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目的:了解中枢神经系统(CNS)奴卡菌感染的临床特点、诊治方法及预后。方法:对青岛大学附属医院收治的1例脑奴卡菌感染病例进行报道,并检索相关文献报道的脑奴卡菌感染共31例,对以上32例进行回顾性分析。结果:32例患者中,22例存在基础疾病,18例有糖皮质激素或免疫抑制剂治疗史。主要临床表现为头痛,发热,恶心、呕吐,口齿不清,意识障碍,肢体功能障碍等。7例接受复方磺胺甲噁唑单药治疗,17例接受复方磺胺甲噁唑联合其他抗生素治疗,8例接受喹诺酮类、氨基糖苷类、β-内酰胺类等联合治疗。23例好转或治愈,9例死亡。结论:免疫功能低下是中枢神经系统奴卡菌病的危险因素;奴卡菌培养阳性是确诊该病的惟一方法;应及早应用磺胺类药物,必要时结合外科手术治疗。
Objective: To understand the clinical features, diagnosis and treatment methods and prognosis of nocardiosis in central nervous system (CNS). Methods: One case of SNAO infection in Affiliated Hospital of Qingdao University was reported, and 31 cases of SLE infection were searched from related literature. The above 32 cases were retrospectively analyzed. Results: Of the 32 patients, 22 had underlying disease and 18 had glucocorticoid or immunosuppressive agents. The main clinical manifestations of headache, fever, nausea, vomiting, speechless, unconsciousness, limb dysfunction. Seven patients received compound sulfamethoxazole monotherapy, 17 patients received sulfamethoxazole combined with other antibiotics, 8 patients received quinolones, aminoglycosides, β-lactams and other combination therapy. 23 cases improved or cured, 9 died. Conclusion: Immunocompromised patients are the risk factors of Nocardiopathy in the CNS. The positive culture of Nocardia is the only way to diagnose the disease. Sulfa drugs should be used as soon as possible and combined with surgical treatment if necessary.