Torres Harrys A, Reddy Bhavananda T, Raad Issam I, Tarrand Jeffrey, Bodey Gerald P, Hanna Hend A, Rolston Kenneth V I, Kontoyiannis Dimitrios P
Department of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Medicine (Baltimore). 2002 Sep;81(5):388-97. doi: 10.1097/00005792-200209000-00004.
Nocardiosis (NOC) is an important cause of infection in immunocompromised patients. However, large series in patients with cancer have not been described. We review the records of patients with cancer and NOC who were evaluated at The University of Texas M. D. Anderson Cancer Center, Houston, Texas, between 1988 and 2001, and we describe the incidence, microbiologic and clinical characteristics, treatment, and outcome of NOC in this population. Forty-two patients with a total of 43 episodes of NOC were identified (incidence of 60 cases of NOC per 100,000 admissions). Twenty-seven patients (64%) had hematologic malignancies. In 13 patients, NOC complicated bone marrow transplantation. Neutropenia was observed in 4 (10%) of 40 episodes with information available, and lymphopenia in 20 (50%) of 40 episodes. Patients had received steroids for 25 episodes (58%) and had received chemotherapy for 10 episodes (23%) within 30 days before the onset of NOC. Nine episodes of breakthrough NOC were identified in 7 (23%) of the 40 patients with information available. Pulmonary NOC was seen in 30 (70%) of 43 cases; soft-tissue NOC in 7 (16%); central venous catheter-related nocardemia in 3 (7%); and disseminated NOC, central nervous system NOC, and a perinephric abscess each in 1 (2%). Twenty-three percent of patients with pulmonary NOC had an acute presentation. complex was the most common causative species (77%). Therapy for NOC was mainly concurrent trimethoprim/ sulfamethoxazole and either a tetracycline or a beta-lactam. The median duration of treatment was 113 days (range, 10-600 d). Nine (60%) of 15 patients with outcome data died from NOC. NOC, although infrequent, is an important cause of morbidity and mortality in patients with cancer. It has pleomorphic manifestations, and it can be seen as a breakthrough infection. The present study confirms that timely diagnosis, the site of NOC, the type of, the presence of comorbidities, and cytomegalovirus coinfection influence the outcome of patients with cancer and NOC.
诺卡菌病（NOC）是免疫功能低下患者感染的重要原因。然而，尚未有关于癌症患者的大型系列研究报道。我们回顾了1988年至2001年期间在德克萨斯大学MD安德森癌症中心（位于德克萨斯州休斯顿）接受评估的癌症合并NOC患者的记录，并描述了该人群中NOC的发病率、微生物学和临床特征、治疗及预后情况。共确定了42例患者发生43次NOC发作（每100,000次入院中有60例NOC的发病率）。27例患者（64%）患有血液系统恶性肿瘤。13例患者中，NOC并发骨髓移植。在有信息可查的40次发作中，4次（10%）观察到中性粒细胞减少，40次发作中有20次（50%）观察到淋巴细胞减少。在NOC发作前30天内，25次发作（58%）的患者接受了类固醇治疗，10次发作（23%）的患者接受了化疗。在有信息可查的40例患者中，7例（23%）出现了9次突破性NOC发作。43例病例中有30例（70%）为肺部NOC；7例（16%）为软组织NOC；3例（7%）为中心静脉导管相关诺卡菌血症；各有1例（2%）为播散性NOC、中枢神经系统NOC和肾周脓肿。肺部NOC患者中有23%表现为急性发作。复合体是最常见的致病菌种（77%）。NOC的治疗主要是同时使用甲氧苄啶/磺胺甲恶唑和四环素或β-内酰胺类药物。治疗的中位持续时间为113天（范围为10 - 600天）。有预后数据的15例患者中有9例（60%）死于NOC。NOC虽然不常见，但却是癌症患者发病和死亡的重要原因。它有多种表现形式，可表现为突破性感染。本研究证实，及时诊断、NOC的部位、类型、合并症的存在以及巨细胞病毒合并感染会影响癌症合并NOC患者的预后。
