Koffi N, Aka-Danguy E, Ngom A, Kouassi B, Yaya B A, Dosso M
Service de Pneumologie, CHU de Cocody, Abidjan, Côte d'Ivoire.
Rev Mal Respir. 1998 Oct;15(5):643-7.
This is a prospective study recruiting 120 patients successively who were admitted to the chest department in hospital for respiratory infections irrespective of their aetiology. The aim of the study was to assess the frequency of nocardiosis in respiratory pathology in the era of AIDS and in an area where tuberculosis is endemic. The HIV serology was carried out on all 120 patients. A systemic search was made for nocardiosis and Koch's bacillus in the sputum and also in the broncho-alveolar lavage liquid obtained by endoscopy. The HIV serology was positive in 74 patients (61.7%). Pulmonary nocardiosis was diagnosed in five patients (4.2%), of whom four patients were HIV positive (80%). Tuberculosis was diagnosed in 58 cases (48.3%) of whom 40 were HIV positive (70%). The association of nocardiosis and tuberculosis was present in only one patient. The radioclinical aspect of nocardiosis in our service was suggestive of tuberculosis. The prevalence of nocardiosis in our series at 4.2% is in agreement with that obtained in autopsy studies in the Ivory Coast. The similarity of the radioclinical appearance between tuberculosis and nocardiosis demands that a search is made for the latter on all HIV positive patients and in negative cases a search for Koch's bacillus and empirical antibiotic therapy ought to have a spectrum of activity that would include nocardia.
这是一项前瞻性研究，连续招募了120名因呼吸道感染入住医院胸科的患者，无论其病因如何。该研究的目的是评估在艾滋病时代以及结核病流行地区呼吸道疾病中诺卡菌病的发生率。对所有120名患者进行了HIV血清学检测。对痰液以及通过内窥镜检查获得的支气管肺泡灌洗液进行了诺卡菌病和结核杆菌的系统检测。74名患者（61.7%）的HIV血清学检测呈阳性。5名患者（4.2%）被诊断为肺诺卡菌病，其中4名患者HIV呈阳性（80%）。58例（48.3%）患者被诊断为结核病，其中40例HIV呈阳性（70%）。仅1名患者同时患有诺卡菌病和结核病。我们科室诺卡菌病的放射临床特征提示为结核病。我们系列研究中诺卡菌病的患病率为4.2%，与在象牙海岸进行的尸检研究结果一致。结核病和诺卡菌病在放射临床表现上的相似性要求对所有HIV阳性患者进行诺卡菌病检测，对于HIV阴性患者，应检测结核杆菌，经验性抗生素治疗应具有涵盖诺卡菌的活性谱。
