Beucher J, Belleguic C, Brinchault G, Deneuville E, Donnio P-Y, Roussey M
Centre de ressources et de compétence de la mucoviscidose, CHU de Rennes, université de Rennes I, 35203 Rennes, France.
Rev Mal Respir. 2010;27(1):76-9. doi: 10.1016/j.rmr.2009.08.001. Epub 2010 Jan 20.
Infections by Nocardia species are uncommon and generally affect immunocompromised patients. This bacteria has rarely been isolated from cystic fibrosis patients (CF), especially those who are not taking oral corticosteroids. We report a case of a patient with CF harbouring Nocardia farcinica. An 18-year-old male diagnosed with CF at the age of eight (F508 del/G85E) had been treated for allergic bronchopulmonary aspergillosis in 1998 with itraconazole, and a first colonization with Pseudomonas aeruginosa was eradicated in 2003. From May 2006, he presented with recurrent left- and right-sided pneumothorax. In June 2006, he presented with dyspnoea, fever, and nodular eruption on his ankles. Chest X-ray and CT scan revealed a right pneumothorax, severe bronchiectasis and bilateral alveolar consolidation. N. farcinica was idolated from his sputum without any other pathogens. Treatment with intravenous cotrimoxazole associated with imipenem and amikacin was initiated for three weeks followed by oral cotrimoxazole for a further nine months. The patient's symptoms and alveolar consolidation on CT scan improved. During 2007, his respiratory condition worsened and his FEV(1) declined from 50 to 26 % predicted. His pneumothorax recurred. He had chronic colonization with P. aeruginosa and was on the list for lung transplantation. Nocardia, a Gram positive bacillus, causes mainly pulmonary infection, usually in the context of immune suppression. The most frequent species is N. asteroides. In CF, very few cases have been reported; almost always N. asteroides, but exceptionally N. farcinica. In CF patients with worsening pulmonary condition, Nocardia should be considered, as well as other unusual pathogens.
诺卡菌属感染并不常见，通常影响免疫功能低下的患者。这种细菌很少从囊性纤维化患者（CF）中分离出来，尤其是那些未服用口服皮质类固醇的患者。我们报告一例患有诺卡菌属的CF患者。一名18岁男性在8岁时被诊断为CF（F508 del/G85E），1998年曾用伊曲康唑治疗过敏性支气管肺曲霉病，2003年首次根除了铜绿假单胞菌的定植。从2006年5月起，他反复出现左侧和右侧气胸。2006年6月，他出现呼吸困难、发热和脚踝结节性皮疹。胸部X线和CT扫描显示右侧气胸、严重支气管扩张和双侧肺泡实变。从他的痰液中分离出豚鼠耳炎诺卡菌，未发现其他病原体。开始静脉注射复方新诺明联合亚胺培南和阿米卡星治疗三周，随后口服复方新诺明再治疗九个月。患者的症状和CT扫描显示的肺泡实变有所改善。2007年期间，他的呼吸状况恶化，第一秒用力呼气量（FEV1）从预计值的50%下降到26%。他的气胸复发。他长期定植有铜绿假单胞菌，正在等待肺移植。诺卡菌是一种革兰氏阳性杆菌，主要引起肺部感染，通常发生在免疫抑制的情况下。最常见的菌种是星形诺卡菌。在CF患者中，报道的病例很少；几乎都是星形诺卡菌，但也有例外是豚鼠耳炎诺卡菌。在肺部状况恶化的CF患者中，应考虑诺卡菌以及其他不常见的病原体。
