Serino Mariana, Sousa Catarina, Redondo Margarida, Carvalho Teresa, Ribeiro Manuela, Ramos Angélica, Cruz-Martins Natália, Amorim Adelina
Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
Clinical Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.
J Appl Microbiol. 2022 Nov;133(5):3239-3249. doi: 10.1111/jam.15778. Epub 2022 Aug 23.
Chronic lung diseases are a recognized risk factor for Nocardia spp.
Nocardia spp. isolation does not inevitably imply disease, and thus colonization must be considered. Here, we aimed to analyse the differences between pulmonary nocardiosis (PN) and Nocardia spp. colonization in patients with chronic lung diseases.
A retrospective study of patients with laboratory confirmation of isolation of Nocardia spp. in at least one respiratory sample was performed. Patients with PN and Nocardia spp. colonization were compared. There were 71 patients with Nocardia spp. identification, 64.8% were male, with a mean age of 67.7 ± 11.2 years. All patients had ≥1 pre-existing chronic lung disease, and 19.7% of patients were immunocompromised. PN and Nocardia spp. colonization were considered in 26.8% and 73.2% of patients, respectively. Symptoms and chest CT findings were significantly more frequent in patients with PN (p < 0.001). During follow-up time, 12 (16.9%) patients died, 6 in PN group. Immunosuppression, constitutional symptoms, haematological malignancy and PN diagnosis were associated with significantly shorter survival times, despite only immunosuppression (HR 3.399; 95% CI 1.052-10.989) and PN diagnosis (HR 3.568; 95% CI 1.078-11.910) remained associated with a higher death risk in multivariate analysis.
PN was associated with clinical worsening, more chest CT findings and worse clinical outcomes.
Nocardia spp. isolation in chronic lung disease patients is more common than expected and the differentiation between colonization and disease is crucial.
慢性肺部疾病是诺卡菌属感染的公认危险因素。
诺卡菌属的分离并不必然意味着患病，因此必须考虑定植情况。在此，我们旨在分析慢性肺部疾病患者中肺诺卡菌病（PN）与诺卡菌属定植之间的差异。
对至少一份呼吸道样本中诺卡菌属分离结果经实验室确认的患者进行回顾性研究。比较了PN患者与诺卡菌属定植患者。共有71例诺卡菌属鉴定病例，64.8%为男性，平均年龄67.7±11.2岁。所有患者均患有≥1种既往慢性肺部疾病，19.7%的患者免疫功能低下。分别有26.8%和73.2%的患者被诊断为PN和诺卡菌属定植。PN患者的症状和胸部CT表现明显更常见（p<0.001）。在随访期间，12例（16.9%）患者死亡，PN组6例。免疫抑制、全身症状、血液系统恶性肿瘤和PN诊断与生存时间显著缩短相关，尽管在多变量分析中只有免疫抑制（HR 3.399；95%CI 1.052 - 10.989）和PN诊断（HR 3.568；95%CI 1.078 - 11.910）与较高的死亡风险相关。
PN与临床病情恶化、更多的胸部CT表现及更差的临床结局相关。
慢性肺部疾病患者中诺卡菌属的分离比预期更常见，而定植与疾病的区分至关重要。
