摘要
目的为临床医师诊治肺诺卡菌病提供参考,并探讨宏基因组二代测序技术(mNGS)对肺诺卡菌病的临床诊断价值。方法对2017年1月至2022年10月南京大学医学院附属鼓楼医院通过mNGS检测诊断的13例肺诺卡菌患者进行回顾性分析,并进行相关文献复习。结果13例患者中,男9例,女4例,年龄35~79岁,平均(57±10)岁;10例伴有基础疾病,4例使用激素或免疫抑制剂。临床表现主要为咳嗽、咳痰、发热、气喘、咯血、消瘦等。胸部CT表现为结节、肺实变、胸膜增厚、空洞、肿块、胸腔积液、支气管扩张、纵隔及腋窝淋巴结肿大、磨玻璃影。通过经支气管镜肺泡灌洗液行mNGS检测确诊9例,经支气管镜肺活检组织行mNGS检测确诊1例,经皮肺穿刺活检组织行mNGS检测确诊3例,标本均未培养出诺卡菌。入院至确诊中位时间为8 d(3.50~15.00 d)。治疗药物以复方磺胺甲噁唑为主,分别联合利奈唑胺、阿米卡星、亚胺培南、美罗培南、莫西沙星等抗菌药物。11例随访病情好转,1例随访无好转,3个月后确诊为肺癌,1例自动出院,未继续治疗。结论肺诺卡菌病的临床表现及影像学无明显特异性,容易漏诊、误诊。肺诺卡菌感染可能合并其他潜在病因,需密切随访以免漏诊。相较于传统细菌培养法,mNGS对于肺诺卡菌病是一种敏感高效的诊断方法,有很好的应用前景。
Objective To provide reference for clinicians in the diagnosis and treatment of pulmonary nocardiosis,and to investigate the clinical diagnostic value of metagenomic next-generation sequencing(mNGS)in pulmonary nocardiosis.Methods From January 2017 to October 2022,thirteen patients with pulmonary nocardiosis diagnosed by mNGS detection in Drum Tower Hospital Affiliated to Medical School of Nanjing University were retrospectively analyzed,and review relevant literature.Results Among thirteen patients with pulmonary nocardiosis,there were nine males and four females,aged 35-79 years old,with an average of(57±10)years old.Ten patients had comorbidities,four patients were treated with hormone or immunosuppressant.The main clinical manifestations were cough,expectoration,fever,asthma,hemoptysis and emaciation.The manifestations of chest CT scans included nodules,consolidation,pleural thickening,cavity,masses,pleural effusion,bronchiectasis,mediastinal and axillary lymph node enlargement and ground glass opacity.Nine cases were confirmed by mNGS using bronchoalveolar lavage fluid,one case was confirmed by mNGS using tissue acquired by transbronchial lung biopsy and three cases were confirmed by mNGS using tissues acquired by CT guided percutaneous lung biopsy,nocardia was not cultured in all samples.The median time from admission to diagnosis was 8 days(3.50-15.00 days).The therapeutic drugs were mainly compound sulfamethoxazole combined with linezolid,amikacin,imipenem,meropenem,moxifloxacin and other antibacterial drugs.Eleven patients were followed up for improvement,one patient was not improved and was diagnosed with lung cancer after three months of follow-up,one patient was discharged automatically without continuing treatment.Conclusion The clinical manifestations and CT imaging features of pulmonary nocardiosis are nonspecific and easy to be missed and misdiagnosed.Pulmonary nocardiosis may be associated with other potential causes,so close follow-up is needed to avoid missed diagnosis.Compared to the traditional bacterial culture method,mNGS is a sensitive and efficient diagnostic method for pulmonary nocardiosis,which has a promising application prospect.
作者
周丽娟
邱玉英
曹孟淑
张英为
代静泓
黄妹
曹敏
张之烽
肖永龙
李燕
ZHOU Lijuan;QIU Yuying;CAO Mengshu;ZHANG Yingwei;DAI Jinghong;HUANG Mei;CAO Min;ZHANG Zhifeng;XIAO Yonglong;LI Yan(Department of Respiratory and Critical Care Medicine,Drum Tower Hospital Affiliated to Medical School of Nanjing University,Nanjing 210008,Jiangsu,China;Department of Clinical Laboratory,Drum Tower Hospital Affiliated to Medical School of Nanjing University,Nanjing 210008,Jiangsu,China)
出处
《东南国防医药》
2023年第2期122-128,共7页
Military Medical Journal of Southeast China
基金
江苏省自然科学基金面上项目(BK20221168)
南京市卫生科技发展专项资金医药卫生科研课题(YKK22084)。
关键词
诺卡菌
肺诺卡菌病
宏基因组二代测序
nocardia
pulmonary nocardiosis
metagenomic next-generation sequencing
