Disseminierte Nokardiose bei einem immunkompetenten jungen Stahlarbeiter

Zusammenfassung

Patienten mit Exposition zu inhalativen Noxen sollte bei unklaren Lungeninfektionen auch an Nokardien gedacht werden. Eine disseminierte Nokardiose ist häufig schwer zu diagnostizieren. Das Risiko für Komplikationen ist aufgrund der Verzögerung bis zum Diagnosezeitpunkt und aufgrund der langwierigen und komplizierten antibiotischen Therapie erhöht. In der hier präsentierten Kasuistik ist der Zusammenhang zwischen beruflich-induzierter pulmonaler Prädisposition und der zu vermutenden Inhalation von Erdstaub besonders zu betonen. Eine interdisziplinäre Diagnostik und anschließende infektiologisch begleitete Langzeittherapie ist notwendig.

Abstract

In patients exposed to inhaled noxious substances, nocardia should also be considered in cases of unclear pulmonary infections. Disseminated nocardiosis is often difficult to diagnose. The risk of complications is increased due to the delay in diagnosis and the long and complicated antibiotic therapy. In the case report presented here, the connection between occupationally induced pulmonary predisposition and suspected inhalation of dust must be emphasized as particularly important. Interdisciplinary diagnostics and subsequent infectious disease-supported prolonged therapy are necessary.

Schlüsselwörter

disseminierte Nokardiose - N. paucivorans - Stahlarbeiter - Infektion - Ambulante Parenterale Antiinfektivatherapie

Keywords

disseminated nocardiosis - N. paucivorans - metal worker - infection - outpatient parenteral antimicrobial therapy

Publication History

Received: 23 November 2024

Accepted after revision: 02 April 2025

Article published online:
12 June 2025

• Literatur

• 1 U.S. Centers for Disease control and prevention. Clinical Overview of Nocardiosis. Nocardiosis. 2024 Accessed September 21, 2024 at: https://www.cdc.gov/nocardiosis/hcp/clinical-overview/index.html
• 2 Gray TJ, Serisier DJ, Gilpin CM. et al. Nocardia paucivorans – A cause of disseminated Nocardiosis. Journal of Infection 2007; 54: e95-e98
• 3 Buelte D, Noth J, Mull M. et al. Different manifestations of the cerebral nocardiosis. Nervenarzt 2008; 79: 1432-1435
• 4 Berner R, Bialek R, Forster J. Deutsche Gesellschaft für Pädiatrische Infektiologie e.V. (DGPI). et al. 106 Nokardiose. 7. vollst. überarb. Aufl.. Stuttgart: Thieme Verlag; 2018
• 5 Beaman BL, Beaman L. Nocardia species: host-parasite relationships. Clin Microbiol Rev 1994; 7: 213-264
• 6 Lerner PI. Nocardiosis. Clin Infect Dis 1996; 22: 891-903 quiz 904–905
• 7 Wenger PN, Brown JM, McNeil MM. et al. Nocardia farcinica sternotomy site infections in patients following open heart surgery. J Infect Dis 1998; 178: 1539-1543
• 8 McNeil MM, Brown JM. The medically important aerobic actinomycetes: epidemiology and microbiology. Clin Microbiol Rev 1994; 7: 357-417
• 9 Schaal KP, Lee HJ. Actinomycete infections in humans – a review. Gene 1992; 115: 201-211
• 10 Peleg AY, Husain S, Qureshi ZA. et al. Risk factors, clinical characteristics, and outcome of Nocardia infection in organ transplant recipients: a matched case-control study. Clin Infect Dis 2007; 44: 1307-1314
• 11 Martínez Tomás R, Menéndez Villanueva R, Reyes Calzada S. et al. Pulmonary nocardiosis: risk factors and outcomes. Respirology 2007; 12: 394-400
• 12 Wilson JW. Nocardiosis: Updates and Clinical Overview. Mayo Clinic Proceedings 2012; 87: 403-407
• 13 Aliaga L, Fatoul G, Guirao-Arrabal E. et al. Nocardia paucivorans brain abscess. Clinical and microbiological characteristics. IDCases 2018; 13: e00422
• 14 Corti E, Villafañe-Fioti MF. Review Nocardiosis: a review. Int J Infect Dis 2003; 7: 243-250
• 15 Margalit I, Lebeaux D, Tishler O. et al. How do I manage nocardiosis?. Clin Microbiol Infect 2021; 27: 550-558
• 16 Yassin AF, Rainey FA, Burghardt J. et al. Nocardia paucivorans sp. nov. International Journal of Systematic and Evolutionary Microbiology 2000; 50: 803-809
• 17 Provost F, Laurent F, Blanc MV. et al. Transmission of nocardiosis and molecular typing of Nocardia species: a short review. Eur J Epidemiol 1997; 13: 235-238
• 18 Martínez-Barricarte R. Isolated Nocardiosis, an Unrecognized Primary Immunodeficiency?. Front Immunol 2020; 11: 590239
• 19 Brugnoli B, Salvati L, Di Lauria N. et al. Disseminated nocardiosis and anti-GM-CSF antibodies. Eur J Clin Microbiol Infect Dis 2024; 43: 1003-1007
• 20 Ataya A, Knight V, Carey BC. et al. The Role of GM-CSF Autoantibodies in Infection and Autoimmune Pulmonary Alveolar Proteinosis: A Concise Review. Front Immunol 2021; 12: 752856