Mixed Infection by Sulfamethoxazole-Resistant Nocardia Asteroides and Multidrug-Resistant Mycobacterium Tuberculosis-A Case Report

磺胺類抗藥性土壤絲菌和多重抗藥性肺結核合併感染－病例報告

謝正雄(Cheng-Shiung Hsieh) ； 曹世明(Shih-Ming Tsao) ； 吳子卿(Tzu-Chin Wu)

《胸腔醫學》 22卷3期 (2007/06) Pp. 162-167

https://doi.org/10.29806/TM.200706.0002

摘要

肺部土壤絲菌症並不常見但會造成嚴重感染，最常在免疫失調病人身上被發現。土壤絲菌症造成的肺部感染由於臨床上及放射學上並無特異性而難以診斷出來。肺部土壤絲菌和肺結核合併感染更是罕見。我們報告一例並不尋常的病例在腎病症候群經類固醇治療後是以肺部多發性開洞性結節表現。膿瘍和痰液培養長出對磺胺類藥物具有抗藥性的土壤絲菌。在四週後的痰液培養正式報告，多重抗藥性的肺結核菌也被鑑定出來。抗生素治療在磺胺類抗藥性土壤絲菌和多重抗藥性肺結核合併感染方面值得加以討論並須要更多的研究。

關鍵字

土壤絲菌症 ； 肺結核

並列摘要

Pulmonary nocardiosis (PN) is an infrequent but severe infection that is found most commonly in immunocompromised patients. A correct diagnosis based on clinical and radiological features is difficult, since they are nonspecific. Combined PN and Mycobacterium tuberculosis (MTB) infection is even rarer. We report an unusual case of a patient with nephrotic syndrome who had received corticosteroid therapy and presented with multiple cavitary pulmonary nodules. Pus and sputum cultures yielded trimethoprim-sulfamethoxazole (TMP-SMX)-resistant Nocardia asteroides. Multidrug-resistant (MDR) MTB was formally reported 4 weeks later. The patient was finally treated with second-line anti-tuberculosis drugs.

並列關鍵字

pulmonary nocardiosis ； Mycobacterium tuberculosis