Clinical characteristics and prognosis of nocardiosis in elderly patients / 中华老年医学杂志

ABSTRACT

Objective:To analyze the differences in clinical characteristics, microbiologic distributions, in vitro susceptibility, treatment and outcomes between elderly and young/middle-aged patients with nocardiosis.Methods:A total of 27 patients diagnosed with nocardiosis by bacteria culture and gene sequencing in our hospital from May 2007 to September 2011 were included.Patients were separated into two groups according to their ages.Clinical characteristics, laboratory tests, treatment and prognosis were compared between the two groups.Results:Of the 27 patients, 11 were male and 16 were female, with a median age of 50 years(range, 20-84 years old)and a median course of 3.0 months(range, 0.5-60.0 months). There were 6 cases in the elderly group and 21 cases in the non-elderly group.The common underlying diseases were chronic pulmonary disease(4/6, 66.7%), metabolic disease(2/6, 33.3%)and connective tissue disease(2/6, 33.3%)in the elderly group, and connective tissue disease(9/21, 42.9%), chronic pulmonary disease(6/21, 28.6%)and hematological disease(2/21, 9.5%)in the non-elderly group.Results of laboratory tests revealed that white blood cell counts were normal or elevated, lymphocyte percentages decreased and neutrophils percentages were elevated in both two groups.All patients in the elderly group had pulmonary infection, while 71.4%(15/21)had pulmonary infection and 28.6%(6/21)had disseminated infection in the non-elderly group.The proportion of patients with pulmonary consolidation on CT was higher in the elderly patients than in the non-elderly patients(100% vs.42.9%, P=0.02). The detection rates of N. cyriacigeorgica, N. farcinica, N. abscessus, N. Africana and N. wallacei were 50.0%(3/6), 16.7%(1/6), 16.7%(1/6), 16.7%(1/6)and 0%(0/6)in the elderly group and 23.8%(5/21), 42.9%(9/21), 42.9%(9/21), 4.8%(1/21)and 14.3%(3/21)in the non-elderly group, respectively.The mortality rate was 16.7% in the elderly patients and 28.6% in the non-elderly patients.The 5-year survival rates in both two groups were 100%. Conclusions:Elderly patients with nocardiosis often have underlying pulmonary disease with a long disease course. N. farcinica is the main observed strain.Multiple nodules and plaques and consolidation are common on CT.Multi-drug combinations are recommended in treatment.Concomitant fungal or other bacterial infections are factors for poor prognosis.The long-term prognosis is good in patients with nocardiosis.