Menéndez R, Cordero P J, Santos M, Gobernado M, Marco V
Pneumology Service, University Hospital La Fe, Valencia, Spain.
Eur Respir J. 1997 Jul;10(7):1542-6. doi: 10.1183/09031936.97.10071542.
Pulmonary nocardiosis (PN) is an infrequent and severe infection due to Nocardia spp., microorganisms that may behave both as opportunists and as primary pathogens. The aim of this study and review was to evaluate the clinical features, evolution and prognostic factors of PN. The study group comprised 10 consecutive patients with pulmonary nocardiosis acquired in a community setting, diagnosed and followed in a tertiary teaching hospital. Chronic obstructive pulmonary disease (COPD), neoplastic disease and human immunodeficiency virus (HIV) infection were the most frequent predisposing factors. Four patients were receiving corticosteroid treatment. Clinical course was chronic and diagnosis was delayed 3 weeks or more in seven of the patients. Lobar or multilobar condensation was the most frequent radiographic pattern. Antimicrobial susceptibility testing showed: 100% sensitivity for amikacin; 83% for imipenem; 71% for cefotaxime; and 71% for trimethoprim-sulphamethoxazole. The disease remained localized in the lung in five cases, with a trend toward chronicity in one with bronchiectasis. In the other five, the disease disseminated, affecting subcutaneous tissue, the central nervous system and the kidney. Three patients died, one with disseminated disease and two who were receiving corticosteroid therapy. The following conclusions were reached: 1) pulmonary nocardiosis is difficult to diagnose, diagnosis is frequently delayed and a high level of suspicion is, thus, required in patients with underlying diseases or chronic corticosteroid therapy; 2) there is frequent dissemination and high mortality; and 3) antimicrobial combinations with proven synergy, such as imipenem and amikacin, are recommended for initial therapy.
肺诺卡菌病（PN）是由诺卡菌属引起的一种罕见且严重的感染，该类微生物既可能作为机会致病菌，也可能作为原发性病原体。本研究及综述的目的是评估肺诺卡菌病的临床特征、病情演变及预后因素。研究组包括10例在社区获得性肺诺卡菌病患者，这些患者在一家三级教学医院被诊断并接受随访。慢性阻塞性肺疾病（COPD）、肿瘤性疾病和人类免疫缺陷病毒（HIV）感染是最常见的易感因素。4例患者正在接受皮质类固醇治疗。临床病程呈慢性，7例患者的诊断延迟3周或更长时间。大叶或多叶实变是最常见的影像学表现。抗菌药物敏感性试验显示：阿米卡星的敏感性为100%；亚胺培南为83%；头孢噻肟为71%；复方磺胺甲恶唑为71%。5例患者的疾病局限于肺部，其中1例合并支气管扩张有慢性化趋势。在另外5例中，疾病发生播散，累及皮下组织、中枢神经系统和肾脏。3例患者死亡，1例死于播散性疾病，2例正在接受皮质类固醇治疗。得出以下结论：1）肺诺卡菌病难以诊断，诊断常常延迟，因此对于患有基础疾病或长期接受皮质类固醇治疗的患者需要高度怀疑；2）疾病常发生播散且死亡率高；3）推荐使用具有协同作用的抗菌药物联合治疗，如亚胺培南和阿米卡星，作为初始治疗方案。
