Wang Hua-Kung, Sheng Wang-Huei, Hung Chien-Ching, Chen Yee-Chun, Lee Mong-Hong, Lin Wagner S, Hsueh Po-Ren, Chang Shan-Chwen
Department of Internal Medicine, En Chu Kong Hospital, New Taipei City, Taiwan.
Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
J Formos Med Assoc. 2015 Aug;114(8):742-9. doi: 10.1016/j.jfma.2013.07.017. Epub 2013 Sep 3.
BACKGROUND/PURPOSE: Nocardia are ubiquitous in the environment worldwide and cause a variety of infections. Clinical manifestations and outcomes of nocardiosis can vary with different populations, host immunity, and presentations. The purpose of this study was to analyze the differences in clinical characteristics, antimicrobial susceptibility, and outcomes for patients with skin, lung, and disseminated nocardiosis.
We conducted a retrospective survey of culture-proven nocardial infections in 81 patients with invasive nocardiosis over an 18-year period at the National Taiwan University Hospital. The clinical syndromes included skin infections (n = 44), localized pulmonary infections (n = 24), and disseminated infections (n = 13).
Disseminated nocardiosis included lung and brain involvement (7 patients), brain and skin involvement (2 patients), localized brain abscess (1 patient), lung involvement with bacteremia (1 patient), lymphadenitis (1 patient), and liver cirrhosis with spontaneous nocardial peritonitis (1 patient). Eleven (14%) of all patients died due to nocardiosis. In comparison with those with skin infections, patients with lung and disseminated nocardiosis tended to have chronic lung disease, malignancy, concomitant bacteremia, were often misdiagnosed as having tuberculosis, were receiving immunosuppressive treatments, and demonstrated an increased mortality. Nocardia strains isolated from patients with lung infections or disseminated infections tended to have lower in vitro antimicrobial susceptibility than those isolated from skin infections [cefotaxime: 67% (lung) vs. 86% (skin); trimethoprim/sulfamethoxazole: 75% (disseminated) vs. 97% (skin)].
These results highlight the protean disease manifestations and antimicrobial susceptibility of Nocardia and indicate the need to address the option of combined antimicrobial therapy for lung and disseminated nocardiosis.
背景/目的：诺卡菌在全球环境中普遍存在，可引起多种感染。诺卡菌病的临床表现和结局会因不同人群、宿主免疫力及表现形式而有所不同。本研究旨在分析皮肤、肺部及播散性诺卡菌病患者在临床特征、抗菌药物敏感性及结局方面的差异。
我们对国立台湾大学医院18年间81例经培养证实的侵袭性诺卡菌感染患者进行了回顾性调查。临床综合征包括皮肤感染（44例）、局限性肺部感染（24例）及播散性感染（13例）。
播散性诺卡菌病包括肺部和脑部受累（7例）、脑部和皮肤受累（2例）、局限性脑脓肿（1例）、肺部受累合并菌血症（1例）、淋巴结炎（1例）及肝硬化合并自发性诺卡菌性腹膜炎（1例）。所有患者中有11例（14%）死于诺卡菌病。与皮肤感染患者相比，肺部和播散性诺卡菌病患者往往患有慢性肺病、恶性肿瘤、合并菌血症，常被误诊为结核病，正在接受免疫抑制治疗，且死亡率增加。从肺部感染或播散性感染患者分离出的诺卡菌菌株体外抗菌药物敏感性往往低于从皮肤感染患者分离出的菌株[头孢噻肟：67%（肺部）对86%（皮肤）；甲氧苄啶/磺胺甲恶唑：75%（播散性）对97%（皮肤）]。
这些结果突出了诺卡菌多样的疾病表现和抗菌药物敏感性，并表明需要探讨针对肺部和播散性诺卡菌病联合抗菌治疗的选择。
