[Clinical and bacteriological aspects of nocardiasis. 9 cases].
OBJECTIVE
Nocardial infection is usually localized in the immunocompetent patient and occurs as an opportunistic disseminated infection in about half of the cases in immunoincompetents patients.


METHODS
We report a retrospective assessment of 9 cases of nocardial infection diagnosed between January 1991 and February 1994.


RESULTS
Six of the patients were immunodepressed: 3 had a disseminated infection with pulmonary (n = 2), brain (n = 2), skin (n = 3) and/or ocular (n = 1) localizations. There were 3 immunocompetent patients with an isolated local infection: skin and bone mycetoma, knee joint and lung. Diagnosis was made on samples obtained invasively in 7 patients. Nocardia asteroides was isolated in 5 patients, N. farcinica in 3 and N. caviae in 1. These organisms showed in vitro sensitivity to amoxicillin-clavulanic acid 5/9, cefotaxime 5/9 (0/3 for N. farcinica), imipeneme 7/9, amikacin 8/8, minocyclin 5/8, pefloxacin 0/8 and trimethoprime-sulfamethoxazol (TMP-SMX) 3/9. Clinical outcome was favourable in all cases and was not always correlated with laboratory sensitivity.


CONCLUSIONS
TMP-SMX remains the reference antibiotic. For one patient, only TMP-SMX (resistant in vitro) was effective; with all the other antibiotic tried (sensitive in vivo) treatment failed.
Bani-Sadr
F
F
Service de Médecine interne Pr Grolleau, Hôtel-Dieu, Rouen.
Hamidou
M
M
Raffi
F
F
Chamoux
C
C
Caillon
J
J
Freland
C
C
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007121:Immunocompetence; D008171:Lung Diseases / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D009615:Nocardia / Q000187:drug effects / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D009616:Nocardia asteroides / Q000187:drug effects / Q000302:isolation & purification*; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
Aspects cliniques et bactériologiques des nocardiosis. 9 observations.