Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presencia de factores de riesgo
- tos con esputo purulento
- fiebre
Outros fatores diagnósticos
- cefalea
- náuseas y vómitos
- confusión
- disminución del nivel de consciencia
- úlceras o abscesos cutáneos
Fatores de risco
- receptores de trasplante de células madre hematopoyéticas y órgano sólido
- Infectado por el virus de la inmunodeficiencia humana (VIH) y recuento celular CD4 T bajo (<100 células/mm^3)
- inmunosupresión
- enfermedad pulmonar estructural
- neoplasia maligna y quimioterapia
- trabajo agrícola
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- Tinciones de Gram y ácido-alcohol resistentes
- cultivo
- espectrometría de masas desorción/ionización por láser asistida por matriz con analizador de tiempo de vuelo (MALDI-TOF MS)
- tipificación bioquímica de especies
- técnicas basadas en la reacción en cadena de la polimerasa (PCR)
- radiografía de tórax
- TC craneal
Investigações a serem consideradas
- exploración de tórax por tomografía computarizada (TC)
- resonancia magnética (IRM) de cabeza
Novos exames
- secuenciación de nueva generación
Algoritmo de tratamento
nocardiosis grave: enfermedad diseminada, afectación del SNC, lesiones pulmonares cavitarias o compromiso inmunológico
nocardiosis no grave: inmunocompetente, no diseminada, sin afectación del sistema nervioso central (SNC), sin lesiones pulmonares cavitarias
Colaboradores
Autores
Timothy Sullivan, MD
Associate Professor
Division of Infectious Diseases
Icahn School of Medicine at Mount Sinai
New York
NY
Declarações
TS declares that he has no competing interests.
Agradecimentos
Dr Timothy Sullivan would like to gratefully acknowledge Dr Jorge Garbino and Dr Juan Ambrosioni, previous contributors to this topic.
Declarações
JG declares that he has no competing interests. JA is an advisory board member of Gilead Sciences and ViiV Healthcare.
Revisores
Senu Apewokin, MD
Associate Professor of Medicine
Director, Transplant Infectious Diseases
University of Cincinnati
Cincinnati
OH
Declarações
SA declares that she has no competing interests.
Rebecca N. Kumar, MD, MS
Assistant Professor of Medicine
Georgetown University Medical Center
Washington
DC
Declarações
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.
Referências
Principais artigos
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.Texto completo Resumo
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.Texto completo Resumo
Corti ME, Villafane-Fioti MF. Nocardiosis: a review. Int J Infect Dis. 2003 Dec;7(4):243-50.Texto completo Resumo
Margalit I, Lebeaux D, Tishler O, et al. How do I manage nocardiosis? Clin Microbiol Infect. 2021 Apr;27(4):550-8.Texto completo Resumo
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. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Tuberculosis
- Actinomicosis
- Absceso pulmonar
Mais Diagnósticos diferenciaisDiretrizes
- Nocardia infections in solid organ transplantation
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