摘要
目的 探讨放线菌病的临床特征,提高该疾病的早期诊断及治愈率。方法 对2011年1月-2022年12月首都医科大学附属北京世纪坛医院收治的5例放线菌病患者的临床资料进行回顾性分析。结果 5例患者均为男性,其中4例有基础疾病,4例有糖尿病,且均血糖控制不佳,2例有口腔疾病,1例有支气管扩张,仅1例无基础疾病,但长期饮酒且发病前出现醉酒呕吐。1例出现皮肤受累,表现为胸壁皮下肿块;4例出现肺脏受累,可表现为发热、咳嗽、咳痰及咯血。胸部CT检查主要表现肺实变或浸润影、多发结节或团块影。有3例患者经组织活检病理确诊放线菌病,1例经痰液病理确诊肺放线菌病,1例经支气管肺泡灌洗液宏基因组二代测序检查确诊肺放线菌病。5例患者均接受了青霉素类药物治疗,其中1例青霉素治疗1周效果不佳行手术治疗,1例因合并真菌感染,联合伊曲康唑胶囊口服治疗。治疗后患者病情均有好转,随访病情稳定。结论 放线菌病患者多有基础疾病,尤其是糖尿病,临床表现无特异性。胸部CT主要表现为肺实变、结节或团块影。组织活检病理和宏基因组二代测序技术可早期发现放线菌。治疗首选青霉素,效果不佳者可行手术治疗。
OBJECTIVE To explore the clinical characteristics of actinomycosis so as to improve the early diagnosis and raise the cure rate.METHODS The clinical data of 5 patients with actinomycosis who were treated in Beijing Shijitan Hospital,Capital Medical University from Jan 2011 to Dec 2022 were retrospectively analyzed.RESULTS All the 5 patients were male,4 of whom had underlying diseases,4 had diabetes mellitus and poor control of blood glucose,2 had oral disease,1 had bronchiectasis,and only 1 case did not have any underlying disease but had long-term drinking history and presented drunken vomiting before onset of disease.1 case presented skin involve-ment and subcutaneous mass of chest wall;4 cases had lung involvement and were characterized by fever,cough,expectoration and hemoptysis.The result of chest CT examination showed that the cases mainly presented lung consolidation or infiltration,multiple nodules or block mass.3 patients were diagnosed with actinomycosis by tis-sue biopsy,1 patient was diagnosed with lung actinomycosis by sputum pathology,and 1 patient was diagnosed with lung actinomycosis by metagenomics next-generation sequencing(mNGS)examination of bronchoalveolar lav-age fluid.All the 5 patients received penicillins therapy,1 of whom received surgical procedure due to poor effect of penicillin therapy after 1 week,1 was complicated with fungal infection and received oral administration of itra-conazole.The illness condition of all the patients was improved after the treatment and was stable during follow-up.CONCLUSION Most of the actinomycosis patients have underlying diseases,especially diabetes mellitus,showing no specific clinical manifestations.The major findings of chest CT examination include the lung consolida-tion,nodules and mass.Tissue biopsy and mNGS may facilitate the early identification of actinomycosis.Penicillin is the first choice for the treatment,and surgical procedure is recommended if the therapeutic effect is poor.
作者
许亚丽
张杜超
张捷
钱进
潘磊
XU Ya-li;ZHANG Du-chao;ZHANG Jie;QIAN Jin;PAN Lei(BeijingShijitan Hospital,Capital Medical University,Beijing 100038,China)
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2024年第5期673-677,共5页
Chinese Journal of Nosocomiology
基金
国家重大疾病多学科合作诊疗能力建设基金资助项目(2019YLFW)
北京市临床重点专科建设基金资助项目(2020ZDZK1)。
关键词
放线菌
皮肤
肺脏
病理
青霉素
手术
Actinomycetes
Skin
Lung
Pathology
Penicillin
Surgery
