Farina C, Boiron P, Goglio A, Provost F
Microbiology Institute, Ospedali Riuniti, Bergamo, Italy.
Scand J Infect Dis. 1995;27(1):23-7. doi: 10.3109/00365549509018968.
We conducted a retrospective survey of nocardiosis in 9 city hospitals in northern Italy from 1982 to 1992. The medical records of 30 patients with documented nocardiosis were reviewed. Microbiological data included morphology, biochemical characteristics, serology and in vitro susceptibility testing. The 29 isolates (1 case was diagnosed on the basis of serological results) were Nocardia asteroides (n = 25) and Nocardia farcinica (n = 4). Predisposing factors including immunosuppression for organ transplant rejection prophylaxis, lung disease (silicotuberculosis and pulmonary fibrosis), solid tumours and hematological malignancies, and AIDS. Three patients had no identified risk factors. 20 cases of pulmonary nocardiosis were observed. Sites of infection in patients without previous pulmonary involvement were: brain abscesses, soft tissues, pericardium, blood, and cerebrospinal fluid. Most strains tested were susceptible to amikacin and imipenem. Resistance to several antimicrobial agents was found, particularly erythromycin, fosfomycin, pefloxacin, sulphonamides and trimethoprim. Antimicrobial chemotherapy included sulphonamides, amikacin, ceftriaxone, imipenem and minocycline. 21 patients survived, although 2 relapsed transiently. Nocardiosis appears to be more common than generally realised by physicians in northern Italy. The local species distribution and disease spectrum are similar to those described elsewhere. Nocardiosis should be part of the differential diagnosis in patients with pulmonary infiltrates or brain abscess, particularly those with predisposing factors.
我们对1982年至1992年意大利北部9家城市医院的诺卡菌病进行了回顾性调查。对30例有记录的诺卡菌病患者的病历进行了审查。微生物学数据包括形态学、生化特征、血清学和体外药敏试验。29株分离菌（1例根据血清学结果诊断）为星形诺卡菌（n = 25）和豚鼠耳炎诺卡菌（n = 4）。易感因素包括用于预防器官移植排斥的免疫抑制、肺部疾病（硅肺结核和肺纤维化）、实体瘤和血液系统恶性肿瘤以及艾滋病。3例患者未发现危险因素。观察到20例肺诺卡菌病。既往无肺部受累患者的感染部位有：脑脓肿、软组织、心包、血液和脑脊液。大多数测试菌株对阿米卡星和亚胺培南敏感。发现对几种抗菌药物耐药，尤其是红霉素、磷霉素、培氟沙星、磺胺类药物和甲氧苄啶。抗菌化疗包括磺胺类药物、阿米卡星、头孢曲松、亚胺培南和米诺环素。21例患者存活，尽管有2例短暂复发。在意大利北部，诺卡菌病似乎比医生普遍认识到的更为常见。当地的菌种分布和疾病谱与其他地方描述的相似。对于有肺部浸润或脑脓肿的患者，尤其是有易感因素的患者，诺卡菌病应作为鉴别诊断的一部分。
