aDepartment of Infectious Diseases, CUB-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium bUnité Mobile de Microbiologie Clinique, Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou cUniversité Paris Descartes dCentre d'Infectiologie Necker-Pasteur, Institut Imagine, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
Curr Opin Infect Dis. 2017 Dec;30(6):545-551. doi: 10.1097/QCO.0000000000000404.
Nocardia spp. is a gram-positive bacteria that may cause infections in humans. Nocardiosis has been described since the early years of transplantation. This review aims to provide an overview of present knowledge regarding posttransplant nocardiosis, with a focus on recent findings.
Nocardiosis is not rare among transplant recipients, especially after thoracic transplantation and/or in case of intense immunosuppressive regimen or use of tacrolimus. Low-dose cotrimoxazole is not effective to prevent nocardiosis. Although lung is the most common site of infection, more than 40% of organ transplant patients have a disseminated infection. As central nervous system involvement is frequent (about 1/3 of the patients) and possibly asymptomatic, brain imaging is mandatory. Diagnosis relies on direct examination and culture; molecular species identification is useful to guide treatment. Although cotrimoxazole is the drug for which we have the strongest clinical experience, other antibiotics such as linezolid, parenteral cephalosporins, carbapenems, and amikacin can be used to treat nocardiosis. Although treatment duration has historically been set to at least 6 months, shorter durations (<120 days) seem associated with a good outcome in selected patients.
Physicians in charge of transplant patients should be aware of nocardiosis. Diagnosis and management of transplant recipients with nocardiosis require a multidisciplinary approach.
奴卡菌属是一种革兰阳性细菌，可引起人类感染。奴卡菌病自移植早期就有描述。本文旨在概述目前关于移植后奴卡菌病的知识，重点介绍最新发现。
奴卡菌病在移植受者中并不罕见，尤其是在胸部移植后和/或免疫抑制方案强烈或使用他克莫司时。小剂量复方磺胺甲噁唑不能有效预防奴卡菌病。虽然肺部是最常见的感染部位，但超过 40%的器官移植患者存在播散性感染。由于中枢神经系统受累频繁（约 1/3 的患者）且可能无症状，因此必须进行脑部成像。诊断依赖于直接检查和培养；分子种鉴定有助于指导治疗。尽管复方磺胺甲噁唑是我们临床经验最丰富的药物，但其他抗生素如利奈唑胺、头孢菌素类、碳青霉烯类和阿米卡星也可用于治疗奴卡菌病。虽然治疗时间历史上设定为至少 6 个月，但在选定的患者中，较短的治疗时间（<120 天）似乎与良好的结局相关。
负责移植患者的医生应了解奴卡菌病。诊断和管理奴卡菌病的移植受者需要多学科方法。
