星型奴卡菌感染两例并文献复习

目的:探讨星型奴卡菌感染的临床表现及诊断、治疗、预后,及星型奴卡菌细菌学鉴定、生化反应、及药敏实验的阳性所见。方法:报告广州军区总医院2例星型奴卡菌病的临床资料并复习相关文献,对其临床表现、诊断、治疗及预后进行回顾性分析。结果:两例星型奴卡菌病患者经治疗后痊愈出院,定期随访,未复发。结论:奴卡菌病属于严重的机会性感染,病原菌的分离和鉴定是诊断本病的首要条件,应及早使用磺胺类药物,必要时予外科辅助治疗。     

中枢神经系统奴卡菌感染诊治分析附一例鼻疽奴卡菌脑脓肿

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。     

星关奴卡菌致脑脓肿1例报告

奴卡菌感染较少见 ,奴卡菌为革兰氏阳性菌 ,属放线菌目。主要是星状奴卡菌对人类致病 ,其次为巴西奴卡菌、象鼠奴卡菌。而星状奴卡菌主要引起原发性、化脓性肺部感染 ,出现类似结核症状。肺部病灶可转移至皮下组织 ,形成脓疡和多发性瘘管 ,也可扩散至其它脏器。本院曾接诊 1例脑脓肿患者 ,疗效满意 ,现报告如下。1　临床资料　　患者 ,女 ,5 8岁 ,因反复头疼、头晕 1个半月 ,于 2 0 0 1年 9月 2 1日入院。查体 :体温 3 6.4℃、脉搏 76次 /分、呼吸 2 6次 /分、血压 1 5 / 1 0 .5 k Pa。血象 :WBC 9.1× 1 0 9/ L、 HGB 1 43 g/ L、 LCR…     

关于提高奴卡菌检出率的几点体会

奴卡菌病是由奴卡菌属引起的局限性或播散性化脓性疾病。该病在国外并非少见 ,但在国内少有报道。近来在我院发生 1例奴卡菌继发脑脓肿感染 ,分析临床该菌检出率低的原因主要有以下几点值得注意。1　因本病的临床表现、X线及实验室检查均无特异性 ,故对肺部的慢性感染经一般治疗无效或免疫功能低下患者 ,尤其是长期应用激素治疗的病人应排除本病 ,且其感染病灶的特殊检查与结核病类似 ,易导致误诊。2　对送检标本观察是否有色素颗粒 ,并涂片镜检观察是否存在抗酸性杆菌状 ,凡发现有部分抗酸的分支菌丝 ,且断裂成小棒状或球状者应提高警惕 ,…     

1例L型支气管戈登菌肺部感染的报道

放线菌目戈登菌属支气管戈登菌存在于环境中,在机体免疫力下降时可感染致病。从1例肺部感染4年的78岁患者痰标本中分离出1株菌株,经聚合酶链反应(PCR)扩增16SrRNADNA,序列比对分析证实为支气管戈登菌。该菌株在含蔗糖的Middlebrook7H9(7H9-L)半固体培养基上呈煎蛋样嵌入性生长,在含氯化钠的92-3TB(92-3TB-L)液体培养基也生长,而在罗氏培养基、BACTECMGIT-960、不含氯化钠的92-3TB(92-3TB-B)液体培养基及不含蔗糖的Middlebrook7H9(7H9-B)半固体培养基不生长。涂片抗酸染色显微镜下可见大小不等的抗酸染色阴性球状或短杆状菌。传代培养2代后可见橘红色菌落,涂片抗酸染色可见少量抗酸染色弱阳性杆状菌,革兰染色及扫描电子显微镜观察菌体为杆状。结果表明,从患者痰液中分离的菌株为L型支气管戈登菌,提示肺部感染迁延不愈的免疫力低下患者需考虑感染L型支气管戈登菌的可能。     

艾滋病合并卡氏肺孢子菌肺炎的诊断方法研究进展

卡氏肺孢子菌肺炎是由卡氏肺孢子菌引起的一种呼吸系统机会性感染,作为AIDS、器官移植、肿瘤、化疗等免疫功能低下患者的并发症越来越突出,对其做出正确、及时的诊断也越来越重要。该文就卡氏肺孢子菌的病原学及PCP的实验诊断、影像学诊断方法的研究概况和进展作一综述。     

两种黄素蛋白对奴卡霉素化合物的催化

【背景】2,4-二酮吡咯烷类化合物奴卡霉素和替达霉素都含有C-10酮基结构,但是该结构是由两种不同的酶短链脱氢酶NcmD和黄素腺嘌呤二核苷酸(flavine adenine dinucleotide, FAD)依赖的脱氢酶TrdL分别催化形成的。然而奴卡霉素生物合成基因簇中的FAD依赖的酶NcmL是否能回补NcmD的功能,以及TrdL能否催化奴卡霉素C-10酮基的形成,尚无相关的实验证据。【目的】通过体外酶催化实验研究NcmL和TrdL对奴卡霉素II和奴卡霉素F的C-10位羟基的催化作用。【方法】通过克隆ncmL和trdL至pET-28a(+)中,然后于大肠杆菌中进行诱导表达。诱导后的蛋白经纯化后,考察了纯化的NcmL和TrdL对奴卡霉素II和奴卡霉素F的催化作用,利用高效液相色谱与高分辨质谱联用技术鉴定了酶反应产物。【结果】NcmL不能催化奴卡霉素II和奴卡霉素F的C-10位羟基的脱氢反应,TrdL能催化奴卡霉素II和奴卡霉素F的C-10位羟基脱氢,分别得到奴卡霉素I和奴卡霉素G。【结论】体外生化研究表明,NcmL不参与奴卡霉素C-10酮基的生物合成反应,TrdL具有较广的底物谱,能催化多种奴卡霉素的C-10位羟基转化为酮基。     

艾滋病合并肺部感染12例临床分析

目的:探讨艾滋病(AIDS)合并肺部感染的临床特点、实验室检查及影像学特征。方法:回顾性分析我院2008年1月-2012年4月期间确诊的12例AIDS合并有肺部感染患者的病例资料。结果:发病以男性为主(11例),临床症状以发热、咳嗽、胸闷等为主,实验室检查血沉明显增快、中性粒细胞升高,2例合并有梅毒螺旋体感染,5例合并有乙肝病毒感染,1例合并丙肝病毒感染,氏肺孢子虫肺炎发生率41.67%(5/12);影像学检查主要表现为双肺弥漫性病变,肺门部位为主的毛玻璃样改变。结论:AIDS合并肺部感染患者早期不易诊断,应进一步提高对AIDS的临床症状及影像学认识提高对AIDS的早期诊断率,如存在高危因素者应及时进行艾滋病病毒抗体检测以明确诊断。     

艾滋病合并肺孢子菌肺炎1例的诊断治疗探讨

耶氏肺孢子菌肺炎（Pneumocystis jiroveci pneumonia,PJP,但习惯上仍简称PCP）常发生于未经高效抗反转录病毒药物治疗（highly active antiretroviral drugs therapy,HAART）的艾滋病（acquired immunodeficiency syndrome,AIDS）患者及PCP一级预防（即CD4＋T淋巴细胞计数〈200×10^5/L的患者接受抗PCP的预防性化疗）广泛应用之前,     

圣乔治教堂诺卡菌引起的肺部感染1例

诺卡菌肺部感染可引起肺诺卡菌病,因其无特异性的临床表现,容易误诊、漏诊。因此,临床实验室的培养鉴定能力非常重要,若不能及时诊治,则会导致病死率较高。诺卡菌病临床较为少见,为引起临床实验室对诺卡菌的鉴定和药敏试验的重视,本文报道了上海市嘉定区中心医院2019年2月收治的1例由圣乔治教堂诺卡菌(Nocardia cyriacigeorgica)感染引起的肺诺卡菌病病例,针对其临床特征、实验室检测及治疗等进行分析,期望对临床诊治诺卡菌病有所帮助。     

Nocardia cyriacigeorgica is a significant pathogen responsible for nocardiosis in Japan and Thailand

Nocardia cyriacigeorgica is a recently described species. During routine diagnostic testing of 121 clinical isolates, we found that about one fourth of the strains from Japan (19 isolates) and Thailand (8 isolates), which were identified in our laboratories as N. asteroides, in fact belong to N. cyriacigeorgica. To our knowledge, this is the first report of infection due to N. cyriacigeorgica in Japan and Thailand, and the third report of infection anywhere in the world. Although N. cyriacigeorgica is usually differentiated from other Nocardia species by utilization of glucose and gluconate, we found that it can also be differentiated by a characteristic synergistic effect between imipenem (IPM) and tobramycin (TOB).     

Resistance to Nocardia brasiliensis infection in mice immunized with either Nocardia or BCG

Different vaccination procedures to increase the mecha nisms of host resistance to Nocardia brasiliensis were studied in mice. When mice were challenged in the footpad, 2×10⁸ N. brasiliensis 20 days after footpad inoculation with either viable or killed N. brasiliensis, the mice demonstrated significant resistance to infection when compared with noninfected and nonimmunized mice. The degree of resistance seems to be correlated with the delayed-type hypersensitivity response in the vaccinated animals. Vaccination with another acid-fast bacilli, BCG, afforded both a mild protection and low DTH reactivity. Antibody levels to Nocardia were similar in either Nocardia- or BCG- treated groups indicating that they do not play an important role in resistance to infection by N. brasiliensis.     

A case of amniotic membrane transplantation in non-healing Nocardia asteroides keratitis

A patient with severe non-healing microscopically proven Nocardia keratitis was treated with maximal topical amikacin followed by amniotic membrane transplantation (AMT) 2 months later (single-layer epithelial side-down). Epithelial healing was achieved, but neovascularization continued. This case report indicates that AMT combined with topical antibiotic provides pain relief and allows epithelial healing in severe Nocardia keratitis.     

An unusual murine behavior following infection with log-phase Nocardia asteroides type 6 strain GUH-2 (Nocardia cyriacigeorgica GUH-2)

Nocardia asteroides (Nocardia cyriacigeorgica) strain GUH-2 infects the brains of mice following intravenous injection. Non-lethal infections resulted in a transitory increase of bacterial numbers in the brain followed by the development of permanent impaired movements at a time when bacteria appeared to be eliminated from the brain. These signs included headshake, rigidity, stooped posture, dyskinesia, retropulsion, and abnormal tail positioning in approximately 20% of infected animals. The attached video presents a typical mouse following infection with this organism, as compared to an age- and gender-matched uninfected control mouse.     

A study of the enzymatic profile of soil isolates of Nocardia asteroides

In this study, using the API-ZYM system, we have reported the enzyme profile of 42 soil strains and 2 clinical strains of Nocardia asteroides isolated locally. Of the 19 enzymes tested, only 7 were demonstrable in over 90% of the soil isolates. These included alkaline phosphatase, esterase lipase, leucine arylamidase, acid phosphatase, phosphohydrolase, α-glucosidase and β-glucosidase. In addition, β-galactosidase activity was demonstrated in all the strains by the O-nitrophenyl-β-D-galactopyranoside (ONPG) test. The enzymes which were not demonstrable in >95% of the strains included valine arylamidase, cystine arylamidase, trypsin, chymotrypsin, α-galactosidase, β-glucoronidase, N-acetyl-β-glucosaminidase, α-mannosidase and α-fucosidase. With the exception of valine arylamidase, which was lacking in all but one isolate, the enzyme profiles of the soil isolates were comparable with the clinical isolates of N. asteroides reported in previous studies. The reasons for this difference in the two sets of isolates is not clear. The study reinforces the view that specific differences in the enzymatic profiles of Nocardia species could be used for their rapid identification. However, more extensive studies are needed to establish the reproducibility of this method. To the best of our knowledge, this is the first study of the enzymatic profile of soil isolates of N. asteroides originating from a single geographic region. This revised version was published online in June 2006 with corrections to the Cover Date.     

Primary subcutaneous Nocardia asteroides infection in a renal allograft recipient

Nocardia asteroides is an important opportunistic pathogen in immunocompromised hosts. The primary infection is usually in the lungs and is followed by dissemination to other parts of the body. Primary subcutaneous infection with Nocardia asteroides has been reported rarely (three reports) and no such case has been reported in a renal transplant recipient. We describe here a case of renal transplant recipient who developed primary subcutaneous infection with Nocardia asteroides within one and half years of the transplantation. This revised version was published online in June 2006 with corrections to the Cover Date.     

红色诺卡氏菌的生物活性

为了考察红色诺卡氏菌菌体(NC)的生物活性, 通过一定浓度的NC对小鼠灌胃给药, 检测其毒性及对免疫器官、巨噬细胞(MΦ)吞噬功能的影响和对肉瘤S180抑制作用。结果表明小鼠口服NC, LD50>10 g/kg; NC明显增加小鼠胸腺脾脏重量、提升白细胞数量和提高小鼠MΦ的吞噬活性; 对小鼠腹腔MΦ具有明显的激活作用, 激活了的MΦ能增强抑杀白色念珠菌作用, 正常的小鼠MΦ也有一定的杀菌作用, 两者差异显著; 对小鼠S180腹水型转实体瘤具有明显的抑制作用。由此得出的结论是, NC毒性低, 能显著增强机体     

First human case of nocardiosis caused by Nocardia pseudobrasiliensis in Japan

Nocardia sp. IFM 0896, an actinomycete with biochemical characteristics that differed from Nocardia brasiliensis, was isolated from a 71-year-old Japanese man with a history of tuberculosis and cancer. Although the isolate was tentatively identified as N. brasiliensis, the morphological and physiological characteristics of strain IFM 0896 were different from those of N. brasiliensis IFM 0236^T. The results of 16S rRNA gene sequence phylogenies and PCR-RFLP analysis of a heat shock protein revealed that Nocardia sp. IFM 0896 belongs to the species N. pseudobrasiliensis. This is the first clinical isolation report of N. pseudobrasiliensis in Japan.This revised version was published online in October 2005 with corrections to the Cover Date.     

Mouse pathogenicity studies of Nocardia asteroides complex species and clinical correlation with human isolates

Abstract Nocardia asteroides complex organisms derived from human specimens between 1979 and 1992 were identified on the species level. Of 117 N. asteroides complex organisms, 34 (29%) were N. farcinica , 28 (24%) were N. nova , and 55 (47%) were N. asteroides sensu stricto . An analysis of the specimen sites from which the organisms were derived showed that isolates derived from blood, brain, or bone marrow were more likely to be N. farcinica than the other two species. A study of the virulence of ten strains of each species was undertaken, using a mouse model with intravenous inoculation. The 50% lethal doses (LD₅₀) for N. farcinica were significantly lower than those of the other two species. LD₅₀ values for N. nova and N. asteroides were not significantly different. The above data confirming the greater virulence of N. farcinica support the identification of species within the N. asteroides complex.