Mok C C, Yuen K Y, Lau C S
University Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
Semin Arthritis Rheum. 1997 Feb;26(4):675-83. doi: 10.1016/s0049-0172(97)80003-0.
This study was performed to study the clinical presentations, treatment, and outcome of six cases of nocardial infection in the systemic lupus erythematosus (SLE) population living in Hong Kong and compare these cases with those reported in the English literature.
Records of 215 SLE patients who attended our lupus and rheumatology clinics were reviewed, and cases of nocardial infection were retrieved and studied in detail. A Medline search from 1966 to 1995 was performed to identify other reported cases. The microbiology, diagnosis, and treatment strategies of nocardiosis were assessed.
Six cases of nocardiosis were found in our lupus series, giving a prevalence of 2.8%. Another 26 cases of nocardial infection in SLE were reported in the literature. All except one were caused by Nocardia asteroides. The lung was the commonest site of involvement (81%), followed by the central nervous system (CNS) (13%). The mortality was high (35%), especially when the CNS was involved (75%). Sulphonamides were the mainstay of treatment, and adjunctive surgical procedures may be needed for suppurative complications.
Nocardiosis has been increasingly recognized in SLE. Although still uncommon, it is an important opportunistic infection because it is curable and mortality is usually caused by delay in diagnosis and treatment. A high index of suspicion, an aggressive approach to diagnosis, and early empirical therapy are essential principles of management.
本研究旨在探讨香港地区系统性红斑狼疮（SLE）患者中6例诺卡菌感染的临床表现、治疗及转归，并与英文文献报道的病例进行比较。
回顾了215例在我们狼疮及风湿病门诊就诊的SLE患者的病历，检索并详细研究了诺卡菌感染病例。对1966年至1995年的Medline进行检索，以确定其他报道的病例。评估了诺卡菌病的微生物学、诊断及治疗策略。
在我们的狼疮病例系列中发现6例诺卡菌病，患病率为2.8%。文献中还报道了另外26例SLE患者的诺卡菌感染。除1例以外，均由星形诺卡菌引起。肺部是最常受累的部位（81%），其次是中枢神经系统（CNS）（13%）。死亡率较高（35%），尤其是当CNS受累时（75%）。磺胺类药物是主要的治疗药物，对于化脓性并发症可能需要辅助手术治疗。
SLE患者中的诺卡菌病已越来越受到重视。虽然仍然不常见，但它是一种重要的机会性感染，因为它是可治愈的，而死亡率通常是由诊断和治疗延误所致。高度的怀疑指数、积极的诊断方法及早期经验性治疗是管理的基本原则。
