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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0003" class="elsevierStylePara elsevierViewall">Both pulmonary nocardiosis and nontuberculous mycobacterial pulmonary disease &#40;NTM-PD&#41; have been reported in immunocompromised or immunocompetent patients&#59; however&#44; few articles have reported their coinfection&#44;<a class="elsevierStyleCrossRefs" href="#bib0001"><span class="elsevierStyleSup">1&#8211;3</span></a> and most of them are in patients with immunodeficiency&#46; Here&#44; we present a case series of coinfection with pulmonary nocardiosis and NTM-PD in patients without known immunodeficiency&#44; and describe the characteristics of this population&#46;</p><p id="para0004" class="elsevierStylePara elsevierViewall">From January 2017 to July 2021&#44; NTM and <span class="elsevierStyleItalic">Nocardia</span> isolates were collected from respiratory tract samples&#44; including the sputum&#44; bronchial wash&#44; bronchoalveolar lavage fluid &#40;BALF&#41;&#44; and lung biopsy specimens at our hospital&#46; <span class="elsevierStyleItalic">Nocardia</span> was identified based on colony morphology and positive modified acid-fast staining&#46; The species were further identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry&#46; <span class="elsevierStyleItalic">Mycobacterium</span> was also identified by colony morphology and acid-fast staining&#46; When the <span class="elsevierStyleItalic">M&#46; tuberculosis</span> antigen test was negative&#44; the species were further identified by universal 16s rRNA gene sequences to confirm the diagnosis of NTM&#46; NTM-PD was diagnosed based on a combination of clinical&#44; radiological&#44; and microbiological features&#44; as described by the American Thoracic Society Mycobacterial Disease Subcommittee&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> Pulmonary nocardiosis was diagnosed when the patient had pulmonary symptoms&#44; radiological abnormalities&#44; and at least one positive culture from sputum&#44; bronchial wash&#44; BALF&#44; or lung biopsy&#46;</p><p id="para0005" class="elsevierStylePara elsevierViewall">From 448 patients with NTM infection&#44; <span class="elsevierStyleItalic">Nocardia</span> was isolated from 14&#46; All 14 patients had pulmonary symptoms and radiographic opacities&#46; According to the diagnosis definition&#44; four patients were excluded because NTM was isolated from the sputum only once&#46; Therefore&#44; coinfection of pulmonary nocardiosis and NTM-PD were identified in 10 patients&#46; All these patients were absent from active malignancy&#44; human immunodeficiency virus infection&#44; corticosteroid or immunosuppressive drug use&#44; solid organ transplantation&#44; or stem cell transplantation&#46; The clinical data of these patients are summarised in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0006" class="elsevierStylePara elsevierViewall">The mean patient age was 59&#46;2 &#177; 11&#46;7 &#40;range 45-84&#41; years&#44; with an apparent female predominance &#40;female&#58;male ratio 4&#58;1&#41;&#46; Bronchiectasis was noted in all patients&#44; with chronic obstructive pulmonary disease &#40;COPD&#41; observed in 5&#47;10 patients&#46; Two patients had a history of smoking and one&#44; alcohol abuse&#46; No patient had diabetes mellitus or pulmonary tuberculosis&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">All patients had NTM-PD first&#44; with pulmonary nocardiosis diagnosed simultaneously or 2&#8211;20 months after NTM-PD&#46; At the time of diagnosis of pulmonary nocardiosis&#44; all patients exhibited cough and sputum production&#44; followed by dyspnoea in 7&#47;10 patients&#44; haemoptysis in 6&#47;10 patients&#44; and fever in 3&#47;10 patients&#46; Both NTM and nocardiosis in all patients were confined to the lungs&#44; without dissemination&#46; The leading species were <span class="elsevierStyleItalic">Mycobacterium intracellular</span> in NTM-PD and <span class="elsevierStyleItalic">Nocardia otitidiscaviarum</span> and <span class="elsevierStyleItalic">Nocardia cyriacigeorgica</span> in pulmonary nocardiosis&#46;</p><p id="para0008" class="elsevierStylePara elsevierViewall">Chest computed tomography &#40;CT&#41; revealed diffuse bronchiectasis and opacities in all patients&#44; along with nodules&#44; masses&#44; infiltrates&#44; and consolidations&#46; The nodules were centrilobular&#44; and all patients showed a diffuse tree-in-bud appearance&#46; Cavities were noted in the upper lobes or superior segment of the lower lobes of three patients&#46; One patient showed atelectasis&#46; No patient had pleural effusion&#46;</p><p id="para0009" class="elsevierStylePara elsevierViewall">All patients were treated medically for at least one year&#44; followed-up for 1&#8211;3 years&#44; and were all alive in March 2022&#46; Patients with NTM-PD were mainly treated with rifampicin&#44; ethambutol&#44; and clarithromycin&#47;azithromycin&#46; Patients with pulmonary nocardiosis were mainly treated with levofloxacin&#47;moxifloxacin &#177; minocycline&#46; Only one patient was treated with sulfamethoxazole &#40;TMPCO&#41;&#46; Post-treatment&#44; seven patients improved clinically and radiologically&#44; two maintained stable symptoms and chest CT findings&#44; and one progressed slowly&#44; with new lesions on chest CT&#46; Sputum cultures during follow-up were negative in 4&#47;4 patients with NTM-PD and 6&#47;7 patients with pulmonary nocardiosis&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">NTM-PD is strongly associated with bronchiectasis&#46; Previous studies showed that the rate of NTM-PD in non-cystic fibrosis bronchiectasis was 5&#37;-30&#37;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>&#59; however&#44; the causal relationship between the two diseases has not been fully established&#46; The risk of pulmonary nocardiosis is increased in immunocompromised patients&#44; particularly in those with defects in cell-mediated immunity&#46; However&#44; patients with chronic lung diseases&#44; such as COPD and bronchiectasis&#44; also have an increased risk of <span class="elsevierStyleItalic">Nocardia</span> infection&#46; Lower airway bacterial colonisation in chronic lung diseases has been suggested to alter ciliary motility and cause epithelial damage&#44; thereby facilitating the presence of <span class="elsevierStyleItalic">Nocardia</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Therefore&#44; bronchiectasis may be a connecting link between pulmonary nocardiosis and NTM-PD in immunocompetent patients&#46; Interestingly&#44; no patient in our series had extrapulmonary nocardiosis or NTM infection&#44; which may be associated with underlying immunocompetence&#44; to restrict infections within the epithelial-damaged lungs&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">TMPCO has been the traditional antimicrobial of choice for pulmonary nocardiosis but was administered to only one patient in this study owing to a confirmed or suspected drug allergy in other patients&#46; Quinolone &#177; minocycline was the treatment of choice for most patients in this study&#44; with most patients showing favourable outcomes&#44; compared with the high mortality rate of approximately 40&#37; reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> The favourable outcomes may be due to the immunocompetent nature of the patients and the confined infection within the lungs&#46; Sulfamethoxazole-free regimens with other sensitive medicines for pulmonary nocardiosis appeared to be effective in this population&#46;</p><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Authors&#39; contributions</span><p id="para0012" class="elsevierStylePara elsevierViewall">SXF and SHL contributed to the conception of the study&#46; SXF&#44; LWJ and LLL contributed to data collection&#44; data analysis and interpretation&#46; SXF&#44; LWJ and SHL drafted the manuscript&#46; All authors revised the manuscript for intellectual content and approved the final version of the manuscript&#46;</p></span></span>"
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NTM&#44; NA&#59; <span class="elsevierStyleItalic">Nocardia</span>&#44; positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; cyriacigeorgica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;AZI&#43;MOXI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;5 years&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; otitidiscaviarum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">MOXI&#43;MINO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 year&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;M&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; otitidiscaviarum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;MOXI&#43;MINO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;5 years&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; otitidiscaviarum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;MOXI&#43;MINO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 years&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; cyriacigeorgica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;TMPCO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 year&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; abscessus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; farcinica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">CLA&#43;LEVO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 year&#44; stable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NTM&#44; NA&#59; <span class="elsevierStyleItalic">Nocardia</span>&#44; Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; farcinica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;AZI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 years&#44; stable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; cyriacigeorgica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;LEVO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 years&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; beijingensis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;LEVO&#43;MINO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 years&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Clinical data of 10 patients with coinfection of pulmonary nocardiosis and nontuberculous mycobacterium pulmonary disease&#46;</p>"
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    "bibliografia" => array:2 [
      "titulo" => "References"
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        0 => array:2 [
          "identificador" => "cebibsec1"
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            0 => array:3 [
              "identificador" => "bib0001"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary nocardiosis caused by Nocardia cyriacigeorgica in patients with Mycobacterium avium complex lung disease&#58; two case reports"
                      "autores" => array:1 [
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "K Yagi"
                            1 => "M Ishii"
                            2 => "H Namkoong"
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                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12879-014-0684-z"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Infect Dis"
                        "fecha" => "2014"
                        "volumen" => "14"
                        "paginaInicial" => "684"
                        "link" => array:1 [
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                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25491030"
                            "web" => "Medline"
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            1 => array:3 [
              "identificador" => "bib0002"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Coinfection by Nocardia asteroides and Mycobacterium avium- intracellulare in a patient with AIDS&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JM Trinidad"
                            1 => "R Teira"
                            2 => "S Zubero"
                            3 => "JM Santamaria"
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                  "host" => array:1 [
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                      "Revista" => array:6 [
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                        "volumen" => "10"
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            2 => array:3 [
              "identificador" => "bib0003"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Unusual mixed infection of thoracic empyema caused by Mycobacteria tuberculosis&#44; nontuberculosis mycobacteria and Nocardia asteroides in a woman with systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "HC Huang"
                            1 => "WL Yu"
                            2 => "CC Shieh"
                            3 => "KC Cheng"
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                  "host" => array:1 [
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                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect"
                        "fecha" => "2007"
                        "volumen" => "54"
                        "numero" => "1"
                        "paginaInicial" => "e25"
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                      ]
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              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Treatment of nontuberculous mycobacterial pulmonary disease&#58; an official ATS&#47;ERS&#47;ESCMID&#47;IDSA clinical practice guideline"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "CL Daley"
                            1 => "JM Iaccarino"
                            2 => "C Lange"
                            3 => "E Cambau"
                            4 => "RJ Wallace Jr"
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                  "host" => array:1 [
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                      "Revista" => array:4 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "2020"
                        "volumen" => "56"
                        "numero" => "1"
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            ]
            4 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nontuberculous mycobacteria in noncystic fibrosis bronchiectasis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "G Bonaiti"
                            1 => "A Pesci"
                            2 => "A Marruchella"
                            3 => "G Lapadula"
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                  "host" => array:1 [
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                      "Revista" => array:2 [
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                        "fecha" => "2015"
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Letter to the Editor
Coinfection of pulmonary nocardiosis and nontuberculous mycobacterial pulmonary disease in patients without known immunodeficiency
X. Suna,1, W. Liub,1, L. Liub, H. Sunb,
Corresponding author
sunhl2010@sina.com

Corresponding author at: Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
a Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
b Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="para0003" class="elsevierStylePara elsevierViewall">Both pulmonary nocardiosis and nontuberculous mycobacterial pulmonary disease &#40;NTM-PD&#41; have been reported in immunocompromised or immunocompetent patients&#59; however&#44; few articles have reported their coinfection&#44;<a class="elsevierStyleCrossRefs" href="#bib0001"><span class="elsevierStyleSup">1&#8211;3</span></a> and most of them are in patients with immunodeficiency&#46; Here&#44; we present a case series of coinfection with pulmonary nocardiosis and NTM-PD in patients without known immunodeficiency&#44; and describe the characteristics of this population&#46;</p><p id="para0004" class="elsevierStylePara elsevierViewall">From January 2017 to July 2021&#44; NTM and <span class="elsevierStyleItalic">Nocardia</span> isolates were collected from respiratory tract samples&#44; including the sputum&#44; bronchial wash&#44; bronchoalveolar lavage fluid &#40;BALF&#41;&#44; and lung biopsy specimens at our hospital&#46; <span class="elsevierStyleItalic">Nocardia</span> was identified based on colony morphology and positive modified acid-fast staining&#46; The species were further identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry&#46; <span class="elsevierStyleItalic">Mycobacterium</span> was also identified by colony morphology and acid-fast staining&#46; When the <span class="elsevierStyleItalic">M&#46; tuberculosis</span> antigen test was negative&#44; the species were further identified by universal 16s rRNA gene sequences to confirm the diagnosis of NTM&#46; NTM-PD was diagnosed based on a combination of clinical&#44; radiological&#44; and microbiological features&#44; as described by the American Thoracic Society Mycobacterial Disease Subcommittee&#46;<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a> Pulmonary nocardiosis was diagnosed when the patient had pulmonary symptoms&#44; radiological abnormalities&#44; and at least one positive culture from sputum&#44; bronchial wash&#44; BALF&#44; or lung biopsy&#46;</p><p id="para0005" class="elsevierStylePara elsevierViewall">From 448 patients with NTM infection&#44; <span class="elsevierStyleItalic">Nocardia</span> was isolated from 14&#46; All 14 patients had pulmonary symptoms and radiographic opacities&#46; According to the diagnosis definition&#44; four patients were excluded because NTM was isolated from the sputum only once&#46; Therefore&#44; coinfection of pulmonary nocardiosis and NTM-PD were identified in 10 patients&#46; All these patients were absent from active malignancy&#44; human immunodeficiency virus infection&#44; corticosteroid or immunosuppressive drug use&#44; solid organ transplantation&#44; or stem cell transplantation&#46; The clinical data of these patients are summarised in <a class="elsevierStyleCrossRef" href="#tbl0001">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0001"></elsevierMultimedia><p id="para0006" class="elsevierStylePara elsevierViewall">The mean patient age was 59&#46;2 &#177; 11&#46;7 &#40;range 45-84&#41; years&#44; with an apparent female predominance &#40;female&#58;male ratio 4&#58;1&#41;&#46; Bronchiectasis was noted in all patients&#44; with chronic obstructive pulmonary disease &#40;COPD&#41; observed in 5&#47;10 patients&#46; Two patients had a history of smoking and one&#44; alcohol abuse&#46; No patient had diabetes mellitus or pulmonary tuberculosis&#46;</p><p id="para0007" class="elsevierStylePara elsevierViewall">All patients had NTM-PD first&#44; with pulmonary nocardiosis diagnosed simultaneously or 2&#8211;20 months after NTM-PD&#46; At the time of diagnosis of pulmonary nocardiosis&#44; all patients exhibited cough and sputum production&#44; followed by dyspnoea in 7&#47;10 patients&#44; haemoptysis in 6&#47;10 patients&#44; and fever in 3&#47;10 patients&#46; Both NTM and nocardiosis in all patients were confined to the lungs&#44; without dissemination&#46; The leading species were <span class="elsevierStyleItalic">Mycobacterium intracellular</span> in NTM-PD and <span class="elsevierStyleItalic">Nocardia otitidiscaviarum</span> and <span class="elsevierStyleItalic">Nocardia cyriacigeorgica</span> in pulmonary nocardiosis&#46;</p><p id="para0008" class="elsevierStylePara elsevierViewall">Chest computed tomography &#40;CT&#41; revealed diffuse bronchiectasis and opacities in all patients&#44; along with nodules&#44; masses&#44; infiltrates&#44; and consolidations&#46; The nodules were centrilobular&#44; and all patients showed a diffuse tree-in-bud appearance&#46; Cavities were noted in the upper lobes or superior segment of the lower lobes of three patients&#46; One patient showed atelectasis&#46; No patient had pleural effusion&#46;</p><p id="para0009" class="elsevierStylePara elsevierViewall">All patients were treated medically for at least one year&#44; followed-up for 1&#8211;3 years&#44; and were all alive in March 2022&#46; Patients with NTM-PD were mainly treated with rifampicin&#44; ethambutol&#44; and clarithromycin&#47;azithromycin&#46; Patients with pulmonary nocardiosis were mainly treated with levofloxacin&#47;moxifloxacin &#177; minocycline&#46; Only one patient was treated with sulfamethoxazole &#40;TMPCO&#41;&#46; Post-treatment&#44; seven patients improved clinically and radiologically&#44; two maintained stable symptoms and chest CT findings&#44; and one progressed slowly&#44; with new lesions on chest CT&#46; Sputum cultures during follow-up were negative in 4&#47;4 patients with NTM-PD and 6&#47;7 patients with pulmonary nocardiosis&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">NTM-PD is strongly associated with bronchiectasis&#46; Previous studies showed that the rate of NTM-PD in non-cystic fibrosis bronchiectasis was 5&#37;-30&#37;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a>&#59; however&#44; the causal relationship between the two diseases has not been fully established&#46; The risk of pulmonary nocardiosis is increased in immunocompromised patients&#44; particularly in those with defects in cell-mediated immunity&#46; However&#44; patients with chronic lung diseases&#44; such as COPD and bronchiectasis&#44; also have an increased risk of <span class="elsevierStyleItalic">Nocardia</span> infection&#46; Lower airway bacterial colonisation in chronic lung diseases has been suggested to alter ciliary motility and cause epithelial damage&#44; thereby facilitating the presence of <span class="elsevierStyleItalic">Nocardia</span>&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> Therefore&#44; bronchiectasis may be a connecting link between pulmonary nocardiosis and NTM-PD in immunocompetent patients&#46; Interestingly&#44; no patient in our series had extrapulmonary nocardiosis or NTM infection&#44; which may be associated with underlying immunocompetence&#44; to restrict infections within the epithelial-damaged lungs&#46;</p><p id="para0011" class="elsevierStylePara elsevierViewall">TMPCO has been the traditional antimicrobial of choice for pulmonary nocardiosis but was administered to only one patient in this study owing to a confirmed or suspected drug allergy in other patients&#46; Quinolone &#177; minocycline was the treatment of choice for most patients in this study&#44; with most patients showing favourable outcomes&#44; compared with the high mortality rate of approximately 40&#37; reported in the literature&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> The favourable outcomes may be due to the immunocompetent nature of the patients and the confined infection within the lungs&#46; Sulfamethoxazole-free regimens with other sensitive medicines for pulmonary nocardiosis appeared to be effective in this population&#46;</p><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0002">Authors&#39; contributions</span><p id="para0012" class="elsevierStylePara elsevierViewall">SXF and SHL contributed to the conception of the study&#46; SXF&#44; LWJ and LLL contributed to data collection&#44; data analysis and interpretation&#46; SXF&#44; LWJ and SHL drafted the manuscript&#46; All authors revised the manuscript for intellectual content and approved the final version of the manuscript&#46;</p></span></span>"
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                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Species of <span class="elsevierStyleItalic">Nocardia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0004"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Time interval from NTM to nocardiosis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0005"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Treatment&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0006"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Outcome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><a name="en0007"></a><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">Sputum cultures during follow-up&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><a name="en0008"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 &#40;M&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0009"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0010"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; otitidiscaviarum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0011"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0012"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;LEVO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0013"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 years&#44; progress slowly&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0014"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NTM&#44; NA&#59; <span class="elsevierStyleItalic">Nocardia</span>&#44; positive&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0015"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0016"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0017"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; cyriacigeorgica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0018"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0019"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;AZI&#43;MOXI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0020"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;5 years&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0021"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0022"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0023"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0024"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; otitidiscaviarum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0025"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0026"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">MOXI&#43;MINO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0027"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 year&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0028"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0029"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 &#40;M&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0030"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0031"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; otitidiscaviarum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0032"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0033"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;MOXI&#43;MINO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0034"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2&#46;5 years&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0035"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0036"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">5 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0037"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0038"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; otitidiscaviarum</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0039"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0040"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;MOXI&#43;MINO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0041"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 years&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0042"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0043"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">6 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0044"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0045"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; cyriacigeorgica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0046"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Simultaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0047"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;TMPCO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0048"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 year&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0049"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0050"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">7 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0051"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; abscessus</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0052"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; farcinica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0053"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0054"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">CLA&#43;LEVO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0055"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">1 year&#44; stable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0056"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NTM&#44; NA&#59; <span class="elsevierStyleItalic">Nocardia</span>&#44; Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0057"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">8 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0058"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0059"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; farcinica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0060"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">4 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0061"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;AZI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0062"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 years&#44; stable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0063"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0064"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">9 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0065"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0066"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; cyriacigeorgica</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0067"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0068"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;LEVO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0069"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">2 years&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0070"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">Negative&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><a name="en0071"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">10 &#40;F&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0072"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">M&#46; intracellulare</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0073"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top"><span class="elsevierStyleItalic">N&#46; beijingensis</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0074"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">20 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0075"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">RFP&#43;EMB&#43;CLA&#43;LEVO&#43;MINO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0076"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">3 years&#44; improved&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><a name="en0077"></a><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="top">NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Clinical data of 10 patients with coinfection of pulmonary nocardiosis and nontuberculous mycobacterium pulmonary disease&#46;</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec1"
          "bibliografiaReferencia" => array:6 [
            0 => array:3 [
              "identificador" => "bib0001"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pulmonary nocardiosis caused by Nocardia cyriacigeorgica in patients with Mycobacterium avium complex lung disease&#58; two case reports"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K Yagi"
                            1 => "M Ishii"
                            2 => "H Namkoong"
                            3 => "T Asami"
                            4 => "H Fujiwara"
                            5 => "T Nishimura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s12879-014-0684-z"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Infect Dis"
                        "fecha" => "2014"
                        "volumen" => "14"
                        "paginaInicial" => "684"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25491030"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0002"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "&#91;Coinfection by Nocardia asteroides and Mycobacterium avium- intracellulare in a patient with AIDS&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "JM Trinidad"
                            1 => "R Teira"
                            2 => "S Zubero"
                            3 => "JM Santamaria"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
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Article information
ISSN: 25310437
Original language: English
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