Systemic Nocardiosis as Unusual Clinical Onset of Late Advanced HIV Infection: A Case Report

Santoro Carmen Rita, Brindicci Gaetano, M. Michele, Giannelli Anna, I. Giovanni, Fiore Silvia, Pappalettera Antonio, Capodivento Saverio, Cascarano Marina, Quinto Nicola, L. Ruggero, L. Monno
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Abstract

The genus Nocardia includes aerobic actinomycetes causing disease in both humans and animals. Nocardiosis is a rare bacterial infection, but the incidence of human disease has increased in the recent years in association with an increasing population of immune-compromised hosts and the improved methods for detection and identification of Nocardia spp. in the clinical laboratory. All those situations of immune-system compromise are conditions associated with increased risk, especially when cell-mediated immunity is involved. The prognosis depends both upon the immediacy of therapy initiation, concomitant disorders and the immune status of the patient. Recently cases of multi-drug resistance nocardiosis and the epidemiology and drug susceptibility of less common Nocardia species have been described. In HIV positive patients pulmonary nocardiosis, the most common clinical presentation, has a low reported prevalence of 0.3%, and it is not considered an AIDS-defining disease. The difficulties in isolation, the non-specific clinical and radiologic presentation, and the widespread use of cotrimoxazole (TMP/SMX) prophylaxis could be responsible for this low prevalence. In this paper, it is described a rare and fatal case of systemic nocardiosis arising with chest pain in a patient with a severe immune deficiency, unaware of his HIV positivity. Systemic nocardiosis is generally caused by N. asteroids and the prognosis is good, but in patients with AIDS, mortality in disseminated forms with central nervous system involvement is more than 50%.
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系统性无心脏病是晚期HIV感染的罕见临床发病:一例报告
诺卡菌属包括能引起人类和动物疾病的需氧放线菌。诺卡菌病是一种罕见的细菌感染,但近年来,随着免疫功能低下宿主群体的增加以及临床实验室检测和鉴定诺卡菌的方法的改进,人类疾病的发病率有所增加。所有这些免疫系统受损的情况都与风险增加有关,特别是当涉及细胞介导的免疫时。预后取决于治疗开始的即时性、伴随疾病和患者的免疫状态。最近的诺卡菌病多药耐药病例和不常见的诺卡菌种类的流行病学和药物敏感性已被描述。在艾滋病毒阳性患者中,肺诺卡菌病是最常见的临床表现,报告的患病率很低,为0.3%,它不被认为是艾滋病的定义疾病。分离的困难,非特异性的临床和放射学表现,以及复方新诺明(TMP/SMX)预防的广泛使用可能是这种低患病率的原因。在这篇论文中,它描述了一个罕见的和致命的系统性诺卡菌病引起胸痛的病人有严重的免疫缺陷,不知道他的HIV阳性。全身诺卡菌病一般由N.小行星引起,预后良好,但在艾滋病患者中,播散性诺卡菌病累及中枢神经系统的死亡率超过50%。
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