Ungewöhnliche grampositive Stäbchenbakterien als Auslöser von Pneumonien

Zusammenfassung

Es werden drei Patienten vorgestellt, die eine Pneumonie durch ungewöhnliche, gram positive Stäbchen hatten. Fall 1 war ein pulmonal vorgeschädigter, 84-jähriger Patient mit Verdacht auf Tbc, bei dem Nocardia spec. als Erreger isoliert wurde. Fall 2 war ein alkoholkranker, 46-jähriger Patient mit Pneumonie, bei dem Actinomadura madurae als Erreger isoliert wurde. Fall 3 war ein 58-jähriger Patient mit Pneumonie bei myelodysplastischem Syndrom (MDS), bei dem Nocardia asteroides isoliert wurde. Allen gemeinsam war, dass sie eine Einschränkung der Immunität aufwiesen (Alter, Alkoholismus und MSD), eine vorgeschädigte Lunge hatten und differenzialdiagnostisch an Tuberkulose gedacht wurde (Fall 1 und 2). Therapeutisch konnte die Infektion durch Actinomadura madurae mit Clindamycin beherrscht werden. Die Therapie der Nocardien mit Moxifloxacin (Fall 1) oder Bactrim (Fall 3) war nur bedingt wirkungsvoll. Im Anhang werden sechs Arten von gram positiven Stäbchen (Nocardien, Actinomyzeten, Actinomadura, Rhodococcus, Corynebakterien und Bazillen) als mögliche Pneumonieerreger zusammenfassend dargestellt.

Abstract

In the last decade, a growing number of patients with pneumonia, caused by unusual gram positive rods have been observed. Mostly, the patients had been infected as a consequence of impaired immunity. In some cases, bioterroristic activities may also induce pneumonia by gram positive rods (B. anthracis). In order to bring these organisms to the attention of the medical community, we present three clinical cases and describe six species of gram positive rods, known to provoke this kind of pneumonias. Case 1 was a 84 years old patient with impaired lungfunction. He was suspecious of tuberculosis (Tbc). Nocardia spec. was isolated. Case 2 was an alcoholic of 46 years with pneumonia. Reactivation of Tbc was suspected. Actinomadura madurae has been isolated. Case 3 was a patient of 58 years with myelodysplastic syndrom (MDS) and pneumonia. N. asteroides was isolated. All patients shared impaired immunity (age, alcoholism, MDS) with impaired lungfunctions; Tbc had been suspected (Case 1 + 2). Infection by A. madurae was contained by Clindamycin. Therapy of Nocardia with Moxifloxacin (Case 1) or Bactrim (Case 3) was only partly effective. In the appendix, six species of gram positive rods which are known to cause pneumonia, are summarized (Nocardia, Actinomyceta, Actinomadura, Rhodococcus, Corynebacterium and Bacillus).

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