肺放线菌病一例报告_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

杨晓娅 , 冯银合 , 谢玲俐 , 汪钰滨 ,  毛辉

四川大学华西医院呼吸与危重症医学科（四川成都 610041）;

Corresponding author：

毛辉, Email: merrymh@126.com

Keywords：

肺放线菌病; 临床特征; 影像学特点; 诊断; 治疗

DOI：

10.7507/1671-6205.202105053

Video：

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目的通过分析1例肺放线菌病患者的临床特征及诊治过程，结合文献复习，加强临床医生对本病的认识，以期早期诊断、规范治疗，改善患者预后。方法回顾性分析1例肺放线菌病患者的临床资料，以“肺放线菌病”、“放线菌肺炎”为关键词在万方数据库、中国知网数据库、中国期刊全文数据库，以“pulmonary”和“actinomycosis”为关键词在PubMed数据库检索相关文献进行文献复习，总结肺放线菌病的临床特征、影像学特点、诊断手段、治疗及预后不良相关因素。结果患者男，53岁，因“反复咳嗽、咳痰4^－个月，伴咯血15 d”入院。患者无明显肺外临床表现，内科查体未见明显异常，外院胸部CT提示左下肺团片影，两次痰液送检二代测序，均检出放线菌菌属（检出最多序列数4393），革兰阳性格雷文尼放线菌多（检出最多序列数4258）。入院后予头孢哌酮舒巴坦针静脉滴注抗感染19 d，出院后继续复方磺胺口服，随访至2021年3月患者胸部影像学提示病变已明显吸收好转。结合本例及国内外文献报道的肺放线菌病相关资料，结果显示该病中老年男性多见，口腔卫生条件不良是该病的主要危险因素，临床症状无特异性，主要表现为咳嗽、咳痰、咯血，胸部CT典型表现为团块影并空洞形成，增强后不均匀强化，病灶内见稍低密度或气体密度，经支气管活检、经皮肺穿刺或手术标本病理为主要确诊手段，近年二代测序技术已成为诊断该病的重要工具。放线菌对多种抗菌药物敏感，但抗菌药物治疗疗程长，推荐6～12个月。内科及介入无法控制的大咯血以及抗菌药物治疗长疗程前提下临床症状无缓解、胸部影像学肺部病灶无明显吸收的患者，手术可能是一种治疗选择。结论肺放线菌病的临床特征及影像学表现均不典型，影像学上常表现为巨大团块，临床上常被误诊为肿瘤。痰液、纤维支气管镜灌洗液标本及经皮肺穿刺组织标本病原微生物二代基因测序有助于确诊。经抗菌药物治疗预后良好，对于止血药物及介入无法控制的大咯血、使用长疗程抗菌药物后临床症状仍缓解不明显或胸部影像学病变未见明显吸收的患者，手术可能是一种治疗选择。

Citation： 杨晓娅, 冯银合, 谢玲俐, 汪钰滨, 毛辉. 肺放线菌病一例报告. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(12): 877-880. doi: 10.7507/1671-6205.202105053 Copy

1.	马楠, 文仲光, 李艳红, 等. 肺放线菌病一例并文献复习. 中华结核和呼吸杂志, 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.	张雪, 仇煜, 荣光生. 支气管异物并发肺部放线菌病. 临床肺科杂志, 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.	张金娥, 赵振军, 何晖, 等. 胸部放线菌病的影像学特征. 中国医学影像技术, 2009, 25(6): 1015-1017.
15.	张有志, 章鹏, 杨海华, 等. 肺放线菌病血培养阳性一例并文献复习. 中国呼吸与危重监护杂志, 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. 马楠, 文仲光, 李艳红, 等. 肺放线菌病一例并文献复习. 中华结核和呼吸杂志, 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. 张雪, 仇煜, 荣光生. 支气管异物并发肺部放线菌病. 临床肺科杂志, 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. 张金娥, 赵振军, 何晖, 等. 胸部放线菌病的影像学特征. 中国医学影像技术, 2009, 25(6): 1015-1017.
15. 张有志, 章鹏, 杨海华, 等. 肺放线菌病血培养阳性一例并文献复习. 中国呼吸与危重监护杂志, 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

肺放线菌病一例报告

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