Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California.
Division of Infectious Diseases, Loyola University Medical Center, Maywood, Illinois.
Semin Respir Crit Care Med. 2020 Aug;41(4):538-554. doi: 10.1055/s-0040-1708816. Epub 2020 Jul 6.
Members of the genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. Although rare as a cause of community-acquired pneumonia, can have severe morbidity and mortality, particularly in patients with comorbidities or compromised immunity. Early diagnosis and timely initiation of therapy are critical to optimizing patient outcomes. Species identification is important in determining treatment, as is in vitro susceptibility testing. Sulfonamide therapy is usually indicated, although a variety of other antimicrobials may be useful, depending on the species and susceptibility testing. Prolonged therapy is usually indicated, for 6 to 12 months, and in some cases surgical debridement may be required to resolve infection.
棒杆菌属的成员在环境中无处不在。这些需氧、革兰阳性的生物体可导致危及生命的感染，通常发生于免疫功能低下的宿主，如实体器官移植受者或因其他原因接受免疫抑制药物治疗的患者。本综述讨论了诺卡菌病的微生物学、感染的危险因素、临床表现、诊断方法和治疗。诺卡菌病主要影响肺部，但也可引起皮肤和软组织感染、脑脓肿、血流感染或累及其他器官的感染。虽然作为社区获得性肺炎的病因较为罕见，但可导致严重的发病率和死亡率，尤其是在存在合并症或免疫功能受损的患者中。早期诊断和及时开始治疗对于优化患者结局至关重要。种属鉴定对于确定治疗方案很重要，体外药敏试验也是如此。磺胺类药物治疗通常是指征，但根据物种和药敏试验，可能还需要使用其他各种抗菌药物。通常需要进行长期治疗，6 至 12 个月，在某些情况下可能需要手术清创来解决感染。
