Mari B, Montón C, Mariscal D, Luján M, Sala M, Domingo C
Department of Pneumology, Corporació Sanitària Parc Taulí, Parc Taulí, Sabadell, Spain.
Respiration. 2001;68(4):382-8. doi: 10.1159/000050531.
Pulmonary nocardiosis is an infrequent infection whose incidence seems to be increasing due to a higher degree of clinical suspicion and the increasing number of immunosuppressive factors.
To study the predisposing factors, clinical characteristics, diagnostic procedures, treatment and progress of pulmonary nocardiosis (PN).
Review of 10 patients (9 male, 1 female, mean age 61) with PN in a 600-bed teaching hospital, diagnosed from 1992 to 1999.
Associated diseases observed were chronic obstructive pulmonary disease (COPD) in 6 patients, human immunodeficiency virus (HIV) infection in 3 and polymyalgia rheumatica in 1. Four patients had received oral corticotherapy for COPD for over a year (mean dose 13 mg/day of prednisone or equivalent). The main reason for consultation was an increase in dyspnea in the patients with COPD (6/6) and fever in those with HIV (3/3). Mean time between onset of symptoms and diagnosis was 5 weeks. In 8 patients, the infection occurred outside the hospital setting. The infection was restricted to the lung in 9/10; in the remaining case, the central nervous system (CNS) and subcutaneous tissue were affected. Lobar or multilobar consolidation was the most frequent radiographic pattern found (6/10). Sputum culture was positive when performed (8 cases). Diagnosis was made or confirmed by bronchoscopy (bronchoaspirate or protected specimen brush) in 5 patients. Germs isolated were: Nocardia asteroides (8/10), Nocardia farcinica (1/10), Nocardia otitidiscaviarum (1/10). Cotrimoxazole was the most used empirical treatment (6/10). Resolution was achieved in 5 cases. Four subjects died: 1 HIV patient with disseminated nocardiosis, and 3 COPD patients, 2 of whom had received long-term corticotherapy. Illness recurred in only 1 case, due to failure to comply with treatment.
(1) In our geographical setting Nocardia presents as a subacute or chronic pulmonary infection, mainly outside the hospital. (2) It tends to affect only the lung. (3) Diagnosis requires a high clinical suspicion, and can be made on the basis of a sputum culture. (4) Nocardia tends to attack patients with underlying COPD, or immunodepressed patients treated with glucocorticoids, or patients with HIV infection. (5) Mortality is high in both COPD and HIV patients. (6) In our area, cotrimoxazole seems to be the most commonly prescribed treatment.
肺诺卡菌病是一种罕见的感染性疾病，由于临床怀疑程度的提高和免疫抑制因素数量的增加，其发病率似乎在上升。
研究肺诺卡菌病（PN）的易感因素、临床特征、诊断方法、治疗及病情进展。
回顾了一家拥有600张床位的教学医院1992年至1999年间确诊的10例PN患者（9例男性，1例女性，平均年龄61岁）。
观察到的相关疾病有6例慢性阻塞性肺疾病（COPD）、3例人类免疫缺陷病毒（HIV）感染和1例风湿性多肌痛。4例患者因COPD接受了超过一年的口服皮质激素治疗（泼尼松或等效药物的平均剂量为13毫克/天）。就诊的主要原因是COPD患者呼吸困难加重（6/6）和HIV患者发热（3/3）。症状出现至诊断的平均时间为5周。8例患者的感染发生在院外。10例中有9例感染局限于肺部；其余1例中枢神经系统（CNS）和皮下组织也受到影响。叶或多叶实变是最常见的影像学表现（6/10）。进行痰培养时8例呈阳性。5例患者通过支气管镜检查（支气管抽吸或保护性标本刷检）确诊或得到证实。分离出的病原菌有：星形诺卡菌（8/10）、豚鼠耳炎诺卡菌（1/10）、鼻疽诺卡菌（1/10）。复方新诺明是最常用的经验性治疗药物（6/10）。5例患者病情得到缓解。4例患者死亡：1例HIV患者发生播散性诺卡菌病，3例COPD患者，其中2例接受了长期皮质激素治疗。仅1例患者病情复发，原因是未遵医嘱治疗。
（1）在我们所在地区，诺卡菌表现为亚急性或慢性肺部感染，主要发生在院外。（2）它往往仅累及肺部。（3）诊断需要高度的临床怀疑，可根据痰培养结果做出诊断。（4）诺卡菌倾向于侵袭患有基础COPD的患者、接受糖皮质激素治疗的免疫抑制患者或HIV感染患者。（5）COPD和HIV患者的死亡率都很高。（6）在我们地区，复方新诺明似乎是最常用的治疗药物。
