背景:反复呼吸道感染是囊性纤维化(pwCF)患者发病和死亡的主要原因。最近,诺卡氏菌作为CF中潜在病原体的出现引起了人们对其作用和管理的质疑,在目前的临床实践中,其临床意义和最佳患者管理仍不清楚。这篇综述通过全面的文献综述,探讨了囊性纤维化(pwCF)患者诺卡氏菌属的临床意义。主要目标包括评估其对肺功能的影响,确定定植风险因素,并评估适当的治疗方法。
方法:文献综述,从MEDLINE等数据库进行到2023年6月30日,PubMed,Embase,还有Cochrane,根据系统评价和荟萃分析(PRISMA)指南建议的首选报告项目,纳入了16篇涉及89pwCF和诺卡氏菌物种分离的文章。包括基于成人和儿科pwCF原始数据报告诺卡氏菌患病率和症状的文章。所有检索到的研究都是观察性的,因此,按研究类型分为病例报告和病例系列.
结果:总共包括89个pwCF和诺卡氏菌物种隔离:42名儿童和47名成人。据报道,我们发现了以下主要的细菌物种:诺卡氏菌小行星(35%,23/64),诺卡氏菌(21%,14/64),tranvalensis诺卡氏菌(13%,8/64)和纳卡氏菌(11%,7/64)。85%的患者报告合并感染(61/72)。在诺卡氏菌隔离前后报告肺功能的患者中,23%(16/68)显示FEV1下降。最重要的是,82例患者在分离诺卡氏菌菌株后至少接受了一次治疗。在93%(77/82)的病例中,隔离后立即开始治疗。根据个体患者的临床状况,按手术或静脉内进行抗生素治疗。82例中只有32例尝试根除诺卡氏菌,这些患者中有78%(25/32)在一个或多个疗程的抗生素后成功根除。报告死亡3例,其中两个是孩子。
结论:一般来说,细菌的分离并不一定意味着治疗,但患者需要密切监测,以评估活动性感染的可能发生。该治疗似乎适用于肺部受累并可能出现肺炎的患者,胸腔积液,发烧,咳嗽,或者FEV1的减少,就像我们描述的那样,或接受肺移植的患者。
BACKGROUND: Recurrent respiratory infections are a leading cause of morbidity and mortality in persons with Cystic Fibrosis (pwCF). Recently, the emergence of
Nocardia species as a potential pathogen in CF has raised questions about its role and management, as its clinical significance and the optimal patient management remain unclear in current clinical practice. This review explores the clinical implications of
Nocardia species in patients with Cystic Fibrosis (pwCF) through a comprehensive literature review. Key objectives include assessing its impact on lung function, identifying colonization risk factors, and evaluating an appropriate treatment.
METHODS: The literature review, conducted until June 30, 2023, from databases like MEDLINE, PubMed, Embase, and Cochrane, included 16 articles involving 89 pwCF with Nocardia species isolation according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline recommendations. Articles reporting Nocardia prevalence and symptoms based on original data in adult and paediatric pwCF were included. All the retrieved studies were observational ones, thus, they were categorized by study type as case report and case series.
RESULTS: Overall 89 pwCF and Nocardia species isolation were included: 42 children and 47 adults. Where reported, we found these main following bacterial species:
Nocardia asteroides (35%, 23/64),
Nocardia farcinica (21%, 14/64),
Nocardia tranvalensis (13%, 8/64) and
Nocardia cyriacigeorgica (11%, 7/64). A co-infection was reported in 85% of patients (61/72). Of patients whose lung function was reported before and after Nocardia isolation, 23% (16/68) showed a decline in FEV1. Above all, 82 patients were treated at least once after isolation of
Nocardia strain. In 93% (77/82) of cases, treatment was started immediately upon isolation. Antibiotic treatment was performed per os or intravenously depending on the clinical condition of the individual patient. Nocardia eradication was attempted in only 32 cases out of 82, and 78% (25/32) of these patients were successfully eradicated after one or more courses of antibiotics. Death was reported in 3 patients, 2 of which were children.
CONCLUSIONS: In general the isolation of the bacteria does not necessarily imply therapy, but patients need to be monitored closely to assess the possible occurrence of active infection. The treatment seems to be indicated in patients showing lung involvement with the possible appearance of pneumonia, pleural effusion, fever, cough, or a decrease in FEV1, as in the case that we described, or in patients undergoing pulmonary transplantation.