Schaal K P, Lee H J
Institute for Medical Microbiology and Immunology, University of Bonn, Germany.
Gene. 1992 Jun 15;115(1-2):201-11. doi: 10.1016/0378-1119(92)90560-c.
Diseases caused by pathogenic aerobic and facultatively anaerobic actinomycetes differ considerably with respect to their etiology, pathogenesis, clinical appearance and epidemiology. Facultatively anaerobic (fermentative) actinomycetes may not only be involved etiologically in the three classical forms of cervicofacial, thoracic and abdominal actinomycoses, but also in infections of the female genital organs, the eye, the tissue adjacent to dental implantation elements and tooth extraction wounds. The species distribution of the fermentative actinomycetes isolated from these conditions varied to a certain, but characteristic, extent, as did the concomitant actinomycotic flora. The sex ratio reported for human Actinomyces infections (male:female = 3:1) appeared to be restricted to actinomycotic abscesses and empyemas. The prevailing pathogenic, obligately aerobic actinomycete species in Germany was found to be Nocardia farcinica followed by Nocardia asteroides. The comparatively high incidence of N. farcinica infections was chiefly due to the occurrence of nosocomial postoperative wound infections by this pathogen observed in two German hospitals. Besides surgical treatment, immunosuppressive treatment appeared to be the most common factor predisposing for nocardiosis. Recent observations strongly suggested that the spectrum of human nocardial infections in Germany has been changing, as regards the overall incidence, the prevalence of N. farcinica, the sex ratio, the mean age of patients, as well as the role of N. farcinica as a possibly important nosocomial pathogen.
由致病性需氧放线菌和兼性厌氧放线菌引起的疾病在病因、发病机制、临床表现和流行病学方面有很大差异。兼性厌氧（发酵性）放线菌不仅在病因上可能与颈面部、胸部和腹部放线菌病的三种经典形式有关，还与女性生殖器官、眼睛、牙种植体周围组织和拔牙伤口的感染有关。从这些病症中分离出的发酵性放线菌的种类分布在一定程度上有所不同，但具有特征性，伴随的放线菌菌群也是如此。据报道，人类放线菌感染的性别比（男性：女性 = 3：1）似乎仅限于放线菌性脓肿和脓胸。在德国，主要的致病性专性需氧放线菌种类是豚鼠诺卡菌，其次是星形诺卡菌。豚鼠诺卡菌感染的相对高发病率主要是由于在两家德国医院观察到该病原体引起的医院术后伤口感染。除了手术治疗外，免疫抑制治疗似乎是诺卡菌病最常见的易感因素。最近的观察结果强烈表明，德国人类诺卡菌感染的范围在总体发病率、豚鼠诺卡菌的流行率、性别比、患者平均年龄以及豚鼠诺卡菌作为可能重要的医院病原体的作用方面一直在发生变化。
