Year: 2019
Type: article
Study design: Observational Study
Abstract: Background: Pulmonary nocardiosis (PN) occurs in chronic pulmonary disease (CPD) in the absence of traditional risk factors.Clinical features that differentiate bacterial exacerbations (AE-CPD b ) from PN-related exacerbations (AE-CPD PN ) are not well described.Objectives: To describe a series of AE-CPD PN without traditional risk factors and compare clinical features, radiology and outcomes with age, gender and CLD-type matched AE-CPD b .Materials and methods: Single-center retrospective review and case-control study.Results: AE-CPD PN had longer duration of symptoms and more leukocytosis at hospitalization.AE-CPD b patients were sicker with more chronic respiratory failure (OR 33.3, p = 0.01), cardiac disease and pulmonary hypertension (OR 6.2, p = 0.008) at diagnosis.More patients with AE-CPD b were discharged on domiciliary oxygen (OR 5.27, p = 0.01).On logistic regression, AE-CPD PN was independently associated with mechanical ventilation (OR 22.3, p = 0.01), length of hospital stay (median difference, 4 days, p = 0.016) but not to hospital mortality.22.7% of AE-CPD PN died.Respiratory failure requiring oxygen, NIPPV or mechanical ventilation was associated with mortality in AE-CPD PN .Conclusion: PN is a rare cause of AE-CPD and can be suspected by longer symptom duration, more leukocytosis, consolidation and cavitation.AE-CPD PN is associated with longer hospital stay and mechanical ventilation.Respiratory failure is associated with mortality in AE-CPD PN . Key messages:• Pulmonary nocardiosis can present in advanced chronic lung disease as an exacerbation in the absence of traditional risk factors like immunosuppression.• Bronchiectasis, followed by chronic obstructive pulmonary disease are the most common chronic lung disease risk factors.• Pulmonary nocardiosis is a rare cause of acute exacerbation of chronic pulmonary disease (CPD).• Compared to exacerbations of CPD due to bacterial infections, nocardiosis-related exacerbations (CPD PN ) were independently related to need for mechanical ventilation and length of hospital stay.• Respiratory failure requiring oxygen, noninvasive ventilation and mechanical ventilation are associated with mortality in AE-CPD PN .
Institution: PSG Institute of Medical Sciences & Research
Language: English
Subfield: Microbiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2998029426