Le Coustumier E M, Denes E, Martin C, Weinbreck P
Service de maladies infectieuses et tropicales, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France; Service de médecine interne A et polyclinique, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
Service de maladies infectieuses et tropicales, centre hospitalier universitaire Dupuytren, 2, avenue Martin-Luther-King, 87042 Limoges cedex, France.
Rev Med Interne. 2017 Feb;38(2):81-89. doi: 10.1016/j.revmed.2016.08.015. Epub 2016 Sep 19.
Nocardiosis are uncommon. The diagnosis may be difficult, with significant morbidity and mortality, often occurring on frail patients. Few data are available in France.
A retrospective single center study was conducted from 2002 to 2014 and included all patients with at least one positive microbiological sample for Nocardia with a follow-up in our hospital.
Nineteen patients, including 15 men, were included with a mean age of 58 years (25-85). Seventeen had a risk factor (lung diseases [13], corticosteroids [12], solid neoplasia [2], HIV infection [2], diabetes mellitus [3], kidney transplant [2], lymphopenia [1]). Infections' locations were: pulmonary (12), brain (3), skin (2), lymph node (1) and corneal (1). The slow growth leads to a median of 35 days for a positive result (3-95). Nine species were identified. Fifteen patients (79%) received one or more lines of antibiotics including: cotrimoxazole (9), amoxicillin (7) cefotaxime/ceftriaxone (7) imipenem (3), or amikacin (3). The average duration of antibiotic therapy was 207 days. Four patients did not receive antibiotics due to a late result or a bacterial co-infection masking nocardiosis. Five patients died (26%) including 2 with cerebral nocardiosis. Six patients were cured, 4 suffered a relapse, 4 had an unknown evolution, and 1 was still treated.
Our study shows that nocardiosis is a disease difficult to treat. A better understanding of this type of infection is necessary.
诺卡菌病并不常见。其诊断可能困难，具有较高的发病率和死亡率，常发生于体弱患者。法国的相关数据较少。
进行了一项回顾性单中心研究，研究时间为2002年至2014年，纳入了所有在我院随访且至少有一份诺卡菌微生物样本呈阳性的患者。
纳入19例患者，其中15例为男性，平均年龄58岁（25 - 85岁）。17例有危险因素（肺部疾病[13例]、皮质类固醇[12例]、实体瘤[2例]、HIV感染[2例]、糖尿病[3例]、肾移植[2例]、淋巴细胞减少[1例]）。感染部位为：肺部（12例）、脑部（3例）、皮肤（2例）、淋巴结（1例）和角膜（1例）。由于生长缓慢，阳性结果的中位时间为35天（3 - 95天）。鉴定出9个菌种。15例患者（79%）接受了一种或多种抗生素治疗，包括：复方新诺明（9例）、阿莫西林（7例）、头孢噻肟/头孢曲松（7例）、亚胺培南（3例）或阿米卡星（3例）。抗生素治疗的平均持续时间为207天。4例患者因结果出现较晚或细菌合并感染掩盖了诺卡菌病而未接受抗生素治疗。5例患者死亡（26%），其中2例为脑诺卡菌病患者。6例患者治愈，4例复发，4例病情转归不明，1例仍在接受治疗。
我们的研究表明，诺卡菌病是一种难以治疗的疾病。有必要更好地了解这类感染情况。
