肺奴卡氏菌病2例并相关文献复习

Pulmonary nocardiosis：2 case reports and literature review

摘要:

目的：探讨肺奴卡菌病的临床特征。方法：对2例确诊并有完整临床资料的肺奴卡菌病从临床特点及诊治过程进行分析，对临床早期诊断提供线索。结果：1例患者有慢性肺病，1例患者皮肌炎长期接受激素及免疫抑制剂治疗，均有奴卡氏菌感染的危险因素；发热、咳嗽为其早期症状，体液培养5 d以上阳性。治疗结果1例死亡，1例曾一度吸收好转，后期合并结核及颅内感染死亡。结论：肺奴卡菌病临床特点及影像学表现均缺乏特异性，延长体液培养时间5 d以上可能获得阳性结果。早期联合治疗可能降低病死率，但警惕没有症状的颅内感染。

Abstract:

Objective：To investigate the clinical features of pulmonary nocardiosis. Methods：The complete clinical data of two cases of pulmonary nocardiosis were analyzed from the clinical features and treatment，clues for early clinical diagnosis were provided. Results：One patient had chronic lung disease，the other patient with dermatomyositis and received long-term steroid and immunosuppressive therapy. They had the risk of infection with the pulmonary nocardia. Their early symptoms were fever，cough，positive body fluid culture for more than 5 days. One case died，and one case was once relieved，but died due to the merger of tuberculosis and intracranial infec－tion. Conclusion：Clinical features and imaging findings of pulmonary nocardiosis are nonspecific. Prolonged fluid incubation time over 5 days may generate a positive result. Early combined treatment may reduce the mortality rate，but the non symptom of intracranial infection should be alerted.