查詢結果分析
相關文獻
- Primary Cutaneous Nocardiosis--A Report of Three Cases and Review of Literature
- Bacteremia and Fungemia in Patients with Advanced Human Immunodeficiency Virus (HIV) Infection in Taiwan
- 原發性免疫不全疾病的造血幹細胞移植治療
- Ultrasound-Guided Percutaneous Transthoracic Needle Aspiration Biopsy for Diagnosis of Pulmonary Lesions in Advanced HIV Infection
- HIV感染孕婦之諮詢與照護
- 後天性免疫不全症候群併肺囊泡蟲肺炎及自發性氣胸--病例報告及文獻回顧
- Patient-controlled Epidural Analgesia for Postherpetic Neuralgia in an HIV-infected Patient as a Therapeutic Ambulatory Modality
- Pattern of Defervescence in Response to Anti-Tuberculosis Therapy in Patients with Extrapulmonary Tuberculosis and Advanced Human Immunodeficiency Virus Infection
- 免疫不全宿主之中樞神經系統感染
- 結核病與人類免疫不全病毒感染
頁籤選單縮合
題名 | Primary Cutaneous Nocardiosis--A Report of Three Cases and Review of Literature=原發性皮膚奴卡氏菌感染--病例報告及文獻回顧 |
---|---|
作者 | 張惇皓; 謝綺瀅; 石育仲; 張克中; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷期 | 27:1 2018.03[民107.03] |
頁次 | 頁75-83 |
分類號 | 415.725 |
關鍵詞 | 原發性皮膚奴卡氏菌; 格蘭氏陽性嗜氧菌; 免疫不全; Primary cutaneous nocardiosis; Nocardia; Skin; Infection; |
語文 | 英文(English) |
中文摘要 | 背景:奴卡氏菌為一緩慢生長的格蘭氏陽性嗜氧菌,普遍存在土壤中,可造成局部或全身性的感染,通常發生在免疫不全的病人身上。但對於免疫功能正常的病人,奴卡氏菌大多經由皮膚的侵犯造成原發性的皮膚病灶。目的及目標:原發性皮膚奴卡氏菌感染並不常見,且大部分的外科醫師對此疾病並不熟悉。我們提出三例病例報告,並做文獻的回顧,以期對此疾病的流行病學、臨床表現、診斷、治療及預後有更深的了解。材料及方法:案例一為一八十七歲女性,於左腿出現許多小水泡合併紅腫一周。水泡後續變成膿包,且出現皮膚壞死。案例二為一四十九歲家庭主婦,有三年的糖尿病史。症症為右小腿有一紅腫熱痛結節。此病灶後來發展為較大片的紅疹及膿包,膝窩及鼠蹊也出現疼痛性的淋巴結節。案例三為一二十八歲男性工人,於操作油壓挖土機時被高壓噴濺的機油造成右手掌的穿刺傷。此傷口併發反覆發作的紅腫和排出竇。三者案例的傷口培養皆為奴卡氏菌,且接受多次的清創手術和不同時間長度的抗生素Trimethoprim/sulfamethoxazole治療。結果:原發性皮膚奴卡氏菌感染有三種典型的臨床表徵。案例一屬於表淺皮膚型,案例二為淋巴皮膚型,案例三則較似於足菌腫型。在接受完整的療程之後,案例一及案例二分別追蹤一年及兩個月,皆無復發。案例三於追蹤三年時手背出現一無痛性結節,切片顯示為肉芽組織且培養無奴卡氏菌,之後康復無異常。結論:原發性皮膚奴卡氏菌感染有著多樣的臨床表徵。診斷此疾病需要高度的臨床懷疑和微生物學的特殊培養。原發性皮膚奴卡氏菌的治療則仰賴手術及長期的抗生素治療,以降低復發機率。 |
英文摘要 | Background: Nocardia is a genus of slow-growing, aerobic, gram-positive, bacilli. It is ubiquitous in soil and can cause local and disseminated infections especially in immunocompromised patients. In immunocompetent patients, Nocardia infection usually presents as a primary cutaneous lesion resulting from bacterial inoculation into the skin. Aim and Objectives: Primary cutaneous nocardiosis (PCN) is uncommon, and most surgeons are unfamiliar with this disease. Here, we reported three cases of PCN and presented a review of literature to better describe the epidemiology, clinical manifestations, diagnosis, management, and outcome of PCN. Materials and methods: Case 1 was an 87-year-old woman presented with erythematous swelling and multivesicular rash of her left leg for 1 week. The vesicles developed into pustular bullae with skin necrosis. Case 2 was a 49-year-old housewife, with a 3-year history of diabetes mellitus, presented with a painful, tender red nodule at the right lower leg. The lesion exacerbated into an erythematous pustule with popliteal and inguinal tender lymphadenopathy. Case 3 was a 28-year-old man who was injured by a spurt of machine oil when operating a hydraulic shovel excavator. This caused a small penetrating wound on his right palm and recurrent erythematous indurations and draining sinuses. The wound culture of Case 1 yielded Nocardia species while both the culture of Case 2 and Case 3 revealed N. asteroids. All the patients were treated with multiple debridement procedures and different duration of Trimethoprim/sulfamethoxazole. Results: Historically, there were three typical clinical presentations of PCN that had been described. Case 1 belonged to the superficial skin infection. Case 2 was the lymphocutaneous infection and Case 3 was more similar to mycetoma. After completion of treatment, Cases 1 and 2 had no signs of recurrence at the 1-year and 2-month follow-ups, respectively. Case 3 had a nodular lesion in the dorsum of the right hand 3 years after the initial injury, but the biopsy revealed only granulation tissue with negative culture for Nocardia. He recovered uneventfully. Conclusion: PCN has the divergent clinical manifestations. Increased awareness about nocardiosis and implementation of specific microbiological investigations are required to avoid misdiagnosis. Furthermore, the treatment of PCN should base on a combined approach involving adequate debridement and prolonged antibiotics to lower the possibility of recurrence. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。