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Pulmonary nocardiosis associated with bronchiectasis: report of two cases and literature review

ObjectiveTo describe the clinical characteristics of pulmonary nocardiosis associated with bronchiectasis and to evaluate the methods of diagnosis and treatment.MethodsClinical data of two patients with pulmonary nocardiosis and bronchiectasis were analyzed and the literature on the subject were reviewed.ResultsTwo 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 for 6 months, and case 2 treated with SMZ/TMP for 3 months. Both patients were clinically cured. Six case reports including 7 patients were searched, including 4 Chinese reports and 2 English reports. Most of them were reported individually. ConclusionsBronchiectasis 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.

肺部豚鼠耳炎诺卡菌感染一例并文献复习

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。

穴位注射致皮疽诺卡菌合并革兰阳性人葡萄球菌感染1例报道

变应性支气管肺曲霉病合并肺诺卡菌感染一例并文献复习

目的提高对变应性支气管肺曲霉病（allergic bronchopulmonary aspergillosis，ABPA）合并诺卡菌感染的认识。方法回顾我科诊断的1例ABPA合并诺卡菌感染的临床资料，结合文献复习ABPA和诺卡菌病的宿主特征、临床表现、影像特点等。结果患者男，79岁，退休工人，咳嗽、咳痰、喘息、胸闷20余年，有影像资料记录至少漏诊ABPA 6年。血嗜酸性粒细胞计数和比例升高，血清总IgE升高，胸部CT表现为中心型支气管扩张和浸润影，诱导痰中性粒细胞和嗜酸性粒细胞比例升高，肺泡灌洗液淋巴细胞和嗜酸性粒细胞比例升高，灌洗液mNGS、灌洗液和痰培养证实有诺卡菌和烟曲霉。给予糖皮质激素、伏立康唑、伊曲康唑和复方磺胺甲噁唑治疗，短期内临床症状减轻，血嗜酸性粒细胞下降，肺部影像有所好转，但血清总IgE无明显下降。复习文献，有3例个案报道。其中，2例ABPA治疗中继发诺卡菌感染，与应用糖皮质激素治疗引起免疫抑制有关，1例确诊ABPA前应用多种抗生素引起诺卡菌“二重感染”。结论ABPA和诺卡菌病的免疫状态不同，前者引起的支气管扩张可能是合并诺卡菌感染的危险因素。

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

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。