Takiguchi Yasuo, Ishizaki Shunsuke, Kobayashi Takayuki, Sato Shun, Hashimoto Yaeko, Suruga Yosuke, Akiba Yoko
Department of Respiratory Medicine, Chiba Aoba Municipal Hospital, Japan.
Department of Laboratory Medicine, Chiba Aoba Municipal Hospital, Japan.
Intern Med. 2017;56(12):1485-1490. doi: 10.2169/internalmedicine.56.8163. Epub 2017 Jun 15.
Objective Pulmonary nocardiosis frequently develops as an opportunistic infection in patients with malignant tumor and is treated with steroids. This study was performed to clarify the clinical features of pulmonary nocardiosis in Japan. Methods The patients definitively diagnosed with pulmonary nocardiosis at our hospital between January 1995 and December 2015 were retrospectively investigated. Results Nineteen men and 11 women (30 in total) were diagnosed with pulmonary nocardiosis. Almost all patients were complicated by a non-pulmonary underlying disease, such as malignant tumor or collagen vascular disease, or pulmonary disease, such as chronic obstructive pulmonary disease or interstitial pneumonia, and 13 patients (43.3%) were treated with steroids or immunosuppressors. Gram staining was performed in 29 patients, and a characteristic Gram-positive rod was detected in 28 patients (96.6%). Thirty-one strains of Nocardia were isolated and identified. Seven strains of Nocardia farcinica were isolated as the most frequent species, followed by Nocardia nova isolated from 6 patients. Seventeen patients died, giving a crude morality rate of 56.7% and a 1-year survival rate of 55.4%. The 1-year survival rates in the groups with and without immunosuppressant agents were 41.7% and 59.7%, respectively, showing that the outcome of those receiving immunosuppressants tended to be poorer than those not receiving them. Conclusion Pulmonary nocardiosis developed as an opportunistic infection in most cases. The outcome was relatively poor, with a 1-year survival rate of 55.4%, and it was particularly poor in patients treated with immunosuppressant agents. Pulmonary nocardiosis should always be considered in patients presenting with an opportunistic respiratory infection, and an early diagnosis requires sample collection and Gram staining.
目的 肺诺卡菌病常作为恶性肿瘤患者的机会性感染出现，并采用类固醇进行治疗。本研究旨在阐明日本肺诺卡菌病的临床特征。方法 对1995年1月至2015年12月期间在我院确诊为肺诺卡菌病的患者进行回顾性调查。结果 共诊断出19例男性和11例女性（共30例）患有肺诺卡菌病。几乎所有患者都合并有非肺部基础疾病，如恶性肿瘤或胶原血管疾病，或肺部疾病，如慢性阻塞性肺疾病或间质性肺炎，13例患者（43.3%）接受了类固醇或免疫抑制剂治疗。对29例患者进行了革兰氏染色，28例患者（96.6%）检测到特征性革兰氏阳性杆菌。分离并鉴定出31株诺卡菌。分离出7株豚鼠耳炎诺卡菌为最常见菌种，其次是6例患者分离出的新星诺卡菌。17例患者死亡，粗死亡率为56.7%，1年生存率为55.4%。使用和未使用免疫抑制剂的两组患者1年生存率分别为41.7%和59.7%，表明接受免疫抑制剂治疗的患者预后往往比未接受治疗的患者更差。结论 肺诺卡菌病在大多数情况下是作为机会性感染发生的。预后相对较差，1年生存率为55.4%，在接受免疫抑制剂治疗的患者中尤其差。对于出现机会性呼吸道感染症状的患者，应始终考虑肺诺卡菌病，早期诊断需要采集样本并进行革兰氏染色。
