PDF(Pubmed)
Abstract：
Nocardia pyomyositis in immunocompetent patients is a rare occurrence. The diagnosis may be missed or delayed with the risk of progressive infection and suboptimal or inappropriate treatment. We present the case of a 48-year-old immunocompetent firefighter diagnosed with pyomyositis caused by Nocardia brasiliensis acquired by direct skin inoculation from gardening activity. The patient developed a painful swelling on his right forearm that rapidly progressed proximally and deeper into the underlying muscle layer. Ultrasound imaging of his right forearm showed a 7-mm subcutaneous fluid collection with surrounding edema. Microbiologic analysis of the draining pus was confirmed to be N brasiliensis by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) Mass Spectrometry. After incision and drainage deep to the muscle layer to evacuate the abscess and a few ineffective antibiotic options, the patient was treated with intravenous ceftriaxone and oral linezolid for 6 weeks. He was then de-escalated to oral moxifloxacin for an additional 4 months to complete a total antibiotic treatment duration of 6 months. The wound healed satisfactorily and was completely closed by the fourth month of antibiotic therapy. Six months after discontinuation of antibiotics, the patient continued to do well with complete resolution of the infection. In this article, we discussed the risk factors for Nocardia in immunocompetent settings, the occupational risks for Nocardia in our index patient, and the challenges encountered with diagnosis and treatment. Nocardia should be included in the differential diagnosis of cutaneous infections, particularly if there is no improvement of \"cellulitis\" with traditional antimicrobial regimens and the infection extends into the deeper muscle tissues.
摘要：
免疫功能正常患者的化脓性诺卡氏菌炎很少发生。诊断可能会错过或延迟，并有进行性感染和次优或不适当治疗的风险。我们介绍了一名48岁的有免疫能力的消防员的案例，该消防员被诊断为由通过园艺活动直接皮肤接种而获得的巴西诺卡氏菌引起的化脓性肌炎。患者的右前臂出现疼痛性肿胀，并迅速向近端发展，深入下面的肌肉层。他的右前臂的超声成像显示有7毫米的皮下积液，周围有水肿。通过基质辅助激光解吸/电离飞行时间（MALDI-TOF）质谱法，确定了排水脓液的微生物分析为巴西N。在切开和引流到肌肉层深处以排空脓肿和一些无效的抗生素选择后，患者接受静脉注射头孢曲松和口服利奈唑胺治疗6周.然后将他降级为口服莫西沙星，再持续4个月，以完成6个月的总抗生素治疗持续时间。伤口愈合令人满意，并在抗生素治疗的第四个月完全闭合。抗生素停药六个月后，患者的病情继续良好，感染完全消退。在这篇文章中,我们讨论了诺卡氏菌在具有免疫能力的环境中的危险因素，我们的索引患者诺卡氏菌的职业风险，以及诊断和治疗遇到的挑战。诺卡氏菌应包括在皮肤感染的鉴别诊断中，特别是如果传统的抗菌治疗方案没有改善“蜂窝织炎”，并且感染扩展到更深的肌肉组织。
