Nocardia asteroides osteomyelitis

Nocardia asteroides osteomyelitis has previously been described only in acutely ill patients. It may occur as an isolated event or part of the disease spectrum of disseminated nocardiosis. An 84 year old immune competent man with N. asteroides right tibial osteomyelitis had an unusual presentation, presumed mechanism of disease and outcome. His course affords an opportunity to review the literature on N. asteroides osteomyelitis and to discuss the unique features of his case.     

Primary cutaneous nocardiosis.

Seven patients with primary cutaneous nocardiosis were seen during a 20-month period. Six patients had a history of local trauma to an extremity or did frequent yard work. The spectrum of clinical disease included cellulitis, pustules,pyoderma, or lymphocutaneous syndrome mimicking sporotrichosis. Evidence of Nocardia infection elsewhere was absent, and no patient had a serious underlying disease. Nocardia brasiliensis was isolated from four cases, and N asteroides was identified in the other three patients. In two patients, disease resolved without chemotherapy, while a short course of a sulfonamide with or without trimethoprim therapy was successful in the remaining cases. The relatively benign nature of this disease, the usual failure to obtain cultures of superficial skin infections, and our accumulation of seven cases in less than two years suggest this disease is more common than previously recognized.     

Biochemical identification and molecular characterization (PCR-RFLP) of Nocardia isolates from sputum

BACKGROUND: Nocardia identification has been based on biochemical and morphological characteristics. However, molecular biology techniques allow a better characterization of species and biotypes that are related to invasive diseases. METHODS: Twelve isolates of Nocardia spp. were obtained from sputum of patients with tuberculosis under retreatment. Identification was done based on morphological characteristics, biochemical tests (casein, tyrosine, xanthine, gelatin, and urea) and molecular biology techniques (PCR-RFLP) using restriction enzymes MspI, HinfI, BsaHI, HaeIII and BstEII. RESULTS: Biochemical tests identified the 12 isolates as Nocardia asteroides. PCR-RFLP technique identified nine isolates to species and biotype level: five as N. asteroides type II, two as N. asteroides type VI, and two as N. asteroides type I. The remaining three isolates were identified as follows: one to species level as N. farcinica and two at genus level as Nocardia sp. CONCLUSIONS: Significant statistical differences between the use of traditional techniques and PCR-RFLP were not found at genus level, but there were important differences at species and biotype level. Biochemical tests identified correctly the actinomycete isolates as belonging to Nocardia genus, but at N. asteroides complex level were not able to discern among their different species. PCR-RFLP is a rapid, non-expensive, and reliable method that allows to discriminate the N. asteroides complex species, identifying biotypes related to invasive disease. Our results suggest that the hospital environment was not a contamination source.     

Minocycline treatment of pulmonary nocardiosis

Minocycline hydrochloride was used to treat pulmonary infections with Nocardia asteroides in five cardiac allograft recipients. In three patients, minocycline was successfully used as the only antinocardial agent. Two other patients were found to have leukopenia after initial therapy with sulfisoxazole. These two patients were subsequently treated with minocycline. The clinical success with minocycline in these highly immunosuppressed patients suggests that minocycline is an effective antinocardial agent. These data did not allow any conclusion regarding which drug, minocycline or sulfisoxazole, is superior in the treatment of this disease.     

奴卡菌病（2例报告及文献复习）

目的：提高对奴卡菌病的早期诊断率。方法：报告２例奴卡菌病并复习文献，对其发病高危因素、临床表现、诊断、治疗及预后进行分析。结果：２例奴卡菌病患者，基础疾病分别为肾病综合征及系统性红斑狼疮，均有长期大量使用肾上腺皮质激素史。２例均经病原菌的分离和鉴定后确诊为奴卡菌病。２例患者均合并有脑脓肿。例１因肾病综合征未使用磺胺治疗，例２因磺胺对肾毒性作用而停用。２例患者均死亡。结论：对可疑患者，提高病原菌的分     

Beneficial effects of hyperbaric oxygen therapy in Nocardia brasiliensis soft-tissue infection.

OBJECTIVE: To report the success of hyperbaric oxygen therapy in the treatment of Nocardia brasiliensis mycetoma. We believe this to be only the second report in the medical literature of hyperbaric oxygen therapy used in the therapy of nocardial disease. CLINICAL FEATURES: A 78-year-old man presented to a general hospital outpatient clinic after eight months with a painless swollen left foot. There was no significant medical history, no trauma had occurred, and no foreign body had been detected. The dorsum of the foot had a discharging sinus, from which N. brasiliensis was isolated. INTERVENTIONS: After unsuccessful treatment with surgical debridement and high-dose antibiotic therapy, hyperbaric oxygen therapy was administered in a multiplace recompression chamber (one hour of treatment at 1.8 atmospheres absolute followed by a 30 minute "ascent" to surface pressure). A total of 19 treatments were administered. OUTCOME: Successful healing of an N. brasiliensis mycetoma of the left foot. CONCLUSION: In this case of N. brasiliensis mycetoma involving the lower extremity, the conventional management of surgery and antibiotic therapy was unsuccessful, and only with the addition of hyperbaric oxygen therapy did clinical recovery occur.     

Diversity and frequency of Nocardia spp. in the soil of Isfahan province,Iran

Objective

To isolate and identify Nocardia spp. from soil in different regions of Isfahan province in the center of Iran.

Methods

This study was conducted in 32 districts (16 cities and 16 villages) in Isfahan province during two years. A total of 800 soil samples from these regions were studied by using kanamycin. The isolated Nocardia species were examined by gram and acid-fast staining and were identified biochemically and morphologically. The frequency and distribution of Nocardia spp. were determined in relation to different factors such as soil pH and temperate climate.

Results

From 153 (19.1%) Nocardia isolates identified, Nocardia asteroids (N. asteroids) complex (45.5%) and Nocardia brasiliensis (N. brasiliensis) (24.7%) were the most frequently isolated species, followed by Nocardia otitidiscaviarum (2.2%), Nocardiopsis dassonvillei, Actinomadura actinomadura (each 1.7%) and Nocardia transvalensis (1.1%) and also unknown spp. (23.0%). In this study, most species (54.4%) of Nocardia, especially N. asteroides complex were isolated from soils with pH: 7.01-8, whereas in pH: 8.01-9 more N. brasiliensis was isolated. The most Nocardia spp. was detected from regions with semi-nomadic and temperate climate (41.1%).

Conclusions

N. asteroids complex is more prevalent in Isfahan province and soil can be a potential source of nocardiosis infections. It is to be considering that climate and soil pH are involved in the frequency and diversity of aerobic Actinomycetes.     

肺诺卡菌病4例报告并文献复习

目的提高临床医生对肺诺卡菌病的的认识。方法分析4例肺诺卡菌病的临床特点,并复习相关文献。结果4例肺诺卡菌病患者2例有免疫性疾病并服用免疫抑制剂,4例均有咳嗽咳痰和发热,3例为午后发热。肺部影像学表现4例肺实变影,3例大小不等的结节影／月中块影并可见空洞。病原学检查标本多种。磺胺治疗效果较好。结论肺诺卡菌病缺乏特异性临床表现,肺部多发结节影／月中块影并空洞形成是其影像学特点,磺胺是主要治疗药物。     

PCR为基础的反向线点杂交及16S～23S rDNA间区测序分析5种少见类型奴卡菌

目的探讨5种新出现的奴卡菌种16S～23S rDNA内转录间隔区(internal transcribed spacer,ITS)DNA基因序列的多态性,筛查特异的奴卡菌种逆向线点杂交(reverse line blot,RLB)探针。方法对6例奴卡菌标本进行ITS基因扩增、克隆、测序,设计奴卡菌种特异探针及ITS间区rDNA基因特异的探针,进行以PCR为基础的RLB(PCR/RLB)杂交试验,不同的RLB型进行ITS基因测序分析,以鉴别不同的奴卡菌种及种内分型。结果发现2个Nocardia beijingensis菌株ITS间区有8个基因序列型,4个RLB型;N.thailandica有4个基因序列型及RLB型;N.blacklockiae有5个基因序列型,3个RLB型,其中N-bla RLBⅢ型与所有Nbla-ITS探针杂交没有信号;N.elegans有5个基因序列型,3个RLB型;N.vinacea有5个基因序列型,2个RLB型。结论通过PCR/RLB试验,准确的ITS基因测序认识了新出现的菌种,即N.beijingensis,N.blacklockiae,N.elegans,N.thailandica及N.vinacea。同时建立了可以大量筛查奴卡菌种的PCR/RLB方法,以进行快速临床诊断及流行病学研究。     

Nocardia asteroides sinusitis. Presentation as a trimethoprim-sulfamethoxazole responsive fever of unknown origin.

A patient with a yearlong fever of unknown origin responded to trimethoprim-sulfamethoxazole and was discovered to have culture-proved Nocardia asteroides sinusitis, with absence of detectable disease in other organs. An inhalational route is postulated as the mode of entry of the organism, with localization in the maxillary sinus.     

慢性阻塞性肺疾病合并奴卡菌感染三例临床及影像学分析

目的　了解慢性阻塞性肺疾病合并肺奴卡菌感染的临床特征、影像学特点、临床诊治和预后。方法　选取2017年3月—2018年9月浙江衢化医院收治的3例确诊为慢性阻塞性肺疾病合并肺奴卡菌感染的病例进行总结及文献复习。结果　3例慢性阻塞性肺疾病合并肺奴卡菌感染患者主要症状包括发热、咳嗽、咳黄浓痰;影像学表现为结节或肿块、空洞、实变和胸腔积液。确诊手段主要是痰培养,治疗药物以复方磺胺甲噁唑治疗为基础,可以联合其他抗生素。3例患者均痊愈或好转。结论　结构性肺病是肺奴卡菌感染的基础,临床 表现和影像学特点无特异性,奴卡菌病原菌培养阳性是主要的确诊途径,治疗药物以磺胺甲噁唑为主,酌情联合其他用药。     

结核病专科医院24例诺卡菌病临床特征分析

目的 总结结核专科病院肺诺卡菌病临床特征,为早期识别该病提供依据。方法 收集并分析河北省胸科医院24例肺诺卡菌病患者临床表现、实验室检查、影像学、治疗和预后。结果 24例患者,男16例,女8例,发病年龄（58.1±9.8）岁;半数以上存在肺部基础疾病,其中曾患肺结核病治愈者4例,合并活动性肺结核1例,支气管扩张症18例,艾滋病1例。常见症状为咳嗽（24例）、咳痰（24例）、发热（14例）。胸部影像学表现为胸腔积液（2例）、斑片状影（17例）、胸膜增厚（13例）、纵膈淋巴结肿大（7例）、实变（8例）和空洞（5例）。肺诺卡菌病通过痰液、肺泡灌洗液、肺组织或脓肿穿刺物中发现诺卡菌后经分子生物学方法或质谱鉴定证实。21例患者应用包含复方新诺明的联合治疗方案,3例采用复方新诺明单药治疗,治疗有效21例,1例因多种药物过敏而治疗效果不佳,2例治疗后病情持续恶化自动出院而死亡。结论 结核病院肺诺卡菌病多见于结构性肺病,常规治疗无效的支气管扩张症患者要高度警惕肺诺卡菌病。     

利奈唑胺治疗系统性红斑狼疮并发奴卡菌病一例分析

报告1例应用利奈唑胺治疗系统性红斑狼疮（SLE）并发奴卡菌病的临床资料并复习相关文献.奴卡菌病是SLE并发的罕见但严重的机会性感染,病原菌的分离和鉴定是诊断本病的首要条件;药物治疗需长疗程,特别是免疫功能抑制患者经典的磺胺类药物治疗需半年至1年,选择治疗药物时应权衡利弊;利奈唑胺可有效治疗奴卡菌病,是否可以适当缩短疗程值得探讨.     

Auxotypes of Neisseria gonorrhoeae isolated from localized and disseminated infections in Montreal.

A survey recently made in the United States on the regional distribution of auxotypes of Neisseria gonorrhoeae suggested that isolates from different geographic areas often differ in auxotype. A subsequent auxotyping study in Montreal of 901 isolates of N. gonorrhoeae, 15 from patients with disseminated gonococcal infection, proved interesting in many regards. Gonococcal genetic medium, modified by the addition of other amino acids, was used. Most (93%) of the strains isolated from patients with localized infection belonged to one of the following three phenotypes: arginine-, hypoxanthine- and uracil-dependent (44%); prototrophic (33%); and proline-dependent (16%). Of the 15 strains responsible for disseminated infection 14 required arginine, hypoxanthine and uracil for growth.     

系统性红斑狼疮合并奴卡菌病二例报告并文献复习

目的探讨系统性红斑狼疮(SLE)合并奴卡菌病的临床表现及诊断、治疗、预后.方法报告北京协和医院2例SLE合并奴卡菌病的临床资料并复习相关文献46例,对其临床表现、诊断、治疗及预后进行分析.结果48例SLE并发奴卡菌病患者均为应用肾上腺糖皮质激素和(或)免疫抑制剂发病后;女性发病高于男性(2.2:1);肺部病变最常见(72.9%);细菌培养95%为星形奴卡菌;治疗首选磺胺类药物;死亡率为33.3%.结论奴卡菌病是SLE并发的罕见但严重的机会性感染,病原菌的分离和鉴定是诊断本病的首要条件.应及早使用磺胺类药物,必要时应予外科辅助治疗.     

慢性阻塞性肺疾病并发呼吸衰竭的诊治体会

目的总结分析慢性阻塞性肺疾病（COPD）并发呼吸衰竭的诊断与治疗经验。方法回顾性分析22例慢性阻塞性肺疾病（COPD）并发呼吸衰竭的临床资料。结果 14例经常规抗感染、解痉平喘、化痰止咳等保守治疗均获成功,无效者行机械通气及支气管镜吸痰,支气管肺泡灌洗8例,无效2例。死因为呼吸机相关性肺炎、高气压伤、感染性休克、顽固性心衰、严重电解质紊乱和多脏器功能不全。结论慢性阻塞性肺疾病（COPD）并发呼吸衰竭,常规治疗结合机械通气、支气管镜下吸痰、支气管肺泡灌洗并根据痰或支气管肺泡灌洗液行细菌培养及药敏试验选用抗生素是救治成功的关键,及时治疗原发病和处理合并症,是有效的治疗方法 。     

肺型与进展播散型组织胞浆菌病的临床对比分析

目的：比较肺型与进展播散型组织胞浆菌病的临床特点、诊断及预后差异。 方法：回顾性分析中南大学 湘雅医院2009年2月至2015年10月期间收治的组织胞浆菌病住院患者12例,其中肺型4例,进展播散型8例。从临床表 现、影像学、确诊途径及预后等方面分析两者之间的差异性。 结果：肺型组织胞浆菌病临床表现轻微,干咳多见。 进展播散型患者全身症状明显,极易出现反复高热、全身浅表淋巴结肿大、肝脾肿大,可合并咳嗽、腹痛、关节 痛、皮肤改变等。实验室检查示全血细胞减少、肝功能异常、凝血功能异常等。1例肺型患者给予了左下肺切除术, 其余3例肺型及6例进展播散型患者分别给予两性霉素B脱氧胆酸盐、伊曲康唑、伏立康唑或氟康唑抗真菌感染治疗, 好转出院,1例播散型确诊后暂未治疗即出院,1例播散型因合并重症肺炎及活动性肺结核治疗无效死亡。结论：组 织胞浆菌病临床少见,极易漏诊或误诊,依靠骨髓涂片、病理组织切片特殊染色明确病原学是目前确诊的主要依 据,推荐两性霉素B脂质体、两性霉素B脱氧胆酸盐及伊曲康唑抗感染治疗。     

舒利迭配伍孟鲁斯特治疗中重度慢性阻塞性肺病疗效观察

目的:探究吸入舒利迭联合孟鲁斯特治疗慢性阻塞性肺病的效果。方法:本文收集2010年10月～2011年10月期间在我院就诊的100例慢性阻塞性肺病患者,将其随机分为观察组和对照组,每组各50例,观察组给予吸入舒利迭联合孟鲁斯特,对照组给予口服沐舒坦联合缓释茶碱,进行治疗前后临床疗效和肺功能判定。结果:观察组临床症状及肺功能明显改善。结论:糖皮质激素联合长效β2受体激动剂治疗慢性阻塞性肺病效果显著。     

2000～2010年20例血液病合并结核感染临床分析

目的探讨良、恶性血液病合并结核感染的临床特征及诊断治疗方法。方法对2000～2010年间我院收治的良、恶性血液病合并结核感染患者20例的临床特征和诊治方法总结分析。结果 20例患者均给予正规抗结核(四联)及标准方案抗原发病治疗,抗结核治疗均有效;其中3例3个月后肝脾淋巴结均明显缩小、消失;仅其中1例急性白血病,拒绝行化疗,半年后因合并肺真菌感染及真菌败血症致结核致病灶扩散而死亡。结论恶性血液病合并肺结核感染后的临床表现不典型,对于恶性血液病患者在抗肿瘤治疗有效时出现不明原因的发热,经抗感染、抗真菌治疗无效时,应高度警惕合并结核感染的可能。     

Mycobacterium marinum infection: epidemiology and presentation in Queensland 1971-1990.

OBJECTIVE: Evaluation of the clinical and epidemiological features of Mycobacterium marinum infection in Queensland. DESIGN: Laboratory identification and in-vitro susceptibility tests of 29 isolates from the Queensland Health Department Tuberculosis Reference Laboratory were retrospectively gathered and followed up by contacting referring practitioners and obtaining clinical details of patients involved. SUBJECTS: 29 patients from whom M. marinum was isolated, with a male:female ratio of 3.1:1, and a mean age of 47.4 years. RESULTS: Of 26 patients for whom adequate information was available, 12 had evidence of involvement of deep tissues (including two cases of arthritis) and five suffered sporotrichoid spread of infection. The delay between onset of symptoms and consultation with a medical practitioner was five months (range, two weeks to two years), with a further mean delay to definitive diagnosis of 4.4 weeks. Cure was apparent in 22 of 23 cases. Chemotherapy alone was adequate in 11 cases, as was surgical intervention in three, while a combination approach was successful in eight cases. Trimethoprim/sulfamethoxazole was successful in seven of nine cases and combination rifampicin and ethambutol in six of seven. Tetracyclines were employed as single-agent therapy in nine patients and were effective in seven. CONCLUSIONS: Synovitis was a common presenting feature of M. marinum infection in Queensland patients. Occupational and recreational exposure to salt or fresh water was common, and although this history was available to practitioners a mean delay to definitive diagnosis of 4.4 weeks still occurred. The data suggest that chemotherapy alone is often adequate, even with deep tissue involvement. Combinations of conventional antimycobacterial drugs may be the therapy of choice, especially for serious infections, although success was recorded with trimethoprim/sulfamethoxazole alone.