Pulmonary nocardiosis in patients with COPD: characteristics and prognostic factors.
BACKGROUND
Pulmonary nocardiosis (PN) is a severe infection with a high morbidity and mortality that mainly affects immunocompromised patients. In recent years, an increase in PN cases has been detected among patients with chronic obstructive pulmonary disease (COPD). The factors that are associated with its presence and determine its prognosis remain unknown.


METHODS
Retrospective study of COPD patients diagnosed with PN over the period from 1997-2009 at the Hospital de la Santa Creu i Sant Pau, in Barcelona (Spain). Demographic, clinical, microbiological and evolution data were evaluated in all cases


RESULTS
Thirty patients were identified with PN and COPD. Mean age (standard deviation) was 76 (7) years and the mean FEV(1) was 40 (14)%. Chronic respiratory failure was observed in 56,7% patients and 51,7% had received systemic corticosteroid therapy previous to the PN diagnosis. The most common symptoms were cough and dyspnea (90%). Alveolar infiltrates were observed in 60% of the cases. The most frequently isolated Nocardia species was N. cyriacigeorgica (68%). The one-month mortality rate was 17%, while the one-year mortality rate was 33%. The factors associated with mortality within the first year included previous systemic corticosteroid treatment, less than three months of specific antibiotic therapy and active associated neoplasm.


CONCLUSIONS
PN affects patients with moderate-severe COPD and has high short- and mid-term mortality rates. Previous corticosteroid treatment, specific antibiotic therapy for less than 3 months and active neoplasia were factors associated with mortality.
Servicio de Neumología, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain. lgarciab@santpau.cat
Laia
L
Garcia-Bellmunt
Oriol
O
Sibila
Ingrid
I
Solanes
Ferran
F
Sanchez-Reus
Vicente
V
Plaza
D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004198:Disease Susceptibility; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D016867:Immunocompromised Host; D008297:Male; D009369:Neoplasms / Q000453:epidemiology; D009615:Nocardia / Q000302:isolation & purification; D009617:Nocardia Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D011379:Prognosis; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D051437:Renal Insufficiency / Q000453:epidemiology; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D012907:Smoking / Q000453:epidemiology
D000305:Adrenal Cortex Hormones