Fujita Tetsuo, Ikari Jun, Watanabe Akira, Tatsumi Koichiro
Department of Respirology, Graduate School of Medicine, Chiba University, Japan.
Department of Respirology, Graduate School of Medicine, Chiba University, Japan.
J Infect Chemother. 2016 Nov;22(11):738-743. doi: 10.1016/j.jiac.2016.08.004. Epub 2016 Sep 5.
Pulmonary nocardiosis is a rare but potentially serious infection typically in immunosuppressed patients (ISPs). It is also known to occur in immunocompetent patients (ICPs). However, little is currently known regarding the clinical characteristics and radiographic findings of pulmonary nocardiosis specifically in ICPs. In this study, 30 patients with pulmonary nocardiosis were identified and 10 were considered to be colonized. Of all patients with pulmonary nocardiosis, 12 patients were ICPs and 18 were ISPs. Although half of ISPs were infected by Nocardia nova, ICPs were affected by various Nocardia species. Compared with ISPs, chest CT findings of ICPs showed a higher prevalence of bronchiectasis (67% vs 6%, p < .01) and centrilobular nodular opacities (67% vs 11%, p < .01), both of which are often seen in pulmonary nontuberculous mycobacterial disease. Additionally, nontuberculous mycobacterium was isolated from 6 of 21 ICPs with positive Nocardia species culture. Therefore, we recommend that physicians carefully differentiate pulmonary nocardiosis from pulmonary nontuberculous mycobacterial disease in ICPs.
肺诺卡菌病是一种罕见但可能严重的感染，通常发生在免疫抑制患者（ISP）中。已知在免疫功能正常的患者（ICP）中也会发生。然而，目前对于肺诺卡菌病在ICP中的临床特征和影像学表现知之甚少。在本研究中，确定了30例肺诺卡菌病患者，其中10例被认为是定植。在所有肺诺卡菌病患者中，12例为ICP，18例为ISP。虽然一半的ISP感染了新星诺卡菌，但ICP受多种诺卡菌属影响。与ISP相比，ICP的胸部CT表现显示支气管扩张（67%对6%，p<0.01）和小叶中心结节状混浊（67%对11%，p<0.01）的发生率更高，这两种表现常见于肺非结核分枝杆菌病。此外，在21例诺卡菌属培养阳性的ICP中，有6例分离出非结核分枝杆菌。因此，我们建议医生在ICP中仔细区分肺诺卡菌病和肺非结核分枝杆菌病。
