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2017 ; 56
(12
): 1485-1490
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Pulmonary Nocardiosis: A Clinical Analysis of 30 Cases
#MMPMID28626172
Takiguchi Y
; Ishizaki S
; Kobayashi T
; Sato S
; Hashimoto Y
; Suruga Y
; Akiba Y
Intern Med
2017[]; 56
(12
): 1485-1490
PMID28626172
show ga
Objective Pulmonary nocardiosis frequently develops as an opportunistic infection
in patients with malignant tumor and is treated with steroids. This study was
performed to clarify the clinical features of pulmonary nocardiosis in Japan.
Methods The patients definitively diagnosed with pulmonary nocardiosis at our
hospital between January 1995 and December 2015 were retrospectively
investigated. Results Nineteen men and 11 women (30 in total) were diagnosed with
pulmonary nocardiosis. Almost all patients were complicated by a non-pulmonary
underlying disease, such as malignant tumor or collagen vascular disease, or
pulmonary disease, such as chronic obstructive pulmonary disease or interstitial
pneumonia, and 13 patients (43.3%) were treated with steroids or
immunosuppressors. Gram staining was performed in 29 patients, and a
characteristic Gram-positive rod was detected in 28 patients (96.6%). Thirty-one
strains of Nocardia were isolated and identified. Seven strains of Nocardia
farcinica were isolated as the most frequent species, followed by Nocardia nova
isolated from 6 patients. Seventeen patients died, giving a crude morality rate
of 56.7% and a 1-year survival rate of 55.4%. The 1-year survival rates in the
groups with and without immunosuppressant agents were 41.7% and 59.7%,
respectively, showing that the outcome of those receiving immunosuppressants
tended to be poorer than those not receiving them. Conclusion Pulmonary
nocardiosis developed as an opportunistic infection in most cases. The outcome
was relatively poor, with a 1-year survival rate of 55.4%, and it was
particularly poor in patients treated with immunosuppressant agents. Pulmonary
nocardiosis should always be considered in patients presenting with an
opportunistic respiratory infection, and an early diagnosis requires sample
collection and Gram staining.
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