Bocchino Marialuisa, Paglia Maria Grazia, Marruchella Almerico, Contini Silvia, Festa Anna, Saltini Cesare
Divisione Clinicizzata di Malattie Respiratorie, INMI L. Spallanzani IRCCS, Rome, Italy.
Respiration. 2008;75(4):461-5. doi: 10.1159/000094390. Epub 2006 Jun 30.
Nocardiosis is a rare and potentially life-threatening infection caused by several species of the Nocardia genus. Most cases occur in immunocompromised patients, and a delay in establishing the diagnosis is common due to the non-specific clinical presentations and the difficulty in cultivating Nocardia. Although the majority of pulmonary nocardiosis cases are caused by Nocardia asteroides, cases of human infection due to N. farcinica are increasingly diagnosed due to recent developments in taxonomy and diagnostic methods. N. farcinica is a separate species from N. asteroides and appears to be more virulent and resistant to antibiotics. Herein, we describe the case of a 65-year-old HIV-negative immunocompromised patient with a fulminant bilateral pulmonary nocardiosis while on empirical treatment with trimethoprim/sulfamethoxazole and imipenem. Post-mortem diagnosis of N. farcinica infection was performed by means of DNA amplification and sequencing of the 65-kDa bacterial heat shock protein.
诺卡菌病是由诺卡菌属的几种菌种引起的一种罕见且可能危及生命的感染。大多数病例发生在免疫功能低下的患者中，由于临床表现不具特异性以及培养诺卡菌存在困难，诊断往往会延迟。虽然大多数肺诺卡菌病病例由星形诺卡菌引起，但由于分类学和诊断方法的最新进展，豚鼠耳炎诺卡菌引起的人类感染病例越来越多地被诊断出来。豚鼠耳炎诺卡菌是与星形诺卡菌不同的一个菌种，似乎更具毒性且对抗生素耐药。在此，我们描述了一例65岁的HIV阴性免疫功能低下患者，在接受甲氧苄啶/磺胺甲恶唑和亚胺培南经验性治疗时发生暴发性双侧肺诺卡菌病的病例。通过对65 kDa细菌热休克蛋白进行DNA扩增和测序，对豚鼠耳炎诺卡菌感染进行了尸检诊断。
