Comparison of clinical outcomes of pulmonary nocardiosis between AIDS and non-AIDS patients
Issued Date
2024-06-28
Resource Type
eISSN
14712334
Scopus ID
2-s2.0-85197186355
Pubmed ID
38943055
Journal Title
BMC infectious diseases
Volume
24
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
BMC infectious diseases Vol.24 No.1 (2024) , 649
Suggested Citation
Thipmontree W., Suputtamonkol Y. Comparison of clinical outcomes of pulmonary nocardiosis between AIDS and non-AIDS patients. BMC infectious diseases Vol.24 No.1 (2024) , 649. doi:10.1186/s12879-024-09519-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/99511
Title
Comparison of clinical outcomes of pulmonary nocardiosis between AIDS and non-AIDS patients
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Abstract
BACKGROUND: Nocardia species can affect both immunocompetent and immunocompromised people. METHOD: This retrospective study, from 2009 to 2022, aims to compare the survival analyses of pulmonary nocardiosis in AIDS and non-AIDS patients in northeastern Thailand. RESULTS: A total of 215 culture-confirmed cases of pulmonary nocardiosis: 97 with AIDS and 118 without AIDS. The median CD4 count of AIDS patients was 11 cells/µL (range: 1-198), and 33% had concurrent opportunistic infections. 63.6% of 118 non-AIDS patients received immunosuppressive medications, 28.8% had comorbidities, and 7.6% had no coexisting conditions. Disseminated nocardiosis and pleural effusion were more prevalent among AIDS patients, whereas non-AIDS patients revealed more shock and respiratory failure. One hundred-fifty patients underwent brain imaging; 15 (10%) had brain abscesses. Patients with pulmonary nocardiosis have overall 30-day and 1-year mortality rates of 38.5% (95% CI: 32.3%, 45.4%) and 52.1% (95% CI: 45.6%, 58.9%), respectively. The Cox survival analysis showed that AIDS patients with disseminated nocardiosis had a 7.93-fold (95% CI: 2.61-24.02, p < 0.001) increased risk of death within 30 days compared to non-AIDS patients when considering variables such as age, Charlson comorbidity index, concurrent opportunistic infections, duration of illness, shock, respiratory failure, multi-lobar pneumonia, lung abscesses, and combination antibiotic therapy. While AIDS and pulmonary nocardiosis had a tendency to die within 30 days (2.09 (95% CI, 0.74-5.87, p = 0.162)). CONCLUSION: AIDS with pulmonary nocardiosis, particularly disseminated disease, is a serious opportunistic infection. Early diagnosis and empiric treatment with a multidrug regimen may be the most appropriate approach in a resource-limited setting.