Centro Hospitalar e Universitário de São João, Internal Medicine Department, Oporto, Portugal; Oporto University, Faculty of Medicine, Centro Hospitalar e Universitário de São João, Oporto, Portugal; Centro Académico Clínico de São João, Oporto, Portugal.
Centro Hospitalar de Vila Nova de Gaia Espinho, Infectious Diseases Department, Vila Nova de Gaia, Portugal.
Braz J Infect Dis. 2023 Sep-Oct;27(5):102806. doi: 10.1016/j.bjid.2023.102806. Epub 2023 Oct 3.
Nocardiosis is a rare bacterial infection caused by Nocardia spp. However, an increasing incidence has been described whereby data about epidemiology and prognosis are essential.
A retrospective descriptive study was conducted among patients with positive Nocardia spp. culture, from January 2019 to January 2023, at a Terciary Hospital in Portugal.
Nocardiosis was considered in 18 cases with a median age of 63.8-years-old. At least one immunosuppressive cause was identified in 70% of patients. Five patients had Disseminated Nocardiosis (DN). The lung was the most common site of clinical disease (77.8%) and Nocardia was most commonly identified in respiratory tract samples. The most frequently isolated species were Nocardia nova/africana (n = 7) followed by Nocardia cyriacigeorgica (n = 3) and Nocardia pseudobrasiliensis (n = 3). The majority of the patients (94.4%) received antibiotic therapy, of whom as many as 55.6% were treated with monotherapy. The most frequently prescribed antibiotic was trimethoprim-sulfamethoxazole. Selected antimicrobial agents were generally effective, with linezolid and cotrimoxazole (100% Susceptibility [S]) and amikacin (94% S) having the most activity against Nocardia species. The median (IQR) duration of treatment was 24.2 (1‒51.4) weeks for DN; The overall one-year case fatality was 33.3% (n = 6) and was higher in the DN (66.7%). No recurrence was observed.
Nocardiosis is an emerging infectious disease with a poor prognosis, particularly in DN. This review offers essential epidemiological insights and underscores the importance of gaining a better understanding of the microbiology of nocardiosis. Such knowledge can lead to the optimization of antimicrobial therapy and, when necessary, guide appropriate surgical interventions to prevent unfavorable outcomes.
诺卡菌病是一种由诺卡菌属引起的罕见细菌感染。然而，发病率呈上升趋势，因此了解其流行病学和预后至关重要。
本研究为回顾性描述性研究，纳入了 2019 年 1 月至 2023 年 1 月在葡萄牙一家三级医院进行诺卡菌属培养阳性的患者。
共考虑了 18 例诺卡菌病患者，中位年龄为 63.8 岁。70%的患者至少存在一种免疫抑制原因。5 例患者患有播散性诺卡菌病（DN）。肺部是最常见的临床疾病部位（77.8%），诺卡菌最常从呼吸道样本中分离。最常分离的物种是新诺卡菌/非洲诺卡菌（n=7），其次是西氏诺卡菌（n=3）和假巴西诺卡菌（n=3）。大多数患者（94.4%）接受了抗生素治疗，其中多达 55.6%接受了单药治疗。最常使用的抗生素是复方磺胺甲噁唑。选择的抗菌药物通常有效，其中利奈唑胺和复方磺胺甲噁唑（100%敏感[S]）和阿米卡星（94% S）对诺卡菌属具有最强的活性。DN 的治疗中位（IQR）持续时间为 24.2（1-51.4）周；总的一年病死率为 33.3%（n=6），DN 为 66.7%。未观察到复发。
诺卡菌病是一种具有不良预后的新兴传染病，尤其是在 DN 中。本综述提供了重要的流行病学见解，并强调了更好地了解诺卡菌病微生物学的重要性。这种知识可以优化抗菌治疗，并在必要时指导适当的手术干预，以防止不良结局。
