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余仙娟,何飞,汝触会.播散性天美奴卡菌病1例临床分析并文献复习[J].浙江中西医结合杂志,2020,30(5):
播散性天美奴卡菌病1例临床分析并文献复习
Clinical analysis of the disseminated Nocardia amamiensis infection in China:one case report and literatures review
投稿时间:2019-11-06  修订日期:2020-01-10
DOI:
中文关键词:  天美奴卡菌  个体化治疗  
英文关键词:
基金项目:
作者单位E-mail
余仙娟 杭州市红十字会医院 hzhhyxj2016@163.com 
何飞 杭州市红十字会医院 lung1024@163.com 
汝触会 杭州市红十字会医院  
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中文摘要:
      目的 探讨天美奴卡菌病的临床特点、诊断要点及治疗情况,为临床实践提供参考。方法 回顾分析本院1例播散性天美奴卡菌病病例的诊治经过并复习相关文献。以“天美奴卡菌”为检索词检索万方数据库及中国知网(CKNI),以“Nocardia amamiensis”为检索词检索 PubMed、EMBase数据库,检索时间为 1975—2019年。 结果 本例患者,56岁男性,因“咳嗽咳痰伴气促2月,再发伴下肢酸胀1周”入院,给予抗菌药治疗后病情反复,肺部CT表现为多发结节伴空洞,B超示左侧小腿外侧低回声穿刺见脓液,脓液及肺泡灌洗液培养均示奴卡菌,16sRNA鉴定为天美奴卡菌,予以复方新诺明6月后病灶完全吸收。文献检索到5例天美奴卡菌感染,包括我院的1例共6例,男性4名,女性2名,2例为孤立性肺部感染, 2例为播散性感染(1例肺+皮肤,1例肺+皮肤+脑),2例为眼部感染。天美奴卡菌肺病主要症状为呼吸困难、咳痰。肺CT可表现为结节、空洞、实变。5例患者通过16s rRNA基因扩增技术确诊,1例通过痰培养;1例患者死亡。结论 天美奴卡菌是较罕见的奴卡菌种属,临床表现特异性低,肺部影像表现多样。快速的识别及诊断,制定个体化的治疗及管理方案是成功治疗奴卡菌病的关键。
英文摘要:
      Objective To investigate the clinical characteristics, diagnosis and treatment of the nocardia amamiensis infection. Methods The patient who was suffering from disseminated nocardia amamiensis infection was reported and review related literatures. Moreover, Wanfang Data Knowledge Service Platform, CNKI, PubMed and EMBase were searched with “Nocardia amamiensis” as keywords from 1975 to 2019. Results Our case was a 56-year-old male,who was admitted to hospital due to suffering from cough and sputum with shortness of breath for 2 months,and the symptoms aggravated with soreness of left lower limb for 1 week. The patient’s condition repeats after giving antibiotics. Chest computed tomography (CT) showed multiple nodules with cavities. B-mode ultrasound revealed a hypoechogenic area developed from the left calf on the lateral, and pus swabs were taken from ultrasound-guided aspiration. Culture from the abscess and alveolar lavage fluid grew nocardia. We performed nucleotide sequencing of the 16S rRNA and the result was Nocardia amamiensis. The lung lesions completely absorbed after 6 months with bactrim. 5 studies were included after screening based on the inclusion and exclusion criteria. Among the 6 cases of nocardia amamiensis infection patients, there were 4 males and 2 females, 2 cases with solitary pulmonary infection, 2 cases with disseminated infection (1 to skin ,1 to skin and brain), 2 cases with ocular. The main symptoms were dyspnea and productive cough. The manifestation of CT scans included nodules, cavity and consolidation. 5 cases were confirmed by 16S rRNA, 1 by sputum smear microscopy. There was one death. Conclusion Nocardia amamiensis is a rare species. The clinical symptoms are nonspecific. Imageing changed fast in the patients with pulmonary nocardiosis. Rapid identification and diagnosis, formulate individualized treatment and management scheme is the key to successful treatment nocardia infection.
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