肺奴卡菌病合并曲霉感染三例并文献复习
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摘要
目的总结肺奴卡菌病合并曲霉感染的临床特点,提高对该疾病的诊治水平。方法回顾性分析2015年6月至2016年5月中日友好医院收治的3例肺奴卡菌病合并曲霉感染患者的临床特点。以"奴卡菌"、"曲霉"组合为检索词,通过万方数据库和中国期刊全文数据库进行检索,均未检索到相关文献。以"nocardiosis"及"aspergillosis"在Pub Med数据库检索到国外文献9篇,均为个案报道。结果本院3例患者均通过病原学检测明确为肺奴卡菌病,同时符合肺曲霉感染的临床诊断标准。其中2例病原学结果为烟曲霉,1例病原学未检测到曲霉,但血清和肺泡灌洗液GM试验检测半乳甘露聚糖抗原水平显著升高。结论肺奴卡菌病合并曲霉感染易发生于免疫抑制患者,病原学检测对于诊断十分关键。
Objective To investigate the clinical features of patients who went through Nocardia co-infection with Aspergillus in lung. Methods Clinical 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 Pub Med were reviewed and they all were case report. No Chinese literature was found at Wanfang data and Chinese Journal Fulltext Database. Results All 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. Conclusion Pulmonary nocardiosis complicated with aspergillosis trends to occur in immunocompromised patients, and pathogen detection is important for diagnosis.
Objective To investigate the clinical features of patients who went through Nocardia co-infection with Aspergillus in lung. Methods Clinical 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 Pub Med were reviewed and they all were case report. No Chinese literature was found at Wanfang data and Chinese Journal Fulltext Database. Results All 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. Conclusion Pulmonary nocardiosis complicated with aspergillosis trends to occur in immunocompromised patients, and pathogen detection is important for diagnosis.
引文
1 Abreu C,Rocha-Pereira N,Sarmento A,et al.Nocardia infections among immunomodulated inflammatory bowel disease patients:a review.World J Gastroenterol,2015,21(21):6491-6498.
2 Patterson TF,Thompson GR 3rd,Denning DW,et al.Practice Guidelines for the Diagnosis and Management of Aspergillosis:2016 Update by the Infectious Diseases Society of America.Clin Infect Dis,2016,63(4):el-e60.
3 De Pauw B,Walsh TJ,Donnelly JP,et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group(EORTC/MSG)Consensus Group.Clin Infect Dis,2008,46(12):1813-1821.
4 Casale TB,Macher AM,Fauci AS.Concomitant pulmonary aspergillosis and nocardiosis in a patient with chronicgranulomatous disease of childhood.South Med J,1984,77(2):274-275.
5 Carter JM,Green WR,Callender CO,et al.Pulmonary cavitation with Nocardia and Aspergillus in a renal transplant patient.J Natl Med Assoc,1990,82(7):527-528,530-521.
6 Monteforte JS,Wood CA.Pneumonia caused by Nocardia nova and Aspergillus fumigatus after cardiac transplantation.Eur J Clin Microbiol Infect Dis,1993,12(2):112-114.
7 van Dam AP,Pruijm MT,Harinck BI,et al.Pneumonia involving Aspergillus and Rhizopus spp.after a near-drowning incident with subsequent Nocardia cyriacigeorgici and N.farcinica coinfection as a late complication.Eur J Clin Microbiol Infect Dis,2005,24(1):61-64.
8 Al-Anazi KA,Aljurf MD,Al-Mohareb FI,et al.Successful management of invasive pulmonary nocardiosis and aspergillosis in a patient with T-cell lymphoma:a case report.Clin Med Case Rep,2008,1:65-71.
9 Hamadani M,Benson DM,Jr.Pulmonary Nocardia and Aspergillus co-infection in a patient with chronic graft-versus-host disease.Transpl Infect Dis,2008,10(1):24-26.
10 Cabada MM,Nishi SP,Lea AS,et al.Concomitant pulmonary infection with Nocardia transvalensis and Aspergillus ustus in lung transplantation.J Heart Lung Transplant,2010,29(8):900-903.
11 Misra DP,Parida JR,Chowdhury AC,et al.Pulmonary coinfection with Nocardia and Aspergillus in a patient with adultonset Still's disease receiving steroids and tacrolimus.BMJ Case Rep,2014,2014.
12 Sharma B,Ghosh G,Kamble U,et al.Allergic broncho pulmonary aspergillosis complicated by nocardiosis.Case Rep Pulmonol,2012,2012:758630.
13 Mehrian P,Esfandiari E,Karimi MA,et al.Computed tomography features of pulmonary nocardiosis in immunocompromised and immunocompetent patients.Pol J Radiol,2015,80:13-17.
14 Castellana G,Grimaldi A,Castellana M,et al.Pulmonary nocardiosis in chronic obstructive pulmonary aisease:a new clinical challenge.Respir Med Case Rep,2016,18:14-21.
15 Kandi V.Human Nocardia infections:a review of pulmonary nocardiosis.Cureus,2015,7(8):e304.
16 Canterino J,Paniz-Mondolfi A,Brown-Elliott BA,et al.Nocardia thailandica pulmonary nocardiosis in a post-solid organ transplant patient.J Clin Microbiol,2015,53(11):3686-3690.
17 Kurahara Y,Tachibana K,Tsuyuguchi K,et al.Pulmonary nocardiosis:a clinical analysis of 59 cases.Respir Investig,2014,52(3):160-166.
18 Tsujimoto N,Saraya T,Kikuchi K,et al.High-resolution CT findings of patients with pulmonary nocardiosis.J Thorac Dis,2012,4(6):577-582.
19 Simpson RS,Read RC.Nocardiosis and actinomycosis.Medicine,2014,42:23-25.
20吴小静,顾思超,李敏,等.肺诺卡菌病六例临床分析.中华临床染感染病杂志,2017,10(4):274-277.
2 Patterson TF,Thompson GR 3rd,Denning DW,et al.Practice Guidelines for the Diagnosis and Management of Aspergillosis:2016 Update by the Infectious Diseases Society of America.Clin Infect Dis,2016,63(4):el-e60.
3 De Pauw B,Walsh TJ,Donnelly JP,et al.Revised definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group(EORTC/MSG)Consensus Group.Clin Infect Dis,2008,46(12):1813-1821.
4 Casale TB,Macher AM,Fauci AS.Concomitant pulmonary aspergillosis and nocardiosis in a patient with chronicgranulomatous disease of childhood.South Med J,1984,77(2):274-275.
5 Carter JM,Green WR,Callender CO,et al.Pulmonary cavitation with Nocardia and Aspergillus in a renal transplant patient.J Natl Med Assoc,1990,82(7):527-528,530-521.
6 Monteforte JS,Wood CA.Pneumonia caused by Nocardia nova and Aspergillus fumigatus after cardiac transplantation.Eur J Clin Microbiol Infect Dis,1993,12(2):112-114.
7 van Dam AP,Pruijm MT,Harinck BI,et al.Pneumonia involving Aspergillus and Rhizopus spp.after a near-drowning incident with subsequent Nocardia cyriacigeorgici and N.farcinica coinfection as a late complication.Eur J Clin Microbiol Infect Dis,2005,24(1):61-64.
8 Al-Anazi KA,Aljurf MD,Al-Mohareb FI,et al.Successful management of invasive pulmonary nocardiosis and aspergillosis in a patient with T-cell lymphoma:a case report.Clin Med Case Rep,2008,1:65-71.
9 Hamadani M,Benson DM,Jr.Pulmonary Nocardia and Aspergillus co-infection in a patient with chronic graft-versus-host disease.Transpl Infect Dis,2008,10(1):24-26.
10 Cabada MM,Nishi SP,Lea AS,et al.Concomitant pulmonary infection with Nocardia transvalensis and Aspergillus ustus in lung transplantation.J Heart Lung Transplant,2010,29(8):900-903.
11 Misra DP,Parida JR,Chowdhury AC,et al.Pulmonary coinfection with Nocardia and Aspergillus in a patient with adultonset Still's disease receiving steroids and tacrolimus.BMJ Case Rep,2014,2014.
12 Sharma B,Ghosh G,Kamble U,et al.Allergic broncho pulmonary aspergillosis complicated by nocardiosis.Case Rep Pulmonol,2012,2012:758630.
13 Mehrian P,Esfandiari E,Karimi MA,et al.Computed tomography features of pulmonary nocardiosis in immunocompromised and immunocompetent patients.Pol J Radiol,2015,80:13-17.
14 Castellana G,Grimaldi A,Castellana M,et al.Pulmonary nocardiosis in chronic obstructive pulmonary aisease:a new clinical challenge.Respir Med Case Rep,2016,18:14-21.
15 Kandi V.Human Nocardia infections:a review of pulmonary nocardiosis.Cureus,2015,7(8):e304.
16 Canterino J,Paniz-Mondolfi A,Brown-Elliott BA,et al.Nocardia thailandica pulmonary nocardiosis in a post-solid organ transplant patient.J Clin Microbiol,2015,53(11):3686-3690.
17 Kurahara Y,Tachibana K,Tsuyuguchi K,et al.Pulmonary nocardiosis:a clinical analysis of 59 cases.Respir Investig,2014,52(3):160-166.
18 Tsujimoto N,Saraya T,Kikuchi K,et al.High-resolution CT findings of patients with pulmonary nocardiosis.J Thorac Dis,2012,4(6):577-582.
19 Simpson RS,Read RC.Nocardiosis and actinomycosis.Medicine,2014,42:23-25.
20吴小静,顾思超,李敏,等.肺诺卡菌病六例临床分析.中华临床染感染病杂志,2017,10(4):274-277.