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      Nocardiosis pulmonar como causa de reagudizaciones en un paciente EPOC Translated title: Pulmonary nocardiosis due to reagudizations in a COPD patient

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          Abstract

          La infección pulmonar por Nocardia sp. es una enfermedad poco frecuente que afecta fundamentalmente a pacientes inmunodeprimidos, aunque también puede hacerlo a pacientes inmunocompetentes. Su diagnóstico se basa en el aislamiento en esputo de Nocardia sp. siendo la clínica y la radiología inespecíficas. El tratamiento se realiza con trimetropin (TMP) sulfametoxazol (SMX), aunque ya se han encontrado casos de resistencia. La duración del tratamiento sigue siendo desconocida recomendándose durante 6 semanas-12 meses. Presentamos el caso de un varón de 81 años con antecedentes de EPOC en tratamiento con corticosteroides de forma crónica que ingresa en nuestro servicio por episodios febriles recidivantes en los tres meses previos al ingreso junto con pérdida de peso e infiltrados densos en Rx de tórax de nueva aparición con cultivo de esputo positivo para Nocardia sp. Y buena evolución tras el inicio de tratamiento con TMP-SMX con desaparición de la fiebre y de los infiltrados.

          Translated abstract

          Pulmonary infection due to Nocardia sp. is an infrequent disease that affects principally to immunodefficient patients although it can be also seen in patients with normal immunity. Diagnosis is based in isolation of micro-organism in respiratory samples while clinical presentation and radiology are non specific. Treatment is made with trimethropim-sulfametoxazole (TMP/SMX), though resistance has developed in some patients. The recommended length of treatment is 6 weeks to 12 months depending on the immunitaly status. We present the case of a male patient of 81 years old affected with COPD and treated with glucocorticoids in a chronic basis, who was admitted because relapsing fever episodes during 3 months before, weight loss and new hard pulmonary infiltrates with Nocardia sp. cultured sputum, and evolution to clinical, radiological and microbiologic resolution with TMP/SMX treatment.

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          Most cited references18

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          The medically important aerobic actinomycetes: epidemiology and microbiology.

          The aerobic actinomycetes are soil-inhabiting microorganisms that occur worldwide. In 1888, Nocard first recognized the pathogenic potential of this group of microorganisms. Since then, several aerobic actinomycetes have been a major source of interest for the commercial drug industry and have proved to be extremely useful microorganisms for producing novel antimicrobial agents. They have also been well known as potential veterinary pathogens affecting many different animal species. The medically important aerobic actinomycetes may cause significant morbidity and mortality, in particular in highly susceptible severely immunocompromised patients, including transplant recipients and patients infected with human immunodeficiency virus. However, the diagnosis of these infections may be difficult, and effective antimicrobial therapy may be complicated by antimicrobial resistance. The taxonomy of these microorganisms has been problematic. In recent revisions of their classification, new pathogenic species have been recognized. The development of additional and more reliable diagnostic tests and of a standardized method for antimicrobial susceptibility testing and the application of molecular techniques for the diagnosis and subtyping of these microorganisms are needed to better diagnose and treat infected patients and to identify effective control measures for these unusual pathogens. We review the epidemiology and microbiology of the major medically important aerobic actinomycetes.
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            Nocardiosis

            P Lerner (1996)
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              Pulmonary infection with Nocardia species: a report of 10 cases and review.

              Pulmonary nocardiosis (PN) is an infrequent and severe infection due to Nocardia spp., microorganisms that may behave both as opportunists and as primary pathogens. The aim of this study and review was to evaluate the clinical features, evolution and prognostic factors of PN. The study group comprised 10 consecutive patients with pulmonary nocardiosis acquired in a community setting, diagnosed and followed in a tertiary teaching hospital. Chronic obstructive pulmonary disease (COPD), neoplastic disease and human immunodeficiency virus (HIV) infection were the most frequent predisposing factors. Four patients were receiving corticosteroid treatment. Clinical course was chronic and diagnosis was delayed 3 weeks or more in seven of the patients. Lobar or multilobar condensation was the most frequent radiographic pattern. Antimicrobial susceptibility testing showed: 100% sensitivity for amikacin; 83% for imipenem; 71% for cefotaxime; and 71% for trimethoprim-sulphamethoxazole. The disease remained localized in the lung in five cases, with a trend toward chronicity in one with bronchiectasis. In the other five, the disease disseminated, affecting subcutaneous tissue, the central nervous system and the kidney. Three patients died, one with disseminated disease and two who were receiving corticosteroid therapy. The following conclusions were reached: 1) pulmonary nocardiosis is difficult to diagnose, diagnosis is frequently delayed and a high level of suspicion is, thus, required in patients with underlying diseases or chronic corticosteroid therapy; 2) there is frequent dissemination and high mortality; and 3) antimicrobial combinations with proven synergy, such as imipenem and amikacin, are recommended for initial therapy.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                ami
                Anales de Medicina Interna
                An. Med. Interna (Madrid)
                Arán Ediciones, S. L. (, , Spain )
                0212-7199
                November 2006
                : 23
                : 11
                : 537-539
                Affiliations
                [01] Pamplona orgnameHospital de Navarra orgdiv1Servicio de Medicina Interna
                Article
                S0212-71992006001100007
                10.4321/s0212-71992006001100007
                25259096-9cce-4f42-bd28-3d370667d902

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 14, Pages: 3
                Product
                Product Information: website

                Nocardia sp,Nocardiosis pulmonar,Neumonía bacteriana,EPOC,Pulmonary nocardiosis,Pulmonary bacterial infection,COPD

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