摘要
目的 提高对胸部放线菌病的诊断水平。方法 回顾性分析深圳市人民医院2014年1月—2021年12月诊断的胸部放线菌病病例,总结其临床表现、影像学特征并随访预后。结果 44例胸部放线菌病患者,男36例、女8例,年龄(54.3±14.3)岁。29例(65.9%)合并基础疾病,常见临床表现依次为咳嗽33例(75.0%),咯痰26例(59.1%)、咯血15例(34.1%)、发热12例(27.3%)、体重下降10例(22.7%)和胸闷气短9例(20.5%)。胸部CT主要表现为斑片影、结节影、团块影、实变影、空洞、胸腔积液,病灶中央坏死区不强化,边缘强化明显。11例经组织病理确诊。42例患者均送检了下呼吸道样本(肺泡灌洗液、气管镜取痰)病原学培养,20例(47.6%,20/42)放线菌培养阳性。23例(23/44,52.3%)行宏基因组二代测序(mNGS),检出放线菌序列19例,检出率82.6%(19/23),检出序列数为1~1 667,中位数为14。mNGS对放线菌的检出率(82.6%)高于痰培养(43.5%)(P=0.021)。41例患者使用青霉素治疗,3例使用大环内酯类治疗,疗程3~12个月,中位数为6个月。3例因合并器官功能衰竭死亡,4例失访,其他患者预后良好。结论 胸部放线菌病临床表现缺乏特异性,借助于常规病原学检测手段联合mNGS可以提高疾病的诊断率。
Objective To improve the diagnosis of thoracic actinomycosis.Methods Thoracic actinomycosis diagnosed in Shenzhen People's Hospital from January 2014 to December 2021 were retrospectively analyzed.The clinical manifestations,imaging features and prognosis were summarized.Results The 44 patients with thoracic actinomycetes included 36 males and 8 females.The mean age was(54.3±14.3)years old.Underlying disease was found in 29 patients(65.9%).The main clinical manifestations were cough in 33 cases(75.0%),followed by sputum in 26 cases(59.1%),hemoptysis in 15 cases(34.1%),fever in 12 cases(27.3%),weight loss in 10 cases(22.7%),and shortness of breath in 9 cases(20.5%).The main imaging features were patchy opacities,nodular opacities,masses,consolidation,cavities and pleural effusion.There was no enhancement in the central necrotic area of the lesion,but apparent enhancement was observed at the edge.The diagnosis was confirmed by histopathology in 11 cases.Lower respiratory tract specimens(BALF and sputum obtained by bronchoscopy)were cultured in all 42 patients.Actinomycetes was detected in 20 cases(20/42,47.6%).Meta-genomics next-generation sequencing technology(mNGS)was conducted in 23 cases(23/44,52.3%),and reported positive result in 19 cases(82.6%,19/23).The sequence number ranged from 1 to 1667.The median was 14.The mNGS method detected significantly higher rate(82.6%)of Actinomycetes than sputum culture(47.6%,P=0.021).Overall,41 patients were treated with penicillin and 3 patients with macrolides.The treatment duration ranged from 3 to 12 months,with a median duration of 6 months.Three patients died because of organ failure and 4 patients were lost to follow up.The outcome was good in other patients.Conclusions The clinical manifestations of thoracic actinomycosis are not specific.Conventional etiological detection combined with mNGS can improve the diagnosis rate of the disease.
作者
方颖颖
詹丹婷
王凌伟
FANG Yingying;ZHAN Danting;WANG Lingwei(The Second Clinical Medical College,Jinan University,Shenzhen Guangdong 518020,China)
出处
《中国感染与化疗杂志》
CAS
CSCD
北大核心
2023年第6期691-694,共4页
Chinese Journal of Infection and Chemotherapy
关键词
放线菌病
疾病特征
诊断
宏基因组二代测序
actinomycosis
disease feature
diagnosis
metagenomic next-generation sequencing
