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肺奴卡菌病并脓胸一例及文献复习

临床资料 患者女性, 40 岁, 无业。因“发热、咳嗽、咳痰4 个月, 加重伴胸痛1 个月”于2008 年6月23 日入院。既往史: 确诊为“皮肌炎”8 个月并先后应用环磷酰胺、甲氨蝶呤, 同时规律口服泼尼松并逐渐减量治疗。入院前4 个月无明确诱因出现间断性发热, 体温最高39. 6 ℃, 咳嗽、咳黄痰, 有时痰中带血丝。1 个月前上诉症状加重, 伴有右胸痛, 到皮肤科就诊, 其时每日顿服泼尼松20 mg。考虑为皮肌炎( 活动期) 、社区获得性肺炎( 双侧) , 先后给予多种抗生素( 哌拉西林舒巴坦、替硝唑、左氧氟沙星、头孢哌酮舒巴坦) 抗感染治疗, 并加大糖皮质激素用量为泼尼松每日40 mg 顿服。仍持续高热、咳嗽、咳痰, 遂就诊于呼吸内科。......

奴卡菌病诊治一例

肺奴卡菌病伴颅内感染一例并文献复习

临床资料 患者男性, 43 岁, 务工。因“咳嗽、咳痰、发热1 个多月, 加重1 周”于2012 年11 月18日入院。患者主要表现为受凉后出现咳嗽、咳大量黄色脓痰、发热( 初始38 ～39 ℃, 之后进展至39 ～41 ℃) 。因院外反复抗生素治疗后症状无缓解入我院。病后精神睡眠差, 体温升高后进食差, 大小便未见异常, 体重明显减轻。既往史: 1 年前因水肿、血尿、蛋白尿于外院诊断“肾炎”, 2 个多月前开始“口服强的松60 mg”, 此次病后逐渐减量至入院前6 d停药。吸烟指数10 包年, 30 年饮酒史( 250 g/ d) 。否认冶游史, 婚育、家族史无特殊。......

Pulmonary nocardiosis complicated with aspergillosis: three cases report and literature review

ObjectiveTo investigate the clinical features of patients who went through Nocardia co-infection with Aspergillus in lung.MethodsClinical data of 3 pulmonary nocardiosis patients complicated with aspergillosis from China-Japan Hospital during June 2015 and May 2016 were retrospectively analyzed. Nine related literatures found at PubMed were reviewed and they all were case report. No Chinese literature was found at Wanfang data and Chinese Journal Fulltext Database.ResultsAll of the 3 patients were diagnosed as pulmonary nocardiosis by etiological detection, at the same time meeting the diagnostic criteria of invasive pulmonary aspergillosis. Two cases were infected with Aspergillus fumigatus. Aspergillus was not detected in the third case, but the galactomannan of serum and bronchoalveolar lavage fluid significantly increased.ConclusionPulmonary nocardiosis complicated with aspergillosis trends to occur in immunocompromised patients, and pathogen detection is important for diagnosis.

如何诊治继发性肺结核合并肺奴卡菌病

该文报道了一例患有痛风、糖尿病等多种疾病的高龄男性患者，院外诊断涂阳敏感肺结核并给予抗结核治疗，但呼吸困难症状加重、肺部影像学未改善。多学科讨论认为患者系免疫受损宿主，不排除合并细菌、真菌及特殊病原体感染，因此选择敏感抗生素治疗并合用奥司他韦和磺胺覆盖病毒及卡氏孢子菌、奴卡菌等病原体。痰菌延长培养发现皮疽奴卡菌生长，证实患者系肺结核合并肺奴卡菌病，经上述治疗患者呼吸衰竭好转。