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Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital.

Yang M, Xu M, Wei W, Gao H, Zhang X, Zhao H, Hu J, Dong H, Xu L, Li L - Exp Ther Med (2014)

Bottom Line: Brain images revealed lesions associated with abscesses.Disseminated disease, immunocompromised patients, an older age, brain involvement and concomitant infections were associated with a poor prognosis.Early recognition of the disease and the initiation of appropriate treatment are essential for a good prognosis.

View Article: PubMed Central - PubMed

Affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310058, P.R. China.

ABSTRACT
To the best of our knowledge, no Chinese case studies concerning Nocardia infection have been published to date. Therefore, the present study aimed to retrospectively evaluate the risk factors, clinical features, imaging results, laboratory abnormalities, treatments and outcomes of nocardiosis in a Chinese tertiary hospital. Data collected from patients with laboratory-confirmed nocardiosis were retrospectively analyzed. A total of 40 patients who had a positive culture of Nocardia were included. The median time between the onset of symptoms and diagnosis was 42 days. Underlying diseases were identified in 72.5% of the patients of which diabetes was the most common (32.5%). The most important risk factor was corticosteroid administration. Fever and cough were common clinical symptoms. The pleuropulmonary (85%) were the most frequently involved sites and the disseminated disease rate was 30.0%. Frequent chest computed tomography scans revealed the presence of airspace opacities, nodules and masses, in addition to cavitary lesions that were particularly common among the study group. Brain images revealed lesions associated with abscesses. The majority of the patients (71.1%) were treated with trimethoprim sulfamethoxazole alone or in combination with other drugs. The in-hospital mortality rate was 15.0%. Disseminated disease, immunocompromised patients, an older age, brain involvement and concomitant infections were associated with a poor prognosis. Nocardiosis is an uncommon but emerging disease. The present study reports the first case series on nocardiosis from China and provides important information on the clinical features and risk factors of nocardiosis. Early recognition of the disease and the initiation of appropriate treatment are essential for a good prognosis.

No MeSH data available.


Related in: MedlinePlus

Contrast-enhanced magnetic resonance imaging scan of a 45-year-old male without any underlying diseases but with disseminated central nervous system nocardiosis, showing bilateral involvement of the brain. Multiple ring lesions with surrounding edema are shown (arrow), indicating multiple abscesses.
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f2-etm-08-01-0025: Contrast-enhanced magnetic resonance imaging scan of a 45-year-old male without any underlying diseases but with disseminated central nervous system nocardiosis, showing bilateral involvement of the brain. Multiple ring lesions with surrounding edema are shown (arrow), indicating multiple abscesses.

Mentions: Five patients with brain nocardiosis had undergone brain CT or MRI scans and were found to have a solitary ring-enhancing lesion with central necrosis and surrounding edema within the corresponding localization, which was associated with abscesses (Fig. 2).


Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital.

Yang M, Xu M, Wei W, Gao H, Zhang X, Zhao H, Hu J, Dong H, Xu L, Li L - Exp Ther Med (2014)

Contrast-enhanced magnetic resonance imaging scan of a 45-year-old male without any underlying diseases but with disseminated central nervous system nocardiosis, showing bilateral involvement of the brain. Multiple ring lesions with surrounding edema are shown (arrow), indicating multiple abscesses.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4061227&req=5

f2-etm-08-01-0025: Contrast-enhanced magnetic resonance imaging scan of a 45-year-old male without any underlying diseases but with disseminated central nervous system nocardiosis, showing bilateral involvement of the brain. Multiple ring lesions with surrounding edema are shown (arrow), indicating multiple abscesses.
Mentions: Five patients with brain nocardiosis had undergone brain CT or MRI scans and were found to have a solitary ring-enhancing lesion with central necrosis and surrounding edema within the corresponding localization, which was associated with abscesses (Fig. 2).

Bottom Line: Brain images revealed lesions associated with abscesses.Disseminated disease, immunocompromised patients, an older age, brain involvement and concomitant infections were associated with a poor prognosis.Early recognition of the disease and the initiation of appropriate treatment are essential for a good prognosis.

View Article: PubMed Central - PubMed

Affiliation: State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310003, P.R. China ; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang 310058, P.R. China.

ABSTRACT
To the best of our knowledge, no Chinese case studies concerning Nocardia infection have been published to date. Therefore, the present study aimed to retrospectively evaluate the risk factors, clinical features, imaging results, laboratory abnormalities, treatments and outcomes of nocardiosis in a Chinese tertiary hospital. Data collected from patients with laboratory-confirmed nocardiosis were retrospectively analyzed. A total of 40 patients who had a positive culture of Nocardia were included. The median time between the onset of symptoms and diagnosis was 42 days. Underlying diseases were identified in 72.5% of the patients of which diabetes was the most common (32.5%). The most important risk factor was corticosteroid administration. Fever and cough were common clinical symptoms. The pleuropulmonary (85%) were the most frequently involved sites and the disseminated disease rate was 30.0%. Frequent chest computed tomography scans revealed the presence of airspace opacities, nodules and masses, in addition to cavitary lesions that were particularly common among the study group. Brain images revealed lesions associated with abscesses. The majority of the patients (71.1%) were treated with trimethoprim sulfamethoxazole alone or in combination with other drugs. The in-hospital mortality rate was 15.0%. Disseminated disease, immunocompromised patients, an older age, brain involvement and concomitant infections were associated with a poor prognosis. Nocardiosis is an uncommon but emerging disease. The present study reports the first case series on nocardiosis from China and provides important information on the clinical features and risk factors of nocardiosis. Early recognition of the disease and the initiation of appropriate treatment are essential for a good prognosis.

No MeSH data available.


Related in: MedlinePlus