Division of Infectious Diseases, Faculty of Medicine, University Hospitals of Geneva, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland.
Infection. 2010 Apr;38(2):89-97. doi: 10.1007/s15010-009-9193-9. Epub 2010 Mar 20.
Nocardiosis is a rare opportunistic disease that affects mainly patients with deficient cell-mediated immunity, such as those with acquired immunodeficiency syndrome (AIDS) or transplant recipients. Pulmonary disease is the most common presentation in immunosuppressed patients and approximately one-third have a disseminated disease. Primary cutaneous nocardiosis is more frequently observed in immunocompetent patients with direct inoculation of the organism through professional exposure. The diagnosis can be challenging, as signs and symptoms are not specific and a high index of clinical of suspicion is necessary. Although gram stain, modified acid-fast stain, and cultures remain as the standard diagnostic tools, novel molecular techniques have changed the taxonomy of these organisms and, in some instances, have facilitated their identification. The disease has a marked tendency to recur and a high morbidity and mortality rate in immunosuppressed patients. Treatment is usually prolonged and an associated antibiotic treatment is preferred for severe disease. Although sulfonamides in combination with other antibiotics are still the treatment of choice, other associations such as imipenem plus amikacin are preferred in some centers. Linezolid is a useful alternative therapeutic agent due to its oral availability and activity against most of the isolates studied. Twenty-eight cases of nocardiosis were diagnosed at our center between January 1989 and April 2009. We report the epidemiologic characteristics of Nocardia spp. observed in our institution and discuss the risk factors, clinical features, diagnosis, and management of the disease.
奴卡菌病是一种罕见的机会性疾病，主要影响细胞介导免疫缺陷的患者，如获得性免疫缺陷综合征（AIDS）或移植受者。免疫抑制患者中最常见的表现为肺部疾病，约有三分之一的患者为播散性疾病。原发性皮肤奴卡菌病更常见于机体直接接种的免疫正常患者，通常通过职业暴露。由于其体征和症状不具有特异性，需要高度的临床怀疑，因此诊断具有挑战性。尽管革兰氏染色、改良酸染色和培养仍然是标准的诊断工具，但新的分子技术改变了这些生物体的分类，在某些情况下，有助于它们的鉴定。该疾病在免疫抑制患者中具有明显的复发倾向，发病率和死亡率高。治疗通常需要延长时间，对于严重疾病，建议使用联合抗生素治疗。尽管磺胺类药物联合其他抗生素仍然是治疗的首选，但在某些中心，其他联合治疗如亚胺培南加阿米卡星更受欢迎。由于其口服可用性和对大多数研究分离株的活性，利奈唑胺是一种有用的替代治疗药物。1989 年 1 月至 2009 年 4 月期间，我们中心诊断了 28 例奴卡菌病。我们报告了在我们机构观察到的诺卡氏菌属的流行病学特征，并讨论了该疾病的危险因素、临床特征、诊断和管理。
