UNASSIGNED:描述大量诺卡氏菌培养阳性患者的临床和影像学发现,强调侵袭性疾病和定植之间的差异。
未经评估:我们进行了一个单中心,回顾性队列研究,纳入了1998年8月1日至2018年11月30日期间诺卡氏菌分离菌阳性的133例患者,并在细菌分离日前后30天内进行了胸部计算机断层扫描(CT).
未经证实:定植患者年龄较大(71岁vs65岁;P=.004),常有慢性阻塞性肺疾病(56.8%vs16.9%;P<.001)和冠状动脉疾病(47.7%vs27%,P=.021),并且仅从肺标本中分离出诺卡氏菌(100%vs83.1%;P=0.003)。胸部CT,他们有频繁的气道疾病(84.1%vs51.7%;P<.001)。侵袭性诺卡尼病患者有明显(P<0.05)更多的糖尿病,慢性肾病,实体器官移植,使用皮质类固醇,抗排斥药物,和预防性磺胺。他们发烧更多(25.8%vs2.3%;P<.001),皮肤病变(14.6%vs0%;P=0.005),疲劳(18%对0%;P=.001),肺结节(52.8%vs27.3%;P=.006),和自由流动的胸膜液(63.6%vs29.4%;P=.024)。结节分布的模式是不同的-弥漫性侵入性诺卡氏菌定植的细支气管周围。
未经证实:从有呼吸道症状的患者痰中分离诺卡氏菌并不等同于活动性感染。只有结合临床和胸部CT表现,可以更好地区分侵袭性诺卡氏菌定植和诺卡氏菌定植。
UNASSIGNED: To describe the clinical and radiographic findings in a large cohort of patients with positive cultures for Nocardia emphasizing the differences between invasive disease and colonization.
UNASSIGNED: We conducted a single-center, retrospective cohort study of 133 patients with a positive Nocardia isolate between August 1, 1998, and November 30, 2018, and a computed tomography (CT) of the chest within 30 days before or after the bacteria isolation date.
UNASSIGNED: Patients with colonization were older (71 vs 65 years; P=.004), frequently with chronic obstructive pulmonary disease (56.8% vs 16.9%; P<.001) and coronary artery disease (47.7% vs 27%, P=.021), and had Nocardia isolated exclusively from lung specimens (100% vs 83.1%; P=.003). On CT of the chest, they had frequent airway disease (84.1% vs 51.7%; P<.001). Patients with invasive nocardiosis had significantly (P<.05) more diabetes, chronic kidney disease, solid organ transplant, use of corticosteroids, antirejection drugs, and prophylactic sulfa. They had more fever (25.8% vs 2.3%; P<.001), cutaneous lesions (14.6% vs 0%; P=.005), fatigue (18% vs 0%; P=.001), pulmonary nodules (52.8% vs 27.3%; P=.006), and free-flowing pleural fluid (63.6% vs 29.4%; P=.024). The patterns of nodule distribution were different-diffuse for invasive nocardiosis and peribronchiolar for Nocardia colonization.
UNASSIGNED: The isolation of Nocardia in sputum from a patient with respiratory symptoms does not equal active infection. Only by combining clinical and chest CT findings, one could better differentiate between invasive nocardiosis and Nocardia colonization.