本报告描述了一例播散性诺卡尼病,是由诺卡氏菌引起的,一名患有巨球蛋白血症并反复发烧的61岁男子,咳嗽,呼吸急促,肌肉疼痛。分离的诺卡氏菌菌株对环丙沙星具有抗性,但对阿米卡星易感,庆大霉素,妥布霉素,利奈唑胺,甲氧苄啶-磺胺甲恶唑,阿莫西林/克拉维酸,莫西沙星,头孢曲松,头孢托西姆,还有亚胺培南.患者开始接受美罗培南和多西环素联合治疗,其次是甲氧苄啶-磺胺甲恶唑,随后改用利奈唑胺联合治疗,阿米卡星,和甲氧苄啶-磺胺甲恶唑.病人康复了,他的病情保持稳定。虽然诺卡氏菌感染很少见,在临床实践中很容易漏检,临床医生应该意识到这种感染的可能性.此外,当药物选择广泛时,应确定药物敏感性试验的MIC值。目前病例用利奈唑胺治疗成功,阿米卡星,和甲氧苄啶-磺胺甲恶唑.在播散性诺卡尼病的病例中,患者应接受抗菌治疗至少12个月.此外,应定期进行细菌学检查和抗菌药物敏感性测试。
This report describes a case of disseminated nocardiosis, caused by Nocardia vulneris, in a 61-year-old man with
macroglobulinemia and presenting with repeated fever, cough, shortness of breath, and muscle pain. The isolated Nocardia strain was resistant to ciprofloxacin, but susceptible to amikacin, gentamicin, tobramycin, linezolid, trimethoprim-sulfamethoxazole, amoxicillin/clavulanic, moxifloxacin, ceftriaxone, cefotaxim, and imipenem. The patient was started on combined meropenem and doxycycline treatment, followed by trimethoprim-sulfamethoxazole, which was subsequently switched to a combination treatment of linezolid, amikacin, and trimethoprim-sulfamethoxazole. The patient recovered, and his condition remained stable. Although infection by Nocardia vulneris is rare, and it is easy to miss detection in clinical practice, clinicians should be aware of the possibility of this infection. In addition, the MIC value of the drug sensitivity test should be ascertained when there is a wide choice of medicines. The current case was treated successfully with linezolid, amikacin, and trimethoprim-sulfamethoxazole. In cases of disseminated nocardiosis, the patient should be treated with antimicrobial therapy for at least 12 months. Furthermore, bacteriological examination and antimicrobial susceptibility testing should be performed regularly.