性肺结核病例的临床症状、实验室检查、影像学检查、病原学结果及治疗，并复习国内外相关文献。结果患者女，72岁，在新型冠状病毒感染后出现长期反复发热、咳嗽和咳痰，胸部CT提示双肺炎症，痰涂片抗酸染色阴性，常规痰培养未见可疑致病菌，最终通过肺泡灌洗液宏基因组学二代基因测序发现圣乔治教堂诺卡菌合并结核分枝杆菌感染，经针对上述病原体抗感染治疗后患者病情显著缓解。文献复习显示诺卡菌感染在免疫缺陷患者中的风险高，其合并结核分枝杆菌感染时易出现漏诊和误诊。目前在新型冠状病毒感染期间或感染后出现的诺卡菌病例仅有少数报道，尚未检索到类似本例新型冠状病毒感染后继发诺卡菌病合并活动性肺结核的病例报告。结论诺卡菌病的临床症状、体征和影像学缺乏特异性，病原学培养耗时长，因此对于新型冠状病毒感染后出现反复发热患者，应注重基于分子生物学的病原微生物检测，考虑是否存在诺卡菌合并结核分枝杆菌感染可能，避免因漏诊、误诊而延误治疗。

Citation： 任洁, 汤荣, 杨锴, 谢国钢, 丁凤鸣, 张旻. 新型冠状病毒感染继发诺卡菌病合并活动性肺结核一例并文献复习. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(7): 504-508. doi: 10.7507/1671-6205.202401060 Copy

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2.	McNeil MM, Brown JM. The medically important aerobic actinomycetes: epidemiology and microbiology. Clin Microbiol Rev, 1994, 7(3): 357-417.
3.	Luke E, Swafford K, Shirazi G, et al. TB and COVID-19: an exploration of the characteristics and resulting complications of co-infection. Front Biosci (Schol Ed), 2022, 14(1): 6.
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5.	Traxler RM, Bell ME, Lasker B, et al. Updated review on Nocardia species: 2006-2021. Clin Microbiol Rev, 2022, 35(4): e0002721.
6.	Menéndez R, Cordero PJ, Santos M, etal. Pulmonary infection with Nocardia species: a report of 10 cases and review. Eur Respir J, 1997, 10(7): 1542-1546.
7.	Al Umairi RS, Pandak N, Al Busaidi M. The findings of pulmonary nocardiosis on chest high resolution computed tomography: single centre experience and review of literature. Sultan Qaboos Univ Med J, 2022, 22(3): 357-361.
8.	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.
9.	Lafont E, Conan PL, Rodriguez-Nava V, et al. Invasive nocardiosis: disease presentation, diagnosis and treatment - old questions, new answers? Infect Drug Resist, 2020, 13: 4601-4613.
10.	柳晓金, 杨娜, 程欢欢, 等. 结核病专科医院24例诺卡菌病临床特征分析. 中国热带医学, 2022, 22(2): 177-180.
11.	Nachiappan AC, Rahbar K, Shi X, et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics, 2017, 37(1): 52-72.
12.	Chen Y, Hu W. Co-infection with Mycobacterium tuberculosis and Nocardia farcinica in a COPD patient: a case report. BMC Pulm Med, 2023, 23(1): 136.
13.	Smith I. Mycobacterium tuberculosis pathogenesis and molecular determinants of virulence. Clin Microbiol Rev, 2003, 16(3): 463-496.
14.	Oni T, Patel J, Gideon HP, et al. Enhanced diagnosis of HIV-1-associated tuberculosis by relating T-SPOT. TB and CD4 counts. Eur Respir J, 2010, 36(3): 594-600.
15.	Yagyu K, Nakatsuji Y, Matsushita H. Elevated serum β-d-glucan levels in cavitary pulmonary nocardiosis. BMJ Case Rep, 2020, 13(7): e234738.
16.	Margalit I, Lebeaux D, Tishler O, et al. How do I manage nocardiosis? Clin Microbiol Infect, 2021, 27(4): 550-558.
17.	Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc, 2012, 87(4): 403-407.
18.	Alsayed SSR, Gunosewoyo H. Tuberculosis: pathogenesis, current treatment regimens and new drug targets. Int J Mol Sci, 2023, 24(6): 5202.
19.	Peloquin CA, Davies GR. The treatment of tuberculosis. Clin Pharmacol Ther, 2021, 110(6): 1455-1466.

1. Stamos DB, Barajas-Ochoa A, Raybould JE. Nocardia pseudobrasiliensis co-infection in SARS-CoV-2 patients. Emerg Infect Dis, 2023, 29(4): 696-700.
2. McNeil MM, Brown JM. The medically important aerobic actinomycetes: epidemiology and microbiology. Clin Microbiol Rev, 1994, 7(3): 357-417.
3. Luke E, Swafford K, Shirazi G, et al. TB and COVID-19: an exploration of the characteristics and resulting complications of co-infection. Front Biosci (Schol Ed), 2022, 14(1): 6.
4. Lerner PI. Nocardiosis. Clin Infect Dis, 1996, 22(6): 891-905.
5. Traxler RM, Bell ME, Lasker B, et al. Updated review on Nocardia species: 2006-2021. Clin Microbiol Rev, 2022, 35(4): e0002721.
6. Menéndez R, Cordero PJ, Santos M, etal. Pulmonary infection with Nocardia species: a report of 10 cases and review. Eur Respir J, 1997, 10(7): 1542-1546.
7. Al Umairi RS, Pandak N, Al Busaidi M. The findings of pulmonary nocardiosis on chest high resolution computed tomography: single centre experience and review of literature. Sultan Qaboos Univ Med J, 2022, 22(3): 357-361.
8. 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.
9. Lafont E, Conan PL, Rodriguez-Nava V, et al. Invasive nocardiosis: disease presentation, diagnosis and treatment - old questions, new answers? Infect Drug Resist, 2020, 13: 4601-4613.
10. 柳晓金, 杨娜, 程欢欢, 等. 结核病专科医院24例诺卡菌病临床特征分析. 中国热带医学, 2022, 22(2): 177-180.
11. Nachiappan AC, Rahbar K, Shi X, et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics, 2017, 37(1): 52-72.
12. Chen Y, Hu W. Co-infection with Mycobacterium tuberculosis and Nocardia farcinica in a COPD patient: a case report. BMC Pulm Med, 2023, 23(1): 136.
13. Smith I. Mycobacterium tuberculosis pathogenesis and molecular determinants of virulence. Clin Microbiol Rev, 2003, 16(3): 463-496.
14. Oni T, Patel J, Gideon HP, et al. Enhanced diagnosis of HIV-1-associated tuberculosis by relating T-SPOT. TB and CD4 counts. Eur Respir J, 2010, 36(3): 594-600.
15. Yagyu K, Nakatsuji Y, Matsushita H. Elevated serum β-d-glucan levels in cavitary pulmonary nocardiosis. BMJ Case Rep, 2020, 13(7): e234738.
16. Margalit I, Lebeaux D, Tishler O, et al. How do I manage nocardiosis? Clin Microbiol Infect, 2021, 27(4): 550-558.
17. Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc, 2012, 87(4): 403-407.
18. Alsayed SSR, Gunosewoyo H. Tuberculosis: pathogenesis, current treatment regimens and new drug targets. Int J Mol Sci, 2023, 24(6): 5202.
19. Peloquin CA, Davies GR. The treatment of tuberculosis. Clin Pharmacol Ther, 2021, 110(6): 1455-1466.

Chinese Journal of Respiratory and Critical Care Medicine

新型冠状病毒感染继发诺卡菌病合并活动性肺结核一例并文献复习

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