新型冠狀病毒感染繼發諾卡菌病合并活動性肺結核一例并文獻復習_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

任潔 ¹ , 湯榮 ² , 楊鍇 ³ , 謝國鋼 ¹ ,  丁鳳鳴 ¹ , 張旻 ¹

1. ;
2. ;
3. ;

Corresponding?author：

丁鳳鳴, Email: fmding81@163.com

Keywords：

諾卡菌病; 結核分枝桿菌; 新型冠狀病毒感染; 發熱

DOI：

10.7507/1671-6205.202401060

Video：

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目的分析新型冠狀病毒感染繼發諾卡菌病合并活動性肺結核患者的臨床特征，提高臨床醫師對諾卡菌病的認識。方法回顧性分析1例新型冠狀病毒感染患者繼發諾卡菌病合并活動性肺結核病例的臨床癥狀、實驗室檢查、影像學檢查、病原學結果及治療，并復習國內外相關文獻。結果患者女，72歲，在新型冠狀病毒感染后出現長期反復發熱、咳嗽和咳痰，胸部CT提示雙肺炎癥，痰涂片抗酸染色陰性，常規痰培養未見可疑致病菌，最終通過肺泡灌洗液宏基因組學二代基因測序發現圣喬治教堂諾卡菌合并結核分枝桿菌感染，經針對上述病原體抗感染治療后患者病情顯著緩解。文獻復習顯示諾卡菌感染在免疫缺陷患者中的風險高，其合并結核分枝桿菌感染時易出現漏診和誤診。目前在新型冠狀病毒感染期間或感染后出現的諾卡菌病例僅有少數報道，尚未檢索到類似本例新型冠狀病毒感染后繼發諾卡菌病合并活動性肺結核的病例報告。結論諾卡菌病的臨床癥狀、體征和影像學缺乏特異性，病原學培養耗時長，因此對于新型冠狀病毒感染后出現反復發熱患者，應注重基于分子生物學的病原微生物檢測，考慮是否存在諾卡菌合并結核分枝桿菌感染可能，避免因漏診、誤診而延誤治療。

Citation： 任潔, 湯榮, 楊鍇, 謝國鋼, 丁鳳鳴, 張旻. 新型冠狀病毒感染繼發諾卡菌病合并活動性肺結核一例并文獻復習. Chinese Journal of Respiratory and Critical Care Medicine, 2024, 23(7): 504-508. doi: 10.7507/1671-6205.202401060 Copy

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2.	McNeil MM, Brown JM. The medically important aerobic actinomycetes: epidemiology and microbiology. Clin Microbiol Rev, 1994, 7(3): 357-417.
3.	Luke E, Swafford K, Shirazi G, et al. TB and COVID-19: an exploration of the characteristics and resulting complications of co-infection. Front Biosci (Schol Ed), 2022, 14(1): 6.
4.	Lerner PI. Nocardiosis. Clin Infect Dis, 1996, 22(6): 891-905.
5.	Traxler RM, Bell ME, Lasker B, et al. Updated review on Nocardia species: 2006-2021. Clin Microbiol Rev, 2022, 35(4): e0002721.
6.	Menéndez R, Cordero PJ, Santos M, etal. Pulmonary infection with Nocardia species: a report of 10 cases and review. Eur Respir J, 1997, 10(7): 1542-1546.
7.	Al Umairi RS, Pandak N, Al Busaidi M. The findings of pulmonary nocardiosis on chest high resolution computed tomography: single centre experience and review of literature. Sultan Qaboos Univ Med J, 2022, 22(3): 357-361.
8.	Brown-Elliott BA, Brown JM, Conville PS, et al. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev, 2006, 19(2): 259-282.
9.	Lafont E, Conan PL, Rodriguez-Nava V, et al. Invasive nocardiosis: disease presentation, diagnosis and treatment - old questions, new answers? Infect Drug Resist, 2020, 13: 4601-4613.
10.	柳曉金, 楊娜, 程歡歡, 等. 結核病專科醫院24例諾卡菌病臨床特征分析. 中國熱帶醫學, 2022, 22(2): 177-180.
11.	Nachiappan AC, Rahbar K, Shi X, et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics, 2017, 37(1): 52-72.
12.	Chen Y, Hu W. Co-infection with Mycobacterium tuberculosis and Nocardia farcinica in a COPD patient: a case report. BMC Pulm Med, 2023, 23(1): 136.
13.	Smith I. Mycobacterium tuberculosis pathogenesis and molecular determinants of virulence. Clin Microbiol Rev, 2003, 16(3): 463-496.
14.	Oni T, Patel J, Gideon HP, et al. Enhanced diagnosis of HIV-1-associated tuberculosis by relating T-SPOT. TB and CD4 counts. Eur Respir J, 2010, 36(3): 594-600.
15.	Yagyu K, Nakatsuji Y, Matsushita H. Elevated serum β-d-glucan levels in cavitary pulmonary nocardiosis. BMJ Case Rep, 2020, 13(7): e234738.
16.	Margalit I, Lebeaux D, Tishler O, et al. How do I manage nocardiosis? Clin Microbiol Infect, 2021, 27(4): 550-558.
17.	Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc, 2012, 87(4): 403-407.
18.	Alsayed SSR, Gunosewoyo H. Tuberculosis: pathogenesis, current treatment regimens and new drug targets. Int J Mol Sci, 2023, 24(6): 5202.
19.	Peloquin CA, Davies GR. The treatment of tuberculosis. Clin Pharmacol Ther, 2021, 110(6): 1455-1466.

1. Stamos DB, Barajas-Ochoa A, Raybould JE. Nocardia pseudobrasiliensis co-infection in SARS-CoV-2 patients. Emerg Infect Dis, 2023, 29(4): 696-700.
2. McNeil MM, Brown JM. The medically important aerobic actinomycetes: epidemiology and microbiology. Clin Microbiol Rev, 1994, 7(3): 357-417.
3. Luke E, Swafford K, Shirazi G, et al. TB and COVID-19: an exploration of the characteristics and resulting complications of co-infection. Front Biosci (Schol Ed), 2022, 14(1): 6.
4. Lerner PI. Nocardiosis. Clin Infect Dis, 1996, 22(6): 891-905.
5. Traxler RM, Bell ME, Lasker B, et al. Updated review on Nocardia species: 2006-2021. Clin Microbiol Rev, 2022, 35(4): e0002721.
6. Menéndez R, Cordero PJ, Santos M, etal. Pulmonary infection with Nocardia species: a report of 10 cases and review. Eur Respir J, 1997, 10(7): 1542-1546.
7. Al Umairi RS, Pandak N, Al Busaidi M. The findings of pulmonary nocardiosis on chest high resolution computed tomography: single centre experience and review of literature. Sultan Qaboos Univ Med J, 2022, 22(3): 357-361.
8. Brown-Elliott BA, Brown JM, Conville PS, et al. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev, 2006, 19(2): 259-282.
9. Lafont E, Conan PL, Rodriguez-Nava V, et al. Invasive nocardiosis: disease presentation, diagnosis and treatment - old questions, new answers? Infect Drug Resist, 2020, 13: 4601-4613.
10. 柳曉金, 楊娜, 程歡歡, 等. 結核病專科醫院24例諾卡菌病臨床特征分析. 中國熱帶醫學, 2022, 22(2): 177-180.
11. Nachiappan AC, Rahbar K, Shi X, et al. Pulmonary tuberculosis: role of radiology in diagnosis and management. Radiographics, 2017, 37(1): 52-72.
12. Chen Y, Hu W. Co-infection with Mycobacterium tuberculosis and Nocardia farcinica in a COPD patient: a case report. BMC Pulm Med, 2023, 23(1): 136.
13. Smith I. Mycobacterium tuberculosis pathogenesis and molecular determinants of virulence. Clin Microbiol Rev, 2003, 16(3): 463-496.
14. Oni T, Patel J, Gideon HP, et al. Enhanced diagnosis of HIV-1-associated tuberculosis by relating T-SPOT. TB and CD4 counts. Eur Respir J, 2010, 36(3): 594-600.
15. Yagyu K, Nakatsuji Y, Matsushita H. Elevated serum β-d-glucan levels in cavitary pulmonary nocardiosis. BMJ Case Rep, 2020, 13(7): e234738.
16. Margalit I, Lebeaux D, Tishler O, et al. How do I manage nocardiosis? Clin Microbiol Infect, 2021, 27(4): 550-558.
17. Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc, 2012, 87(4): 403-407.
18. Alsayed SSR, Gunosewoyo H. Tuberculosis: pathogenesis, current treatment regimens and new drug targets. Int J Mol Sci, 2023, 24(6): 5202.
19. Peloquin CA, Davies GR. The treatment of tuberculosis. Clin Pharmacol Ther, 2021, 110(6): 1455-1466.

Chinese Journal of Respiratory and Critical Care Medicine

新型冠狀病毒感染繼發諾卡菌病合并活動性肺結核一例并文獻復習

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