如何診治繼發性肺結核合并肺奴卡菌病_West China Medical Journal

Authors：

樊濤 ¹ , 張宇 ² , 戴仲秋 ³ ,  陳雪融 ⁴

1. ;
2. ;
3. ;
4. ;

Corresponding?author：

陳雪融, Email: 384481688@qq.com

Keywords：

肺奴卡菌病; 奴卡菌; 肺結核; 免疫受損; 磺胺

DOI：

10.7507/1002-0179.201807110

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該文報道了一例患有痛風、糖尿病等多種疾病的高齡男性患者，院外診斷涂陽敏感肺結核并給予抗結核治療，但呼吸困難癥狀加重、肺部影像學未改善。多學科討論認為患者系免疫受損宿主，不排除合并細菌、真菌及特殊病原體感染，因此選擇敏感抗生素治療并合用奧司他韋和磺胺覆蓋病毒及卡氏孢子菌、奴卡菌等病原體。痰菌延長培養發現皮疽奴卡菌生長，證實患者系肺結核合并肺奴卡菌病，經上述治療患者呼吸衰竭好轉。

Citation： 樊濤, 張宇, 戴仲秋, 陳雪融. 如何診治繼發性肺結核合并肺奴卡菌病. West China Medical Journal, 2018, 33(8): 1042-1045. doi: 10.7507/1002-0179.201807110 Copy

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1. Kandi V. Human nocardia infections: a review of pulmonary nocardiosis. Cureus, 2015, 7(8): e304.
2. 賈練, 劉丹, 梁宗安, 等. 肺奴卡菌病的臨床特征與診治分析. 西部醫學, 2016, 28(1): 40-44.
3. 方春曉, 孫博, 季穎群, 等. 肺奴卡菌病并膿胸一例及文獻復習. 中國呼吸與危重監護雜志, 2013, 12(2): 197-198.
4. Boubaker K, Gargah T, Abderrahim E, et al. Mycobacterium tuberculosis infection following kidney transplantation. Biomed Res Int, 2013, 5: 347103.
5. Lerner PI. Nocardiosis. Clin Infect Dis, 1996, 22(6): 891-903.
6. Li S, Song XY, Zhao YY, et al. Clinical analysis of pulmonary nocardiosis in patients with autoimmune disease. Medicine (Baltimore), 2015, 94(39): e1561.
7. Aliye A, Jacobo K, Tan-Lucien H, et al. Pulmonary Nocardiosis after lung transplantation CT findings in 7 patients and review of the literature. J Thorae Imaging, 2007, 22(2): 143-148.
8. Khadka P, Basnet RB, Rijal BP, et al. Pulmonary nocardiosis masquerading renascence of tuberculosis in an immunocompetent host: a case report from Nepal. BMC Res Notes, 2018, 11(1): 488.
9. Saubolle MA, Sussland D. Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol, 2003, 41(10): 4497-4501.
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 (Baltimore), 2017, 96(13): e6526.

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如何診治繼發性肺結核合并肺奴卡菌病

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