Suzuki Chieko, Kimura Tamaki, Arai Akira, Maeda Tetsuya, Tomiyama Masahiko, Kannari Kazuya, Baba Masayuki, Itabashi Chieko, Wada Ryuichi
Department of Neurology, Hirosaki University School of Medicine, 5 Zaifu-cho, Hirosaki 036-8562, Japan.
No To Shinkei. 2006 Jun;58(6):505-8.
A 60-year-old man with surgically treated nocardia pyothorax was referred to our hospital since he became drowsy. Brain MRI revealed multiple brain abscesses. His cerebrospinal fluid (CSF) showed increase in polymorphonuclear cells and decrease in glucose. Since he was allergic to sulfamethoxazole * trimethoprim, ceftriaxone and then minocycline were given. Minocycline resulted in dramatic improvement of neurological symtoms, MRI findings and CSF cell count. PCR analysis of 16S ribosomal DNA using his resected thoracic wall revealed that nocardia from his tissue was strain IFM0860. Strain IFM0860 nocardia was found to be sensitive to minocycline but not to sulfamethoxazole * trimethoprim and ceftriaxone. Intravenous administration of minocycline was followed by three-year per os administration of minocycline during which he had no recurrence of brain abscess. Thus, brain nocardiosis could be successfully treated with appropriate antibiotics. The lesson from the present case is that identification of the type of nocardia by PCR analysis of 16S ribosomal DNA could help accomplish tailor-made antibiotic therapy.
一名60岁接受过手术治疗的诺卡菌性脓胸男性患者，因出现嗜睡症状被转诊至我院。脑部磁共振成像（MRI）显示有多个脑脓肿。他的脑脊液（CSF）显示多形核细胞增多而葡萄糖减少。由于他对复方磺胺甲恶唑、头孢曲松过敏，遂给予米诺环素治疗。米诺环素使患者的神经症状、MRI表现及脑脊液细胞计数显著改善。对其切除的胸壁组织进行16S核糖体DNA的聚合酶链反应（PCR）分析显示，其组织中的诺卡菌为IFM0860菌株。发现IFM0860菌株对米诺环素敏感，但对复方磺胺甲恶唑和头孢曲松不敏感。静脉注射米诺环素后，患者口服米诺环素三年，在此期间脑脓肿未复发。因此，脑诺卡菌病可用适当的抗生素成功治疗。本病例的经验教训是，通过16S核糖体DNA的PCR分析鉴定诺卡菌类型有助于实现量身定制的抗生素治疗。
