Cassir Nadim, Million Matthieu, Noudel Remy, Drancourt Michel, Brouqui Philippe
Unité de Recherchesur les Maladies InfectieusesTropicales et Emergentes (URMITE), UM63, CNRS 7278, IRD 198, Inserm 1095, InstitutHospitalo-UniversitaireMéditerranée-Infection, Aix-Marseille-Université, Marseille, France.
J Med Case Rep. 2013 Apr 11;7:103. doi: 10.1186/1752-1947-7-103.
Nocardial infections, although rare, are challenging for clinicians to treat. Recent contradictory reports of sulfonamide resistance have raised concerns about using this drug to treat nocardial infections.
A 62-year-old immunocompetent Caucasian woman showed disseminated pulmonary nodules and a brain abscess by chest computed tomography and brain magnetic resonance imaging, respectively. Multidrug-resistant Nocardia wallacei was cultured from a stereotactic brain biopsy and confirmed by 16S ribosomal ribonucleic acid gene sequencing. After the first-line treatment failed, a long course of trimethoprim-sulfamethoxazole was prescribed with no evidence of recurrence. To the best of our knowledge, this is the first report of a Nocardia wallacei disseminated infection in an immunocompetent patient, and it is the first detailed description of successful treatment with trimethoprim-sulfamethoxazole despite the resistance observed in vitro.
Species identification of clinical isolates is critical for diagnosis, a prediction of antimicrobial susceptibility and epidemiological tracking. In the case of Nocardia wallacei, the clinical outcome suggests that sulfonamides can be used for treatment despite ambiguous results from in vitro susceptibility tests.
诺卡菌感染虽然罕见，但对临床医生来说治疗颇具挑战性。近期关于磺胺类药物耐药性的矛盾报道引发了对使用该药物治疗诺卡菌感染的担忧。
一名62岁免疫功能正常的白种女性，胸部计算机断层扫描显示肺部有播散性结节，脑部磁共振成像显示有脑脓肿。通过立体定向脑活检培养出多重耐药的沃氏诺卡菌，并经16S核糖体核糖核酸基因测序证实。一线治疗失败后，给予了一个疗程较长的甲氧苄啶 - 磺胺甲恶唑治疗，且无复发迹象。据我们所知，这是免疫功能正常患者中沃氏诺卡菌播散性感染的首例报告，也是首例尽管体外观察到耐药但使用甲氧苄啶 - 磺胺甲恶唑成功治疗的详细描述。
临床分离株的菌种鉴定对于诊断、抗菌药物敏感性预测和流行病学追踪至关重要。对于沃氏诺卡菌，临床结果表明，尽管体外药敏试验结果不明确，但磺胺类药物仍可用于治疗。
