180.4 📌 章末速蚘

  • Nocardia: aerobic, modified AFB +, soil inhalation, immunocompromise, lung + brain abscess common
  • Actinomyces: anaerobic, AFB -, endogenous flora, mucosal breach, “lumpy jaw” + IUD pelvic + sulfur granules
  • Nocardia Tx: TMP-SMX ± imipenem/amikacin × 6-12 mo
  • Actinomyces Tx: PCN / amoxicillin × 6-12 mo + surgical
  • N. farcinica 抗藥芁 ID consult
  • Brain abscess in immunocompromise → 考 Nocardia
  • Sulfur granules = Actinomyces (pathognomonic)
  • IUD long-standing → 考 pelvic Actinomyces
  • Mycetoma (actinomycetoma vs eumycetoma) — chronic localized triad
  • Whipple’s disease: T. whipplei, ceftriaxone → TMP-SMX × 1 yr