A case series and focused review of nocardiosis - Clinical and microbiologic aspects
A case series and focused review of nocardiosis - Clinical and microbiologic aspects
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DOI：
10.1097/01.md.0000141100.30871.39
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发表时间：
2004-09-01
期刊：
影响因子：
1.6
通讯作者：
Crum, NF
中科院分区：
文献类型：
--
作者：
Lederman, ER;Crum, NF
诺卡菌是一种普遍存在的土壤微生物，通常感染有潜在免疫缺陷、肺部疾病或手术或创伤史的患者。我们报告5例诺卡菌病，代表了这个“伟大的模仿者”的各个方面：1)在潜在恶性肿瘤背景下的肺炎，2)耐药菌的慢性肺炎，3)慢性血液恶性肿瘤的菌血症和脓胸，4)原发性皮肤病，5)胸骨伤口感染。我们对1966年至2003年的英国文献进行了总结，重点介绍了我们的5例病例的教学要点以及诺卡菌属的背景流行病学和微生物学。用常规培养基可分离出该菌，但可能需要较长的潜伏期，从而延误诊断和适当治疗。使用含磺胺的治疗方案是标准的治疗方案，但考虑到新出现的耐药性、因不良反应导致的高停药率以及环孢素移植受者可能出现肾毒性，需要进行耐药性检测。
Nocardia species are ubiquitous soil organisms that often infect patients with underlying immune compromise, pulmonary disease, or a history of surgery or trauma. We report 5 cases of nocardiosis representing various aspects of this "great imitator": 1) pneumonia in the setting of underlying malignancy, 2) chronic pneumonia with drug-resistant organism, 3) bacteremia and empyema with chronic hematologic malignancy, 4) primary cutaneous disease, and 5) sternal wound infection. We present a summary of the English literature from 1966 to 2003 with a focus on the teaching points of each of our 5 cases as well as the background epidemiology and microbiology of the Nocardia genus. Isolation of the organism may be achieved with routine media but longer incubation times may be necessary, delaying diagnosis and appropriate therapy. Treatment with a sulfa-containing regimen is standard of care, but resistance testing is warranted given emerging drug resistance, high rates of discontinuation due to adverse reactions, and the potential for nephrotoxicity in transplant recipients on cyclosporine.