Tashiro Hiroki, Takahashi Koichiro, Kusaba Koji, Tanaka Masahide, Komiya Kazutoshi, Nakamura Tomomi, Aoki Yosuke, Kimura Shinya, Sueoka-Aragane Naoko
Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
Department of Laboratory Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
Respir Investig. 2018 Mar;56(2):166-172. doi: 10.1016/j.resinv.2017.11.008. Epub 2018 Feb 22.
Despite treatment, pulmonary nocardiosis, which is a rare opportunistic disease caused by Nocardia species, has poor clinical outcomes including recurrence and death. Currently, the treatment regimen and duration for pulmonary nocardiosis are not fully understood. The present study aimed to clarify the factors related to the clinical outcome of pulmonary nocardiosis.
The medical records of 24 patients with pulmonary nocardiosis were retrospectively reviewed. The patients were divided into two groups based on the outcomes within 2 years: patients with controlled disease (n = 14) and patients who developed recurrence or died (n = 10).
Nocardia was identified by 16S ribosomal RNA sequencing in 17 patients (70.8%) and by conventional biochemical test in five patients (20.8%). The patients' characteristics, clinical findings, radiological features, and treatment history were not different between the two groups. Compared with patients who developed recurrence or died, those with controlled disease had significantly longer total duration of treatment with antibiotics, especially trimethoprim/sulfamethoxazole (67.5 ± 111.6 days vs. 9.0 ± 6.5 days; p = 0.01). Pancytopenia was the most frequent adverse effect of trimethoprim/sulfamethoxazole.
Longer duration of trimethoprim/sulfamethoxazole treatment was significantly associated with better outcomes of pulmonary nocardiosis. In such cases, antibiotics, especially trimethoprim/sulfamethoxazole, should be administered for more than 3 months.
尽管进行了治疗，但肺诺卡菌病是一种由诺卡菌属引起的罕见机会性疾病，临床预后较差，包括复发和死亡。目前，肺诺卡菌病的治疗方案和疗程尚未完全明确。本研究旨在阐明与肺诺卡菌病临床预后相关的因素。
回顾性分析24例肺诺卡菌病患者的病历。根据2年内的预后情况将患者分为两组：病情得到控制的患者（n = 14）和出现复发或死亡的患者（n = 10）。
17例患者（70.8%）通过16S核糖体RNA测序鉴定出诺卡菌，5例患者（20.8%）通过传统生化试验鉴定出诺卡菌。两组患者的特征、临床表现、影像学特征和治疗史无差异。与出现复发或死亡的患者相比，病情得到控制的患者使用抗生素，尤其是甲氧苄啶/磺胺甲恶唑的总疗程明显更长（67.5±111.6天 vs. 9.0±6.5天；p = 0.01）。全血细胞减少是甲氧苄啶/磺胺甲恶唑最常见的不良反应。
甲氧苄啶/磺胺甲恶唑治疗疗程延长与肺诺卡菌病更好的预后显著相关。在这种情况下，抗生素，尤其是甲氧苄啶/磺胺甲恶唑，应使用3个月以上。
