Pulmonary Nocardiosis: A Clinical Analysis And Literatures Review Of 6 Cases

Objective: This study aimed to summarize the clinical characteristics of pulmonary nocardiosis and provide information for early diagnosis and treatment of the disease.Materials and methods: Clinical data of 6 PN cases at the first affiliated hospital of Guangxi medical university from 1993 to 2017.11.The literatures of PN are searched in the database of CNKI,PubMed,Wanfang and Vip to collected and analyzed.Results: 1 patient without underlying disease and 5 patients with underlying disease,4 patients with medical history of corticosteroids and immunosuppressive drugs were identified.Among 6 male PN cases aged 3 to 63 years.Among the patients,cough,sputum,fever,dyspnea,and chest pain were the most common clinical manifestations.The chest computed tomography demonstrates patchy ground,chord structures,multiple nodules and masses.Accompanied with cavitation,pleural effusion,pneumothorax and pleural thickening.The diagnostic measurement of 6 patients including culture of hydrothorax,sputum and BALF,BALF,left upper arm mass,purulent fluid and hydrothorax.Trimethoprim-sulfametho-xazole was the main treatment strategy,and combined treatment improved the therapeutic effect if necessary.The treatment course ranged from 1 to 7 months.Pulmonary lesions of 5 cases improved after treatment,1 cases was discharged automatically due to exacerbation and later lost follow-up.Conclusion: PN mainly occurs in population immunocompromised and that with underlying disease.PN rarely occurs in patients without underlying disease.The main clinical manifestations were cough,sputum,fever and dyspnea,domestic reports also showed chest pain,hemoptysis,abdominal distension,and diarrhea.PN is difficult to diagnose,and etiological examination source mainly from sputum is the gold standard for diagnosis.A variety of detection methods and multiple sampling specimens,such as bronchoscopy,lung biopsy and thoracic puncture are helpful for the detection of Nocardia.Prolong the incubation time is necessary for the growth of Nocardia is slow.Clinicians should communicate with the microbiological laboratory in time when suspected Nocardia infection.Early diagnosis and combination treatment based on sulfonamides can achieve satisfactory therapy response.