Akciğer grafisinde kitle benzeri radyolojik görünüm yapan üç olgu nedeniyle akciğer nokardiyozisi üzerine genel bir değerlendirme

Akciğer nokardiyozisi, immun düşkün hastalarda görülen önemli bir fırsatçı enfeksiyondur. Nocardia türleri tarafından oluşturulan bu enfeksiyon akut, subakut ve kronik hastalık olarak karşımıza çıkabilir. Spesifik tedavisi olmasına rağmen tanısındaki güçlükler nedeniyle mortalitesi yüksek bir enfeksiyondur.Bizim çalışmamızdaki nokardiya olgularının tamamı akciğer nokardiyozisi şeklinde idi. Olgularımızdan birincisi bir yıldır immun süpresif tedavi gören renal transplant alıcısı, ikincisi sistemik lupus eritematozus nedeniyle uzun süredir yüksek doz kortikosteroid ve metotreksat kullanıyordu, üçüncüsü ise yeni tanı almış kronik böbrek yetmezlikli idi. Çalışmamızda tüm hastaların mikrobiyolojik tanıları bronkoalveoler yıkamada nokardiya türlerinin izole edilmesi ile konuldu. Hastaların tümü hastaneden iyileşerek taburcu edildi. Bir hastada tedavi süresi 12 ay, bir tanesinde 2 ay, diğer hastada ise 3 ay sürdü.Olgularımızdan elde edilen bulgular ışığında akciğer nokardiyozisi ile ilgili olarak şu sonuçlara ulaşıldı; Nokardiyozis özellikle hücresel immunitesi baskılanmış hastalarda düşünülmelidir, nokardiya şüphesi oluştuğunda bu bilgi laboratuvara iletilmeli ve tedavi süresi hastalığın ağırlığı ve radyolojik cevaba göre düzenlenmelidir.

A general evaluation on pulmonary nocardiosis due to three patients presenting with a mass like radiographic appearance on chest X-ray

Pulmonary nocardiosis is an important cause of opportunistic infection in immune-compromised patients. Pulmonary nocardiosis manifests as an acute, subacute or chronic infection. Although, there is speciﬁc treatment, there are usually difficulties in its diagnosis and, therefore nocardiosis already has a high rate of mortality.All of the nocardia infections of our study were pulmonary nocardiosis. The first case of our study was receiving immunosuppressive drugs after renal transplantation; second patient was receiving high dose corticosteroid and methotrexate due to the systemic lupus erithematosus; and third patient was newly diagnosed acute renal failure. All the diagnosis of pulmonary nocardiosis was done by isolation of the organism from bronchial lavage fluids. All patients were healed and discharged. The duration of therapy was 12 months in the first patients, 2 months in the second and 3 months in the third patient.According to results of our cases we concluded that nocardia tends to affect patients with cellular immune-compromised, physicians should notify the laboratory staff when Nocardia is suspected and the duration of therapy depends on the severity and the host’s immune status.

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