Pulmonary Nocardiosis in a Non-HIV Patient: A Case Report

非人類免疫缺陷病毒帶原者併發北京諾卡氏菌感染：病例報告

張家豪(Chia-Hao Chang) ； 王秉槐(Ping-Huai Wang) ； 張厚台(Hou-Tai Chang)

《胸腔醫學》 30卷1期 (2015/02) Pp. 30-35

摘要

社區型肺炎的病患中，因為肺諾卡菌感染是非常罕見的。診斷上通常延遲，並且有很高的死亡率。在85種肺諾卡菌中，北京諾卡氏菌在台灣的發生率是很低的（約1.2%至5.9%）。我們報告一位67歲本身有慢性阻塞性肺疾病的男性病患，病人因為社區型肺炎住院，住院時的胸部X光片顯示雙肺為多發結節狀浸潤。病患的痰液的革蘭氏染色顯示革蘭氏陽性分枝絲狀體。16S ribsomal RNA基因序列分析證實為北京諾卡氏菌感染。病人的臨床狀況在使用trimethoprim/sulfamethoxazole後有明顯改善。肺諾卡菌的感染臨床表現並無明顯的特異性，這使得診斷更加困難。即使在免疫正常的病人肺諾卡菌感染也需要保持高度的警覺性。

關鍵字

慢性阻塞性肺病 ； 肺諾卡菌

並列摘要

The occurrence of pulmonary nocardiosis (PN) among patients with community-acquired pneumonia is quite uncommon. The diagnosis is usually delayed and as a result the mortality rate is high. Furthermore, the incidence of Nocardia beijingensis is low in Taiwan. We report a 67-year-old man with chronic obstructive pulmonary disease (COPD) who was admitted under a diagnosis of community-acquired pneumonia. Chest radiography showed multiple nodular infiltrates in bilateral lungs. The sputum Gram stain revealed Gram-positive branched filaments. Nocardia beijingensis was subsequently confirmed by 16S ribosomal RNA gene sequencing analysis. The patient's clinical condition improved after receiving trimethoprim/ sulfamethoxazole treatment. The non-specific clinical manifestations of PN render the correct diagnosis challenging. Therefore, a high degree of clinical suspicion is the key when making a diagnosis, even in patients with a non-human immunodeficiency virus (HIV) status.

並列關鍵字

chronic obstructive pulmonary disease ； nocardiosis