Onaiwu Cherry O, Velagapudi Manasa, Sarsam Luay, Utley Lindsay, Bricker Lauren, Bendi Venkata Sunil, Vivekanandan Renuga
Department of Internal Medicine, Creighton University Medical Center.
Department of Infectious Diseases, Creighton University Medical Center.
Cureus. 2017 Nov 11;9(11):e1839. doi: 10.7759/cureus.1839.
Nocardiosis is an opportunistic infection in patients with depressed cell-mediated immunity. Inhalation is the primary route for exposure via dust particles. Patients with acquired immune deficiency syndrome (AIDS) are at increased risk of disseminated disease. A challenge in the diagnosis of pulmonary nocardiosis is that it can mimic other pulmonary diseases. Nocardia farcinica tends to be a more virulent, multidrug-resistant strain with an increased tendency to disseminate. This report describes a 64-year-old man with AIDS found to have pulmonary nocardiosis that did not respond to standard antibiotic therapy. Further evaluation revealed the virulent, multidrug-resistant Nocardia farcinica species. Targeted antibiotic therapy was initiated, after which the patient had an improvement in pulmonary symptoms. It is important to suspect pulmonary nocardiosis in immunocompromised patients who fail to respond to standard antimicrobial therapy. Susceptibilities should be obtained so that appropriate therapy can be promptly initiated as Nocardia farcinica is highly resistant to multiple antimicrobials.
诺卡菌病是细胞介导免疫功能低下患者的一种机会性感染。吸入是通过尘埃颗粒接触的主要途径。获得性免疫缺陷综合征（AIDS）患者发生播散性疾病的风险增加。肺诺卡菌病诊断中的一个挑战是它可酷似其他肺部疾病。豚鼠耳炎诺卡菌往往是一种更具毒力、多重耐药的菌株，播散倾向增加。本报告描述了一名64岁的AIDS男性患者，发现患有肺诺卡菌病，对标准抗生素治疗无反应。进一步评估发现了毒力强、多重耐药的豚鼠耳炎诺卡菌菌种。开始了针对性抗生素治疗，此后患者肺部症状有所改善。对于对标准抗菌治疗无反应的免疫功能低下患者，怀疑有肺诺卡菌病很重要。应进行药敏试验，以便在豚鼠耳炎诺卡菌对多种抗菌药物高度耐药时能迅速开始适当治疗。
