頁籤選單縮合
題 名 | Human Nocardiosis in Southern Taiwan from 1991 to 1996=南臺灣1991∼1996年之土壤絲菌症 |
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作 者 | 陳淑廷; 劉永慶; 王任賢; 陳垚生; 王堯顯; 萬樹人; 林錫勳; 李欣蓉; 黃文貴; 顏慕庸; 鄭德齡; | 書刊名 | 中華民國感染症醫學會雜誌 |
卷 期 | 8:2 1997.12[民86.12] |
頁 次 | 頁96-104 |
分類號 | 414.83 |
關鍵詞 | 土壤絲菌症; Nocardiosis; Nocardia asteroides complex; Trimethoprim/Sulfamethoxazole; corticosteroid; |
語 文 | 英文(English) |
中文摘要 | 高雄榮民總醫院從1991年1月至1996年4月,5年間共有25位罹患土壤絲菌症(Nocardiosis)病患。其中19位經細菌培養證實,菌株分別為Nocardia asteroides complex(14位),Nocardia spp.(4位)及Nocardia caviae(1位)。其餘6位經由痰液或支氣管刷液之革蘭氏染色及抗酸性染色診斷。18位病人為男性,7位女性(男:女=2.6:1)。年齡介於37與84歲之間(平均65歲)。感染部位如下:20位僅有肺部感染;3位僅有皮膚肌肉軟組織感染;1位同時有肺及皮膚肌肉軟組織感染;另1位同時有肺、皮膚肌肉軟組織及腦部感染。 臨床症狀無特異性;在肺部感染中,以發燒和咳嗽最為常見。出現症狀到確定診斷之中位數時間為18天。17位(68%)病人有服用類固醇的病史,包括因本身的疾病使用類固醇治療及使用含類固醇之中藥。3位(12%)病人無可證實之危險因子。所有病人,除了1位失去追蹤者外,皆以口服或靜脈注射trimethoprim/sulfamethoxazole治療(劑量為15亳克/公斤/天之 trimethoprim)。在13個存活病例中,治療時間之中位數為3個月,且無復發。在藥物感受性試驗中,以amikacin, minocycline, sulfamethoxazole, trimethoprim/sulfamethoxazole, imipenem及ceftriaxone最有效;而erythromycin, amoxicillin, chlortetracycline及ciprofloxacin最無效。死亡率為45.8%(11/24,1病例失去追蹤);死亡時間之中位數是在診斷10天後。使用類固醇治療及使用含類固醇之中藥為最常見的危險因子,且為導致死亡的重要因子。如果病人的胸部X光有異常及/或有慢性皮膚肌肉軟組織感染,特別是使用類固醇製劑治療或使用含類固醇之中藥者,此病均須列入鑑別診斷。 |
英文摘要 | We conducted a retrospective survey of nocardiosis at Veterans General Hospital-Kaohsiung, Kaohsiung, Taiwan from January 1991 to April 1996. The medical records of 25 patients with clinically documented nocardiosis were reviewed. Nineteen patients had positive cultures, including Nocardia asteroides complex (n= 14), Nocardia spp. (n = 4) and Nocardia caviae (n = 1). The remaining 6 cases were diagnosed on the basis of both Gram-stains and acid-fast stains of sputum or bronchial brushing. Eighteen patients were male and 7 female (sex ratio, 2.6:1). The patients' age ranged from 37 to 84 years (average 65.0 years). Sites of infection included the lung only in 20 patients; soft tissue only in 3 patients; both the lung and soft tissue in 1 patient; and lung, soft tissue and brain in 1 patient. Clinical manifestations were nonspecific, with fever and cough being the most common in pulmonary nocardiosis. The duration between onset of symptoms and diagnosis was a median of 18 days. Seventeen patients (68%) had a history of steroid use, including either corticosteroid therapy for underlying diseases or use of steroid-containing Chinese herbal medicine. Three patients (12%) had no identifiable risk factors. All, except 1 patient who was lost to follow-up, were treated with trimethoprim/sulfamethoxazole orally or intravenously (15 mg/kg/day of trimethoprim). The duration of treatment was a median of 3 months in the 13 patients who survived, and all survived without relapse. The most active drugs tested in the susceptibility test by broth microdilution were amikacin, minocycline, sulfamethoxazole, trimethoprim/sulfamethoxazole, imipenem and ceftriaxone; and the least active drugs were erythromycin, amoxicillin, chlortetracycline and ciprofloxacin. The case fatality rate was 45.8% (11/24, excluding the one patient who was lost to follow-up). The survival after diagnosis in fatal cases was a median of 10 days. Steroid use was the most common predisposing factor, and also a significant factor in mortality. Nocardiosis should be considered as one of the differential diagnoses in patients with pulmonary infiltrates and/or chronic soft tissue infection, particularly in patients using steroid-containing Chinese herbal medicine or receiving corticosteroid therapy. |
本系統中英文摘要資訊取自各篇刊載內容。