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Nocardiosis

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  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 4 Nov 2025
最后更新： 21 Nov 2023

小结

定义

病史和体格检查

关键诊断因素

  • cough with purulent sputum
  • fever
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其他诊断因素

  • headache
  • nausea and vomiting
  • confusion
  • depressed consciousness
  • cutaneous ulcers or abscesses
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危险因素

  • solid organ and hematopoietic stem cell transplant recipients
  • HIV-positive and low CD4 T-cell count (<100 cells/mm³)
  • immunosuppression
  • structural pulmonary disease
  • malignancy and chemotherapy
  • agricultural work
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诊断性检查

首要检查

  • Gram and acid-fast stains
  • culture
  • matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS)
  • biochemical species typing
  • polymerase chain reaction (PCR)-based techniques
  • chest x-ray
  • CT head
完整详情

需考虑的检查

  • thoracic CT scan
  • MRI head
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新兴检查

  • next-generation sequencing

治疗流程

急症处理

severe nocardiosis: disseminated disease, CNS involvement, cavitary pulmonary lesions, or immunocompromise

nonsevere nocardiosis: immunocompetent, nondisseminated, no CNS involvement, no pulmonary cavitary lesions

撰稿人

作者

Timothy Sullivan, MD

Associate Professor

Division of Infectious Diseases

Icahn School of Medicine at Mount Sinai

New York

NY

利益声明

TS declares that he has no competing interests.

鸣谢

Dr Timothy Sullivan would like to gratefully acknowledge Dr Jorge Garbino and Dr Juan Ambrosioni, previous contributors to this topic.

利益声明

JG declares that he has no competing interests. JA is an advisory board member of Gilead Sciences and ViiV Healthcare.

同行评议者

Senu Apewokin, MD

Associate Professor of Medicine

Director, Transplant Infectious Diseases

University of Cincinnati

Cincinnati

OH

利益声明

SA declares that she has no competing interests.

Rebecca N. Kumar, MD, MS

Assistant Professor of Medicine

Georgetown University Medical Center

Washington

DC

利益声明

RNK has received research grants from Regeneron and Gilead, which have been paid to Georgetown University.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Brown-Elliott BA, Brown JM, Conville PS, et al. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev. 2006 Apr;19(2):259-82.全文  摘要

Hamdi AM, Fida M, Deml SM, et al. Retrospective analysis of antimicrobial susceptibility profiles of Nocardia species from a tertiary hospital and reference laboratory, 2011 to 2017. Antimicrob Agents Chemother. 2020 Feb 21;64(3):e01868-19.全文  摘要

Corti ME, Villafane-Fioti MF. Nocardiosis: a review. Int J Infect Dis. 2003 Dec;7(4):243-50.全文  摘要

Margalit I, Lebeaux D, Tishler O, et al. How do I manage nocardiosis? Clin Microbiol Infect. 2021 Apr;27(4):550-8.全文  摘要

Restrepo A, Clark NM, Infectious Diseases Community of Practice of the American Society of Transplantation. Nocardia infections in solid organ transplantation: guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation. Clin Transplant. 2019 Sep;33(9):e13509. 摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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