Pulmonary nocardiosis associated with bronchiectasis: report of two cases and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 MU Xiangdong ¹ , GUO Wenjia ¹ , YU Li ² , ZHANG Jujing ²

1. Department of Pulmonary and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, Medical Center, Tsinghua University, Beijing 102218, P. R. China;
2. Department of Internal Medicine, Gucheng County Hospital, Gucheng, Hebei 253800, P. R. China;

Corresponding author：

MU Xiangdong, Email: muxiangdong@medmail.com.cn

Keywords：

Bronchiectasis; Pulmonary nocardiosis; Diagnosis; Treatment

DOI：

10.7507/1671-6205.201703009

Video：

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Objective To describe the clinical characteristics of pulmonary nocardiosis associated with bronchiectasis and to evaluate the methods of diagnosis and treatment.Methods Clinical data of two patients with pulmonary nocardiosis and bronchiectasis were analyzed and the literature on the subject were reviewed.Results Two female patients with bronchiectasis were respectively 55 and 62 years old, both of them presented with fever, cough, expectoration, and leukocytosis. Case 1 also complicated with respiratory failure and leukemoid reaction. Chest CT showed bilateral pulmonary multi-patchy consolidations with cavities in case 1 and unilateral pulmonary local consolidation without cavities in case 2. Sputum smears on modified Ziehl-Neelsen staining of both patients showed typical Nocardia hyphe. Sputum culture of case 1 showed Nocardia otitidiscaviarum, which was sensitive to sulfamethoxazole/trimethoprim (SMZ/TMP), amikacin and moxifloxacin while resistant to ceftriaxone, imipenem and meropenem. Sputum culture of case 2 was negative. Case 1 was treated with SMZ/TMP + moxifloxacin + amikacin for 6 months, and case 2 treated with SMZ/TMP for 3 months. Both patients were clinically cured. Six case reports including 7 patients were searched, including 4 Chinese reports and 2 English reports. Most of them were reported individually. Conclusions Bronchiectasis is a risk factor for pulmonary nocardiosis, and the treatment of nocardiosis should accord with drug susceptibilities and severities of diseases. The prognoses of patients with pulmonary nocardiosis and bronchiectasis are relatively good.

Citation： MU Xiangdong, GUO Wenjia, YU Li, ZHANG Jujing. Pulmonary nocardiosis associated with bronchiectasis: report of two cases and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2019, 18(2): 174-178. doi: 10.7507/1671-6205.201703009 Copy

1.	Kandi V. Human nocardia infections: a review of pulmonary nocardiosis. Cureus, 2015, 7(8): e304.
2.	Pintado V, Gomez-Mampaso E, Fortun J, et al. Infection with nocardia species: clinical spectrum of disease and species distribution in Madrid, Spain, 1978-2001. Infection, 2002, 30(6): 338-340.
3.	Chen J, Zhou H, Xu P, et al. Clinical and radiographic characteristics of pulmonary nocardiosis: clues to earlier diagnosis. PLoS One, 2014, 9(3): e90724.
4.	Fujita T, Ikari J, Watanabe A, et al. Clinical characteristics of pulmonary nocardiosis in immunocompetent patients. J Infect Chemother, 2016, 22(11): 738-743.
5.	Lumb R, Greville H, Martin J, et al. Nocardia asteroides isolated from three patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis, 2002, 21(3): 230-233.
6.	Ferrer A, Llorenç V, Codina G, et al. Nocardiosis and bronchiectasis. An uncommon association?. Enferm Infect Microbiol Clin, 2005, 23(2): 62-66.
7.	Sadamatsu H, Takahashi K, Tashiro H, et al. Successful treatment of pulmonary nocardiosis with fluoroquinolone in bronchial asthma and bronchiectasis. Respirol Case Rep, 2017, 5(3): e00229.
8.	Aidê MA, Loureno SS, Marchiori E, et al. Pulmonary nocardiosis in a patient with chronic obstructive pulmonary disease and bronchiectasis. J Bras Pneumol, 2008, 34(11): 985-988.
9.	陈蕾, 顾云峰, 上官宗校, 等. 肺支气管扩张合并盖尔森基兴奴卡菌感染一例并文献复习. 中华临床感染病杂志, 2015, 8(4): 350-352.
10.	柯会星, 赵洪涛, 孙铁英. 老年人支气管扩张症合并肺奴卡菌感染一例. 中华老年医学杂志, 2003, 22(2): 122.
11.	仝金斋, 黄炎明, 梁丽萍. 支气管扩张合并肺奴卡菌感染临床分析. 临床肺科杂志, 2012, 17(8): 1545-1551.
12.	杨春霞, 王珊珊, 王鹏, 等. 支气管扩张老年男性北京奴卡菌肺部感染一例. 中华内科杂志, 2016, 55(1): 45-46.
13.	Martínez R, Reyes S, Menéndez R. Pulmonary nocardiosis: risk factors, clinical features, diagnosis and prognosis. Curr Opin Pulm Med, 2008, 14(3): 219-27.
14.	黄慧, 陆志伟, 徐作军. 诺卡菌感染 26 例临床特点分析. 中华结核和呼吸杂志, 2010, 33(9): 651-655.
15.	张媛, 张媛媛, 万康林, 等. 诺卡菌的培养和染色特征研究. 中国人兽共患病学报, 2012, 28(3): 230-236.

1. Kandi V. Human nocardia infections: a review of pulmonary nocardiosis. Cureus, 2015, 7(8): e304.
2. Pintado V, Gomez-Mampaso E, Fortun J, et al. Infection with nocardia species: clinical spectrum of disease and species distribution in Madrid, Spain, 1978-2001. Infection, 2002, 30(6): 338-340.
3. Chen J, Zhou H, Xu P, et al. Clinical and radiographic characteristics of pulmonary nocardiosis: clues to earlier diagnosis. PLoS One, 2014, 9(3): e90724.
4. Fujita T, Ikari J, Watanabe A, et al. Clinical characteristics of pulmonary nocardiosis in immunocompetent patients. J Infect Chemother, 2016, 22(11): 738-743.
5. Lumb R, Greville H, Martin J, et al. Nocardia asteroides isolated from three patients with cystic fibrosis. Eur J Clin Microbiol Infect Dis, 2002, 21(3): 230-233.
6. Ferrer A, Llorenç V, Codina G, et al. Nocardiosis and bronchiectasis. An uncommon association?. Enferm Infect Microbiol Clin, 2005, 23(2): 62-66.
7. Sadamatsu H, Takahashi K, Tashiro H, et al. Successful treatment of pulmonary nocardiosis with fluoroquinolone in bronchial asthma and bronchiectasis. Respirol Case Rep, 2017, 5(3): e00229.
8. Aidê MA, Loureno SS, Marchiori E, et al. Pulmonary nocardiosis in a patient with chronic obstructive pulmonary disease and bronchiectasis. J Bras Pneumol, 2008, 34(11): 985-988.
9. 陈蕾, 顾云峰, 上官宗校, 等. 肺支气管扩张合并盖尔森基兴奴卡菌感染一例并文献复习. 中华临床感染病杂志, 2015, 8(4): 350-352.
10. 柯会星, 赵洪涛, 孙铁英. 老年人支气管扩张症合并肺奴卡菌感染一例. 中华老年医学杂志, 2003, 22(2): 122.
11. 仝金斋, 黄炎明, 梁丽萍. 支气管扩张合并肺奴卡菌感染临床分析. 临床肺科杂志, 2012, 17(8): 1545-1551.
12. 杨春霞, 王珊珊, 王鹏, 等. 支气管扩张老年男性北京奴卡菌肺部感染一例. 中华内科杂志, 2016, 55(1): 45-46.
13. Martínez R, Reyes S, Menéndez R. Pulmonary nocardiosis: risk factors, clinical features, diagnosis and prognosis. Curr Opin Pulm Med, 2008, 14(3): 219-27.
14. 黄慧, 陆志伟, 徐作军. 诺卡菌感染 26 例临床特点分析. 中华结核和呼吸杂志, 2010, 33(9): 651-655.
15. 张媛, 张媛媛, 万康林, 等. 诺卡菌的培养和染色特征研究. 中国人兽共患病学报, 2012, 28(3): 230-236.

Chinese Journal of Respiratory and Critical Care Medicine

Pulmonary nocardiosis associated with bronchiectasis: report of two cases and literature review

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