Arlotti M, Zoboli G, Moscatelli G L, Magnani G, Maserati R, Borghi V, Andreoni M, Libanore M, Bonazzi L, Piscina A, Ciammarughi R
Division of Infectious Diseases, Rimini Hospital, Italy.
Scand J Infect Dis. 1996;28(5):463-7. doi: 10.3109/00365549609037941.
Rhodococcus equi causes a rare infection in immunocompromised hosts. We describe 24 cases of infection in patients with AIDS-related complex (ARC)/acquired immunodeficiency syndrome (AIDS). Pneumonia was always the first manifestation of R. equi infection, but extrapulmonary involvement was also observed. The main sources of bacteria were sputum, bronchial washings and blood. The strains isolated were mainly susceptible to erythromycin, vancomycin, teicoplanin, rifampicin, imipenem and aminoglycosides. Initial treatment should involve an intravenously administered antibiotic combination therapy including imipenem or vancomycin or teicoplanin, followed by orally administered maintenance combination therapy. Drug combinations should be investigated for serum bactericidal activity in vitro. Surgery does not increase survival time and should only be performed in cases that do not respond to antibiotic treatment. Presumptive risks of infection (contact with horses or farm dust, or cohabiting with people affected by R. equi infection) were present in more than 50% of patients. This finding, and the frequency of bacteria in the sputum, are not sufficient proof of transmission between humans, but do suggest the need for respiratory isolation of patients affected by R. equi pneumonia.
马红球菌可在免疫功能低下的宿主中引起一种罕见感染。我们描述了24例艾滋病相关综合征（ARC）/获得性免疫缺陷综合征（AIDS）患者的感染病例。肺炎始终是马红球菌感染的首发表现，但也观察到了肺外受累情况。细菌的主要来源是痰液、支气管灌洗液和血液。分离出的菌株主要对红霉素、万古霉素、替考拉宁、利福平、亚胺培南和氨基糖苷类药物敏感。初始治疗应采用静脉注射抗生素联合治疗，包括亚胺培南或万古霉素或替考拉宁，随后采用口服维持联合治疗。应研究药物组合的体外血清杀菌活性。手术并不能延长生存时间，仅在对抗生素治疗无反应的病例中进行。超过50%的患者存在推定的感染风险（接触马匹或农场灰尘，或与受马红球菌感染的人同居）。这一发现以及痰液中细菌的频率，虽不足以证明人与人之间的传播，但确实表明有必要对受马红球菌肺炎影响的患者进行呼吸道隔离。
