Bär W, Wakili J, Márquez de Bär G, Steinhauer H, Schweisfurth H
Carl-Thiem-Klinikum, Institut Medizinische Mikrobiologie, Cottbus.
Pneumologie. 2003 May;57(5):259-67. doi: 10.1055/s-2003-39366.
In the last decade, a growing number of patients with pneumonia, caused by unusual gram positive rods have been observed. Mostly, the patients had been infected as a consequence of impaired immunity. In some cases, bioterrorist activities may also induce pneumonia by gram positive rods (B. anthracis). In order to bring these organisms to the attention of the medical community, we present three clinical cases and describe six species of gram positive rods, known to provoke this kind of pneumonias. Case 1 was a 84 years old patient with impaired lung function. He was suspicious of tuberculosis (Tbc). Nocardia spec. was isolated. Case 2 was an alcoholic of 46 years with pneumonia. Reactivation of Tbc was suspected. Actinomadura madurae has been isolated. Case 3 was a patient of 58 years with myelodysplastic syndrome (MDS) and pneumonia. N. asteroides was isolated. All patients shared impaired immunity (age, alcoholism, MDS) with impaired lung functions; Tbc had been suspected (Case 1 + 2). Infection by A. madurae was contained by Clindamycin. Therapy of Nocardia with Moxifloxacin (Case 1) or Bactrim (Case 3) was only partly effective. In the appendix, six species of gram positive rods which are known to cause pneumonia, are summarized (Nocardia, Actinomyceta, Actinomadura, Rhodococcus, Corynebacterium and Bacillus).
在过去十年中，观察到越来越多由不常见革兰氏阳性杆菌引起肺炎的患者。大多数情况下，这些患者是由于免疫力受损而受到感染。在某些情况下，生物恐怖活动也可能由革兰氏阳性杆菌（炭疽芽孢杆菌）引发肺炎。为引起医学界对这些病原体的关注，我们呈现三例临床病例，并描述六种已知可引发此类肺炎的革兰氏阳性杆菌。病例1是一名84岁肺功能受损的患者。他疑似患有肺结核（Tbc）。分离出诺卡氏菌属。病例2是一名46岁患有肺炎的酗酒者。怀疑是肺结核复发。分离出马杜拉放线菌。病例3是一名58岁患有骨髓增生异常综合征（MDS）并伴有肺炎的患者。分离出星形诺卡菌。所有患者都存在免疫力受损（年龄、酗酒、MDS）以及肺功能受损的情况；均曾怀疑患有肺结核（病例1和2）。马杜拉放线菌感染用克林霉素控制。用莫西沙星（病例1）或复方新诺明（病例3）治疗诺卡氏菌仅部分有效。附录中总结了六种已知可引起肺炎的革兰氏阳性杆菌（诺卡氏菌属、放线菌属、马杜拉放线菌属、红球菌属、棒状杆菌属和芽孢杆菌属）。
