奴卡菌性足菌肿

报告1例奴卡菌性足菌肿。患者男,56岁。左腹股沟术后出现皮肤红肿、破溃、脓液溢出半年。组织病理检查可见大量肉芽性炎性浸润,并见小脓肿形成,其内可见硫磺颗粒;分泌物涂片+抗酸染色镜检见阳性菌,菌丝内连串阳性颗粒;脓液培养见奴卡菌,诊断为奴卡菌性足菌肿。给予复方磺胺甲恶唑联合头孢曲松治疗,皮损完全消失。     

足菌肿

足菌肿是一种由真菌引起的慢性皮肤和皮下组织病变,常侵及其他组织,尤其是肌肉、筋膜和骨。其特点是有排出含有真菌“颗粒”的浆液脓性渗出物的瘘道形成。这类“颗粒”是致病菌的菌落和菌丝。病原学已知有很多种致病菌能引起足菌肿,主要有两大类:放线菌性足菌肿是由巴西诺卡氏菌、豚鼠诺卡氏菌和星状诺卡氏菌等需氧性放线菌类及足菌肿放线菌、白利梯链霉菌和索马里链霉菌等链霉菌类所引起。真菌性或马杜拉足菌肿是由不同的菌类所引起。常见的有马杜拉足分枝菌,灰色足     

星形奴卡菌性足菌肿1例

患者女,40岁。左足背被田间竹枝戳伤后出现结节、肿块,部分破溃伴少量溢脓,逐渐加重8年。皮损组织病理示:真皮组织中见散在分布放射状结构的杵状体,周围有大量中性粒细胞、淋巴细胞及组织细胞浸润。深部组织真菌镜检和培养均(-),深部组织脓液培养见菌落生长,菌种鉴定为星形奴卡菌。诊断:星形奴卡菌性足菌肿。予复方磺胺甲恶唑、青霉素G和阿米卡星联合治疗,局部清创处理后好转。     

皮肤诺卡菌病诊断与治疗进展

皮肤诺卡菌病是诺卡菌属经皮肤伤口引起的感染,多种诺卡菌均可引起,包括巴西诺卡菌、星形诺卡菌等.皮肤诺卡菌病临床表现无特异性,但以皮下结节伴有瘘管形成最常见.及时、准确的诊断对皮肤诺卡菌病的治疗有重要意义.磺胺类药物仍是治疗皮肤诺卡菌病的一线药物,但耐药株和多重耐药株的发现为临床治疗带来了新的挑战.建立准确的体外药敏谱和选择敏感抗生素对临床用药有指导意义.     

一株巴西诺卡菌的分离鉴定

诺卡菌是一类需氧的放线菌,它广泛存在于自然界的土壤和淡水中,可分布于世界各地,无地域差别[1].迄今为止可引起人类致病的菌种有星形诺卡菌、巴西诺卡菌、豚鼠诺卡菌和鼻疽诺卡菌,近年来国内陆续有病例报道[2,3].诺卡菌引起人类致病的临床特点主要为皮肤、皮下组织和肺、脑的急慢性化脓性感染,多为局灶性,少为系统性,系统性感染常见于免疫功能低下和慢性消耗性疾病,如白血病、肿瘤等.     

马杜拉分支菌引起下颌部真菌性足菌肿一例

目的 探讨1例真菌性足菌肿的临床病理特点、诊断、治疗及预后,并对其致病菌进行鉴定。方法 分析我科收治的1例下颌部真菌性足菌肿的临床及病理特点,进行真菌学及分子生物学鉴定。结果 该患者以下颌部肿胀、多发窦道形成、排大量黑色颗粒为主要症状,病理检查示化脓性肉芽肿性炎症,PAS染色可见大量藕节状真菌菌丝。ITS1、ITS2和D1/D2区测序结果示:病原菌与足菌肿马杜拉分支菌有最大的相似性,但相似性小于97%。结论 本病例为发生在下颌部的由马杜拉分支菌属内一新的菌种引起的真菌性足菌肿。     

皮肤巴西诺卡菌感染1例及文献复习

患者男,55岁,左前臂、背部红肿热痛4d。皮肤科情况:左前臂、背部分别可见一大小约3cm×3cm皮肤红肿,局部皮温增高,皮色暗红,局部皮肤破溃,有渗液,触痛明显。脓液细菌培养及鉴定为巴西诺卡菌。诊断:原发性皮肤巴西诺卡菌感染。经脓肿切开引流术及阿米卡星抗感染治疗后好转,出院1个月后随访伤口恢复良好。     

足菌肿1例

患者男,32岁。左底及足背起红斑结节斑块伴溢脓3年。皮损组织病理示:表皮呈假上皮瘤样增生,真皮可见大量混合炎细胞浸润,可见硫磺颗粒,未见菌丝及孢子。脓液及组织块真菌培养示:裴氏着色真菌;细菌培养示:猪红斑丹毒丝菌。诊断为足菌肿,给予克林霉素,伊曲康唑及特比萘芬,治疗好转,目前正在随访中。     

足菌肿5例临床分析

目的 探讨足菌肿的临床特点及诊断与治疗方法，加深疾病认知，减少临床误诊误治。方法 对近6年来本科室收治的5例足菌肿患者的临床特点及治疗进行详细报道，并在中国知网数据库检索2000—2022年发表的“足菌肿”相关中文文献，纳入资料完整的患者13例，分析其临床特点及诊疗方法。结果 共纳入18例足菌肿病例，其中男13例，女5例，年龄27～70岁。外伤致皮肤破损(72.22%)是该病常见诱因，足部(77.78%)最常累及，临床多表现为局部肿胀、结节、皮肤破溃，排出含颗粒的脓性或血性分泌物。细菌及真菌培养、组织病理和影像学检查是辅助诊断手段，抗菌药物和手术清创是常用治疗方案。9例(50.00%)患者存在误诊误治病史，多数病程较长，持续2个月～44年不等。结论 足菌肿的诊断需综合临床表现、细菌及真菌培养、组织病理及影像学检查，抗菌药物联合手术是常规治疗方案。早期明确诊断，合理规范化治疗是提高足菌肿治愈率和降低致残率的关键。     

SLE并发鼻疽诺卡菌感染引起皮下及脑脓肿一例

目的 探讨一例ＳＬＥ患者脑脓肿及皮下脓肿的病原菌。方法 从患者脑脊液和皮下脓肿取材,涂片Ｇｒａｍ染色并培养。结果 涂片Ｇｒａｍ染色阳性,培养菌落类似星形诺卡菌,但在生化特性方面略有不同;抗酸性为阳性,不分解酪氨酸,黄嘌呤,能发酵葡萄糖,鼠李糖,赤藓糖。可在４５℃生长,确证为鼻疽诺卡菌并证实此分离菌株对多种药物耐药。小鼠动物实验证明它可引起多发性脑脓肿。结论 鼻疽诺卡菌有致病性,多重耐药性,毒力强。     

SMALL GRAIN MYCETOMAS IN THE TROPICS

Biopsy specimens from 159 patients with mycetoma filed in the departments of pathology of four medical colleges in Tamil Nadu, India, were examined histologically; small grain mycetoma due to Nocardia species was found in 27 cases. In addition, 17 clinically diagnosed cases of mycetoma without the characteristic discharging “granules” were investigated for the presence of Nocardia spp. by paraffin baiting and Nocardia spp. were isolated from nine of them. Of these, five were Nocardia asteroides, one was N. brasiliensis and three were identified as Nocardia spp. The classification and geographic distribution of Nocardia spp. are discussed.     

Lymphocutaneous nocardiosis caused by Nocardia asteroides. Case report and literature review

A 22-year-old man developed erythematous nodules and an ulcer mimicking sporotrichosis on his right hand and forearm, which was subsequently diagnosed as lymphocutaneous nocardiosis caused by Nocardia asteroides. To our knowledge, 21 cases of lymphocutaneous nocardiosis have been reported, with the majority of those cases, except for a few that remain uncertain, being due to Nocardia brasiliensis. The case reported herein, the first known definitive case caused by N asteroides (to our knowledge), showed a more chronic course and less inflammatory manifestation compared with that caused by N brasiliensis. This is probably because N brasiliensis has a stronger virulence than N asteroides.     

Cutaneous nocardiosis developing around gravel inserted during a traffic injury

A 65-year-old Japanese woman with nocardial mycetoma which developed five years after a compound bone fracture of the left foot due to a traffic accident was reported. During this accident, two small pieces of gravel had entered her foot. Nocardia asteroides, which had been attached to the gravel, was probably inserted 5 years previously during the trauma. The lesion did not respond to oral minocycline and trimethoprim-sulfamethoxazole and was finally removed surgically; she has been free from recurrences for one year, of follow-up.     

Nocardia asteroides septicemia in a pemphigus patient. Successful treatment with trimethoprim-sulfamethoxazole and amikacin association

We report the case of a patient with pemphigus who presented Nocardia asteroides septicemia. The infection was controlled with an original association of trimethoprim-sulfamethoxazole and amikacin.     

Nocardia asteroides infection with dissemination to skin and joints

A 56-year-old diabetic woman developed multiple cutaneous lesions and septic arthritis secondary to disseminated Nocardia asteroides pulmonary infection. The diagnosis was made rapidly by Gram's and acid-fast stains of pus, sputum, and synovial fluid and later confirmed by cultures. Sulfonamides are the drugs of choice for nocardiosis, and this patient had a complete response to two weeks of intravenous trimethoprim and sulfamethoxasole followed by three months of oral therapy.     

Disseminated Nocardia brasiliensis infection following cryptococcal disease

Nocardiosis is an increasing clinical problem, especially in immunocompromised patients. The offending species is almost always Nocardia asteroides. Cryptococcosis is also an increasing problem in the immunosuppressed. We describe a patient with probable disseminated cryptococcosis followed by disseminated Nocardia brasiliensis infection. Only eight patients with disseminated N brasiliensis infection have been described, to our knowledge, in the United States.     

Isolation of both Sporothrix schenckii and Nocardia asteroides from a mycetoma of the forefoot

Mycetoma is a localized primary subcutaneous infection due to fungi (eumycetoma) or aerobic actinomycetes (actinomycetoma). We report a patient who acquired an implantation infection on the forefoot following a motorcycle accident in Crete. Both Sporothrix schenckii and Nocardia asteroides were isolated simultaneously from the lesion. Under combined therapy with itraconazole and trimethoprim-sulphamethoxazole for 7 months the lesion healed completely. A combination of causative organisms in mycetomas is rare, and the combination of S. schenckii and N. asteroides together has not been reported from one lesion.     

Disseminated cutaneous nocardiosis mimicking cellulitis and erythema nodosum

Infection with Nocardia asteroides is a rare, life-threatening infection, which is most commonly encountered in immunocompromised patients. Cutaneous involvement is usually seen with disseminated infection but may also occur as primary cutaneous nocardiosis. We present a case of an immunocompromised patient who presented with cellulitis of the right hand and disseminated subcutaneous nodules of the lower extremities resembling erythema nodosum. Cultures from both a skin biopsy of a subcutaneous nodule on the leg as well as a surgical specimen from the debridement of her hand grew Nocardia asteroides. The patient was treated successfully with trimethoprim-sulfamethoxazole. This case likely represents primary cutaneous nocardiosis with secondary dissemination, which has been rarely reported. It also emphasizes that nocardial infection should be considered in the differential diagnosis of lesions suggestive of cellulitis or erythema nodosum in the severely immunocompromised patient.     

Disseminated Cutaneous Nocardia Brasiliensis Infection

Abstract: Nocardia brasiliensis is an uncommon pathogen in the United States despite its presence in soil samples. It is most frequently seen in patients who are immunosuppressed, but can occur in the immunocompetent host also. Usually in a healthy host the infection is localized to one area of the body. Disseminated infection was diagnosed in a healthy child who recovered fully after initiation of oral sulfonamide therapy. We suspect that the source was soil to which the patient was exposed during a family camping trip.
Nocardia asteroides is the most frequent cause of nocardial infections in North America (1). These infections are unusual in healthy individuals, occurring more often in immunologically compromised hosts (1). They are usually acquired by a pulmonary route and may disseminate widely, most commonly to the central nervous system and skin. Nocardia brasiliensis , when it does occur in the United States, usually causes a chronic cutaneous and subcutaneous infection manifesting itself as mycetoma, abscess, or ulcer (2). We saw acute suppurative lymphocutaneous Nocardia brasiliensis infection in an otherwise healthy 2-year-old boy.