肺放線菌病一例報告_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

楊曉婭 , 馮銀合 , 謝玲俐 , 汪鈺濱 ,  毛輝

四川大學華西醫院呼吸與危重癥醫學科（四川成都 610041）;

Corresponding?author：

毛輝, Email: merrymh@126.com

Keywords：

肺放線菌病; 臨床特征; 影像學特點; 診斷; 治療

DOI：

10.7507/1671-6205.202105053

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目的通過分析1例肺放線菌病患者的臨床特征及診治過程，結合文獻復習，加強臨床醫生對本病的認識，以期早期診斷、規范治療，改善患者預后。方法回顧性分析1例肺放線菌病患者的臨床資料，以“肺放線菌病”、“放線菌肺炎”為關鍵詞在萬方數據庫、中國知網數據庫、中國期刊全文數據庫，以“pulmonary”和“actinomycosis”為關鍵詞在PubMed數據庫檢索相關文獻進行文獻復習，總結肺放線菌病的臨床特征、影像學特點、診斷手段、治療及預后不良相關因素。結果患者男，53歲，因“反復咳嗽、咳痰4^－個月，伴咯血15 d”入院。患者無明顯肺外臨床表現，內科查體未見明顯異常，外院胸部CT提示左下肺團片影，兩次痰液送檢二代測序，均檢出放線菌菌屬（檢出最多序列數4393），革蘭陽性格雷文尼放線菌多（檢出最多序列數4258）。入院后予頭孢哌酮舒巴坦針靜脈滴注抗感染19 d，出院后繼續復方磺胺口服，隨訪至2021年3月患者胸部影像學提示病變已明顯吸收好轉。結合本例及國內外文獻報道的肺放線菌病相關資料，結果顯示該病中老年男性多見，口腔衛生條件不良是該病的主要危險因素，臨床癥狀無特異性，主要表現為咳嗽、咳痰、咯血，胸部CT典型表現為團塊影并空洞形成，增強后不均勻強化，病灶內見稍低密度或氣體密度，經支氣管活檢、經皮肺穿刺或手術標本病理為主要確診手段，近年二代測序技術已成為診斷該病的重要工具。放線菌對多種抗菌藥物敏感，但抗菌藥物治療療程長，推薦6～12個月。內科及介入無法控制的大咯血以及抗菌藥物治療長療程前提下臨床癥狀無緩解、胸部影像學肺部病灶無明顯吸收的患者，手術可能是一種治療選擇。結論肺放線菌病的臨床特征及影像學表現均不典型，影像學上常表現為巨大團塊，臨床上常被誤診為腫瘤。痰液、纖維支氣管鏡灌洗液標本及經皮肺穿刺組織標本病原微生物二代基因測序有助于確診。經抗菌藥物治療預后良好，對于止血藥物及介入無法控制的大咯血、使用長療程抗菌藥物后臨床癥狀仍緩解不明顯或胸部影像學病變未見明顯吸收的患者，手術可能是一種治療選擇。

Citation： 楊曉婭, 馮銀合, 謝玲俐, 汪鈺濱, 毛輝. 肺放線菌病一例報告. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(12): 877-880. doi: 10.7507/1671-6205.202105053 Copy

1.	馬楠, 文仲光, 李艷紅, 等. 肺放線菌病一例并文獻復習. 中華結核和呼吸雜志, 2009, 32(7): 485-488.
2.	Pulverer G, Schütt-Gerowitt H, Schaal KP. Human cervicofacial actinomycoses: microbiological data for 1997 cases. Clin Infect Dis, 2003, 37(4): 490-497.
3.	Yildiz O, Doganay M. Actinomycoses and Nocardia pulmonary infections. Curr Opin Pulm Med, 2006, 12(3): 228-234.
4.	Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur Respir J, 2003, 21(3): 545-551.
5.	García-García JA, Corzo JE, Ramírez M, et al. Pulmonary actinomycosis secondary bacteremia in a HIV-infected patient. Med Clin (Barc), 2004, 123(15): 599.
6.	Galaria II, Marcos A, Orloff M, et al. Pulmonary actinomycosis in solid organ transplantation. Transplantation, 2003, 75(11): 1914-1915.
7.	Farrokh D, Rezaitalab F, Bakhshoudeh B. Pulmonary actinomycosis with endobronchial involvement: a case report and literature review. Tanaffos, 2014, 13(1): 52-56.
8.	Sun XF, Wang P, Liu HR, et al. A retrospective study of pulmonary actinomycosis in a single institution in China. Chin Med J (Engl), 2015, 128(12): 1607-1610.
9.	Wong VK, Turmezei TD, Weston VC. Actinomycosis. BMJ. 2011, 343: d6099.
10.	Grzywa-Celińska A, Emeryk-Maksymiuk J, Szmygin-Milanowska K, et. al. Pulmonary actinomycosis - the great imitator. Ann Agric Environ Med, 2017, 25(2): 211-212.
11.	Kim SR, Jung LY, Oh IJ, et. al. Pulmonary actinomycosis during the first decade of 21 st century:cases of 94 patients. BMC Infect Dis, 2013, 13: 216.
12.	張雪, 仇煜, 榮光生. 支氣管異物并發肺部放線菌病. 臨床肺科雜志, 2016, 21(3): 568-571.
13.	Chouabe S, Perdu D, Deslée G, et al. Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature. Chest, 2002, 121(6): 2069-2072.
14.	張金娥, 趙振軍, 何暉, 等. 胸部放線菌病的影像學特征. 中國醫學影像技術, 2009, 25(6): 1015-1017.
15.	張有志, 章鵬, 楊海華, 等. 肺放線菌病血培養陽性一例并文獻復習. 中國呼吸與危重監護雜志, 2014, 13(6): 565-568.
16.	Wilson MR, Naccache SN, Samayoa E, et al. Actionable diagnosis of neuroleptospirosis by next-generation sequencing. N Engl J Med, 2014, 370(25): 2408-2417.
17.	Wang W, Ren D, Xu C, et al. Pulmonary actinomycosis diagnosed by radial endobronchial ultrasound coupled with metagenomic next-generation sequencing: a case report and brief literature review. Int J Infect Dis, 2020, 100: 379-381.
18.	Heo SH, Shin SS, Kim JW, et al. Imaging of actinomycosis in various organs: a comprehensive review. Radiographics, 2014, 34(1): 19-33.
19.	Song JU, Park HY, Jeon K, et al. Treatment of thoracic actinomycosis: a retrospective analysis of 40 patients. Ann Thorac Med, 2010, 5(2): 80-85.

1. 馬楠, 文仲光, 李艷紅, 等. 肺放線菌病一例并文獻復習. 中華結核和呼吸雜志, 2009, 32(7): 485-488.
2. Pulverer G, Schütt-Gerowitt H, Schaal KP. Human cervicofacial actinomycoses: microbiological data for 1997 cases. Clin Infect Dis, 2003, 37(4): 490-497.
3. Yildiz O, Doganay M. Actinomycoses and Nocardia pulmonary infections. Curr Opin Pulm Med, 2006, 12(3): 228-234.
4. Mabeza GF, Macfarlane J. Pulmonary actinomycosis. Eur Respir J, 2003, 21(3): 545-551.
5. García-García JA, Corzo JE, Ramírez M, et al. Pulmonary actinomycosis secondary bacteremia in a HIV-infected patient. Med Clin (Barc), 2004, 123(15): 599.
6. Galaria II, Marcos A, Orloff M, et al. Pulmonary actinomycosis in solid organ transplantation. Transplantation, 2003, 75(11): 1914-1915.
7. Farrokh D, Rezaitalab F, Bakhshoudeh B. Pulmonary actinomycosis with endobronchial involvement: a case report and literature review. Tanaffos, 2014, 13(1): 52-56.
8. Sun XF, Wang P, Liu HR, et al. A retrospective study of pulmonary actinomycosis in a single institution in China. Chin Med J (Engl), 2015, 128(12): 1607-1610.
9. Wong VK, Turmezei TD, Weston VC. Actinomycosis. BMJ. 2011, 343: d6099.
10. Grzywa-Celińska A, Emeryk-Maksymiuk J, Szmygin-Milanowska K, et. al. Pulmonary actinomycosis - the great imitator. Ann Agric Environ Med, 2017, 25(2): 211-212.
11. Kim SR, Jung LY, Oh IJ, et. al. Pulmonary actinomycosis during the first decade of 21 st century:cases of 94 patients. BMC Infect Dis, 2013, 13: 216.
12. 張雪, 仇煜, 榮光生. 支氣管異物并發肺部放線菌病. 臨床肺科雜志, 2016, 21(3): 568-571.
13. Chouabe S, Perdu D, Deslée G, et al. Endobronchial actinomycosis associated with foreign body: four cases and a review of the literature. Chest, 2002, 121(6): 2069-2072.
14. 張金娥, 趙振軍, 何暉, 等. 胸部放線菌病的影像學特征. 中國醫學影像技術, 2009, 25(6): 1015-1017.
15. 張有志, 章鵬, 楊海華, 等. 肺放線菌病血培養陽性一例并文獻復習. 中國呼吸與危重監護雜志, 2014, 13(6): 565-568.
16. Wilson MR, Naccache SN, Samayoa E, et al. Actionable diagnosis of neuroleptospirosis by next-generation sequencing. N Engl J Med, 2014, 370(25): 2408-2417.
17. Wang W, Ren D, Xu C, et al. Pulmonary actinomycosis diagnosed by radial endobronchial ultrasound coupled with metagenomic next-generation sequencing: a case report and brief literature review. Int J Infect Dis, 2020, 100: 379-381.
18. Heo SH, Shin SS, Kim JW, et al. Imaging of actinomycosis in various organs: a comprehensive review. Radiographics, 2014, 34(1): 19-33.
19. Song JU, Park HY, Jeon K, et al. Treatment of thoracic actinomycosis: a retrospective analysis of 40 patients. Ann Thorac Med, 2010, 5(2): 80-85.

Chinese Journal of Respiratory and Critical Care Medicine

肺放線菌病一例報告

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