Zhong Cheng, Huang Pingping, Zhan Yasheng, Yao Yake, Ye Junhui, Zhou Hua
Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Affiliated Hangzhou Chest Hospital, Hangzhou, 310003, People's Republic of China.
Infect Drug Resist. 2022 Mar 21;15:1167-1174. doi: 10.2147/IDR.S359596. eCollection 2022.
To investigate the clinical features of pulmonary nocardiosis (PN) in patients with different underlying diseases.
Clinical, imaging, treatment and prognosis data from patients diagnosed with PN from July 2011 to June 2021 at the First Affiliated Hospital, Zhejiang University School of Medicine were collected and analyzed. According to different underlying diseases, patients were grouped into immunocompromised host (ICH) group and immunocompetent host (ICO) group, and clinical characteristics were compared between the two groups.
There were 64 patients with PN, including 42 males, aged from 21 to 86 (57.1 ± 15.7) years. The most common clinical manifestations were cough, expectoration, fever. There were 41 cases in the ICH group and 23 cases in the ICO group. There were 11 cases with underlying pulmonary diseases in the ICH group, including 2 cases of bronchiectasis, 4 cases of chronic obstructive pulmonary disease (COPD), etc. There were 11 cases of underlying pulmonary basic diseases in ICO group, including 7 cases of bronchiectasis and COPD, 1 case of bronchiectasis, 1 case of COPD, etc. The proportion of patients with bronchiectasis and COPD in the ICO group was significantly higher (P < 0.05). Extrapulmonary nocardiosis infection occurred in 6 patients of the ICH group. During the period of hospitalization, 87.0% patients in ICO group received SMZ/TMP therapy, 73.2% of patients in ICH group received two drug combination therapy. In the ICH group, mortality at 28 days was 14.6% and 8.7% in the ICO group.
PN mainly occurred in ICH patients, but also occurred in the ICO cases to a lesser extent, especially in patients with bronchiectasis and/or COPD. Complicated with extrapulmonary infections mainly occurred in ICH population and combination of two antibiotics was often used in ICH group. The case fatality rates were 14.6% in ICH and 8.7% in ICO cases, respectively.
探讨不同基础疾病患者肺诺卡菌病（PN）的临床特征。
收集并分析2011年7月至2021年6月在浙江大学医学院附属第一医院确诊为PN的患者的临床、影像学、治疗及预后数据。根据不同基础疾病，将患者分为免疫功能低下宿主（ICH）组和免疫功能正常宿主（ICO）组，比较两组的临床特征。
共有64例PN患者，其中男性42例，年龄21至86岁（57.1±15.7岁）。最常见的临床表现为咳嗽、咳痰、发热。ICH组41例，ICO组23例。ICH组有11例合并基础肺部疾病，包括支气管扩张2例、慢性阻塞性肺疾病（COPD）4例等。ICO组有11例合并基础肺部疾病，包括支气管扩张和COPD 7例、支气管扩张1例、COPD 1例等。ICO组支气管扩张和COPD患者比例明显更高（P<0.05）。ICH组6例发生肺外诺卡菌病感染。住院期间，ICO组87.0%的患者接受复方磺胺甲恶唑治疗，ICH组73.2%的患者接受两药联合治疗。ICH组28天死亡率为14.6%，ICO组为8.7%。
PN主要发生在ICH患者中，但在ICO患者中也有一定比例发生，尤其是支气管扩张和/或COPD患者。肺外感染主要发生在ICH人群中，ICH组常使用两种抗生素联合治疗。ICH组和ICO组的病死率分别为14.6%和8.7%。
