- 期刊
奴卡氏菌引起的蜂窩性組織炎－病例報告
Nocardial Orbital Cellulitis in an Adult-A Case Report
摘要
全身性的奴卡氏菌感染多發生在免疫不全的病人身上，而奴卡氏菌造成的局部感染雖不常見，但也可以發生在免疫功能正常的病人身上。皮膚的感染多因為小的創傷，穿刺傷，昆蟲動物咬傷，使得奴卡氏菌直接侵入傷口，多發生在從事園藝或種田時。本病例是一位五十六歲女性，初始症狀為左眼眶上方之丘疹，經過未清潔的手擠壓後，引起左眼眶周圍紅腫熱痛之現象。使用抗生素oxacillin，再改為amoxicillin-clavulanate(Augmentin)之後並無改善，經向局部切開引流膿瘍確診，細菌培養為奴卡氏菌感染(Nocardia brasiliensis)，而改以抗生素trimethoprim-sulfamethoxazole(Septrin)使用一週後，出院時僅有左眼眶上方一無痛結節，抗生素改為口服trimethoprim-sulfamethoxazole(Baktar)使用，於門診追蹤無復發狀況。向於奴卡氏菌引起的峰窩性組織炎在臨床上的表現不易和常見的化膿性細菌如金黃色葡萄球菌或A型鏈球菌所造成的感染做區分，因此容易延遲診斷以及治療。僅藉此病例加強醫師對於治療反映不佳的峰窩性組織炎需考慮此一鑑別診斷，以及在使用抗生素前能早期作細菌培養的重要性。
關鍵字
無資料並列摘要
Nocardiosis is typically regarded as an opportunistic infection in immunocompromised patients. However, Cutaneous disease usually occurs by direct inoculation of the organism as a result of trauma, surgery, stabbing, and animal scratches or animal bites while farming or gardening. This 56-year-old woman was a case of orbital cellulitis with initial presentation of periorbital painful swelling and erythematous change. Final diagnosis was made by wound culture which revealed Nocardia brasiliensis infection. No brain abscess was found by head CT study. Trimethoprim-sulfamethoxazole was given according to the test. The patient was discharged without complication after a 7-day antibiotics treatment course. Cutaneous infection by Nocardial species is clinically indistinguishable from lesions produced by common pyogenic bacteria such as Staphylococcus aureus or group A streptococcus. Thus delaying the diagnosis and treatment are common. By this case, physician could familiarize the disease when poor response happened after empirical antibiotics use for cellulitis, and recognize the importance of making wound culture as early as possible before antibiotics use.
延伸閱讀
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