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Omori K, Kitagawa H, Nagaoka R, Naka Y, Kawamoto K, Horimasu Y, Nomura T, Shigemoto N, Yaguchi T, Hattori N, Ohge H. Lung and Cerebral Nocardiosis Caused by Nocardia elegans in a Lung Transplant Recipient: A Case Report and Literature Review. Intern Med 2023; 62:431-437. [PMID: 35831116 PMCID: PMC9970818 DOI: 10.2169/internalmedicine.9813-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Patients after lung transplantation are at risk for Nocardia infections. We herein report a case of lung and cerebral nocardiosis caused by Nocardia elegans, a rare species of Nocardia, in a lung transplant recipient. Antibiotic therapy, including sulfamethoxazole-trimethoprim (ST), and brain abscess drainage improved symptoms and imaging findings. A literature review of N. elegans infections showed that 12 of 14 cases (85.7%) were reported from East Asia, particularly Japan (9 cases, 64.2%). The lungs were the predominant site (12/14 cases, 85.7%), and most of the cases were susceptible to ST (9/10 cases, 90%).
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Affiliation(s)
- Keitaro Omori
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hiroki Kitagawa
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Rie Nagaoka
- Section of Clinical Laboratory, Department of Clinical Support, Hiroshima University Hospital, Japan
- Division of Clinical Laboratory Medicine, Hiroshima University Hospital, Japan
| | - Yasuhiko Naka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kazuma Kawamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Toshihito Nomura
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Norifumi Shigemoto
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
- Translational Research Center, Hiroshima University, Japan
| | | | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
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Maraki S, Mavromanolaki VE, Detorakis EE, Stafylaki D, Moraitis P, Scoulica E. Nocardia elegans primary iliopsoas abscess: A case report and literature review. Acta Microbiol Immunol Hung 2022; 69:351-357. [PMID: 36190829 DOI: 10.1556/030.2022.01868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022]
Abstract
Nocardia species are rare causative agents of psoas abscess, more frequently occurring as part of disseminated infection. Only sporadic cases have been reported so far, with Nocardia asteroides and Nocardia farcinica being the most common causative agents. Nocardia elegans is an opportunistic pathogen, accounting for only 0.3-0.6% of infections caused by Nocardia species, usually affecting the respiratory tract.In this study, a previously healthy 74-year-old man was admitted to the University Hospital of Heraklion with fever and intense pain radiating from the lumbar region to the groin and the left thigh, increasing with movement. Imaging findings revealed a large abscess in the left iliopsoas. Blood and pus aspirate cultures yielded a pure culture of Nocardia that was identified by 16S rRNA sequence as N. elegans. The patient was successfully treated with drainage of the abscess along with administration of ceftriaxone, linezolid and trimethoprim-sulfamethoxazole. To our knowledge, this is the first report of iliopsoas abscess caused by N. elegans. Early, accurate diagnosis and timely treatment with drainage of the abscess and long-term administration of antimicrobial agents optimize the outcome.
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Affiliation(s)
- Sofia Maraki
- 1Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Heaklion, Crete, Greece
| | | | - Efstathios E Detorakis
- 3Department of Radiology, Section of Computed Tomography and Magnetic Resonance Imaging, University Hospital of Heraklion, 71500 Heraklion, Crete, Greece
| | - Dimitra Stafylaki
- 1Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Heaklion, Crete, Greece
| | - Panagiotis Moraitis
- 1Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Heaklion, Crete, Greece
| | - Effie Scoulica
- 4Laboratory of Clinical Microbiology and Molecular Microbiology, School of Medicine, University of Crete, 70013 Heraklion, Crete, Greece
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3
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Watanabe C, Kimizuka Y, Fujikura Y, Hamamoto T, Watanabe A, Yaguchi T, Sano T, Suematsu R, Kato Y, Miyata J, Matsukuma S, Kawana A. Mixed Infection of Cytomegalovirus and Pulmonary Nocardiosis Caused by Nocardia elegans Diagnosed Using Nanopore Sequencing Technology. Intern Med 2022; 61:1613-1617. [PMID: 34707041 PMCID: PMC9177376 DOI: 10.2169/internalmedicine.7639-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 69-year-old woman who had undergone renal transplantation and was receiving sulfamethoxazole/trimethoprim (ST) developed pulmonary nocardiosis. To our knowledge, this is the first report of the identification of Nocardia elegans using nanopore sequencing, supported by 16S rDNA capillary sequencing findings. Chest computed tomography performed after ST initiation revealed significant improvement of the pulmonary shadows compared to previous findings. We herein report the value of nanopore sequencing for rapid identification of rare pathogens, such as Nocardia elegans. Furthermore, our findings suggest that Nocardia may infect even patients receiving ST, which is currently the most effective prophylactic drug.
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Affiliation(s)
- Chie Watanabe
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yoshifumi Kimizuka
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Takaaki Hamamoto
- Department of Laboratory Medicine, National Defense Medical College Hospital, Japan
| | - Akira Watanabe
- Division of Bio-resources, Medical Mycology Research Center, Chiba University, Japan
| | - Takashi Yaguchi
- Division of Bio-resources, Medical Mycology Research Center, Chiba University, Japan
| | - Tomoya Sano
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Ryohei Suematsu
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yoshiki Kato
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Jun Miyata
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Susumu Matsukuma
- Department of Laboratory Medicine, National Defense Medical College Hospital, Japan
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
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Tajima K, Okuyama S, Terada T, Akaneya D, Hori R, Abe S, Honma T, Tsumanuma R, Omoto E, Ito J, Gonoi T. Clarithromycin As an Alternative and Prophylactic Agent in a Hematopoietic Stem Cell Transplantation Patient. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931731. [PMID: 34129542 PMCID: PMC8216568 DOI: 10.12659/ajcr.931731] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Patient: Male, 34-year-old Final Diagnosis: Nocardia infection Symptoms: Chest pain Medication: — Clinical Procedure: — Specialty: Infectious Diseases
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Affiliation(s)
- Katsushi Tajima
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Shuhei Okuyama
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Taichi Terada
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Daisuke Akaneya
- Department of Laboratory Medicine, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Ryuichiro Hori
- Department of Laboratory Medicine, Yamagata University School of Medicine, Yamagata, Japan
| | - Shuichi Abe
- Department of Infectious Diseases, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Tsuguo Honma
- Department of Radiology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Riko Tsumanuma
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Eijiro Omoto
- Department of Hematology, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Junko Ito
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - Tohru Gonoi
- Medical Mycology Research Center, Chiba University, Chiba, Japan
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5
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Martínez-Barricarte R. Isolated Nocardiosis, an Unrecognized Primary Immunodeficiency? Front Immunol 2020; 11:590239. [PMID: 33193422 PMCID: PMC7606290 DOI: 10.3389/fimmu.2020.590239] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/31/2020] [Indexed: 01/19/2023] Open
Abstract
Nocardiosis is an infectious disease caused by the gram-positive bacterium Nocardia spp. Although it is commonly accepted that exposure to Nocardia is almost universal, only a small fraction of exposed individuals develop the disease, while the vast majority remain healthy. Nocardiosis has been described as an "opportunistic" disease of immunocompromised patients, suggesting that exposure to the pathogen is necessary, but a host predisposition is also required. Interestingly, increasing numbers of nocardiosis cases in individuals without any detected risk factors, i.e., without overt immunodeficiency, are being reported. Furthermore, a growing body of evidence have shown that selective susceptibility to a specific pathogen can be caused by a primary immunodeficiency (PID). This raises the question of whether an undiagnosed PID may cause nocardiosis affecting otherwise healthy individuals. This review summarizes the specific clinical and microbiological characteristics of patients with isolated nocardiosis published during the past 30 years. Furthermore, it gives an overview of the known human immune mechanisms to fend off Nocardia spp. obtained from the study of PIDs and patients under immunomodulatory therapies.
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Affiliation(s)
- Rubén Martínez-Barricarte
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Pathology, Microbiology, and Immunology, Vanderbilt Center for Immunobiology, Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center, Nashville, TN, United States
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6
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Takahashi S, Murata K, Ozawa K, Yamada H, Kawakami H, Nakayama A, Asano Y, Mochizuki K, Mikamo H. Moraxella species: infectious microbes identified by use of time-of-flight mass spectrometry. Jpn J Ophthalmol 2019; 63:328-336. [PMID: 31273564 DOI: 10.1007/s10384-019-00669-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To report the clinical manifestations, identification, antimicrobial susceptibilities, and treatment outcomes of ocular infections caused by Moraxella species. STUDY DESIGN Retrospective study. PATIENTS AND METHODS The medical records of all patients treated at the Departments of Ophthalmology of the Ogaki Municipal Hospital and the Gifu University Graduate School of Medicine for ocular infections caused by Moraxella species between January 2011 and June 2017 were examined. The stored Moraxella species isolated from ocular samples were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), molecular identification, and the biochemical properties. RESULTS Sixteen eyes of 16 patients were treated for Moraxella ocular infections. The patients' median age was 72 years. A predisposing systemic or ocular condition was identified in 15 of the patients. Nine of the patients developed keratitis; four, conjunctivitis; and three, blebitis. M lacunata (6 eyes), M catarrhalis (6), M nonliquefaciens (3), and M osloensis (1) were identified by MALDI-TOF MS. All isolates were sensitive to levofloxacin, tobramycin, ceftazidime, ceftriaxone, and cefazolin. Twelve patients with keratitis or blebitis were treated with various topical antimicrobial combinations, and systemic antibiotics were used in 10 of the 12 patients. The mean time for the complete closure of the epithelial defects with keratitis was 24 days. The visual outcomes after treatment were favorable except in 1 keratitis patient who underwent enucleation. CONCLUSIONS The use of duo-therapy with a combination of fluoroquinolone and cefmenoxime should be considered in cases nonresponsive to monotherapy, such as keratitis and bleb-associated infections. MALDI-TOF MS is useful for the identification of Moraxella to the species level.
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Affiliation(s)
- Shunsuke Takahashi
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kazuhiro Murata
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Kenji Ozawa
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroki Yamada
- Department of Ophthalmology, Ogaki Municipal Hospital, Gifu, Japan
| | - Hideaki Kawakami
- Department of Ophthalmology, Gifu Municipal Hospital, 7-1 Kashima-cho, Gifu-shi, Gifu, 500-8513, Japan.
| | - Asami Nakayama
- Department of Clinical Laboratory, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuko Asano
- Department of Clinical Laboratory, Ogaki Municipal Hospital, Gifu, Japan
| | - Kiyofumi Mochizuki
- Department of Ophthalmology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Aichi, Japan
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7
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Disseminated nocardiosis caused by Nocardia elegans: a case report and review of the literature. Infection 2018; 46:705-710. [PMID: 29737456 DOI: 10.1007/s15010-018-1144-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Disseminated nocardiosis is a rare disease mostly occurring in immunocompromised patients. METHODS We report a case of disseminated nocardiosis in a diabetic patient with both pulmonary and cutaneous involvement. Nocardia elegans was isolated and identified using the 16s ribosomal RNA gene sequence data. RESULTS Clinical improvement was observed within 3 months after initiation of antimicrobial treatment with oral doxycycline, trimethoprim-sulfamethoxazole and intravenous penicillin, but the patient died 5 months later after arbitrary discontinuation of the treatment. CONCLUSIONS This is the first case report of disseminated nocardiosis caused by Nocardia elegans in China.
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8
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Hadano Y, Kinugasa Y, Ohkusu K, Ishibashi K, Isoda M. Gemella haemolysans bacteremia in a patient with secondary peritonitis due to a duodenal ulcer perforation: A case report. IDCases 2018; 12:133-135. [PMID: 29942771 PMCID: PMC6010975 DOI: 10.1016/j.idcr.2018.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 12/15/2022] Open
Abstract
We describe a case of Gemella haemolysans septic shock in a 75-year old Japanese male with a duodenal perforation and secondary peritonitis. Blood cultures on admission were positive for Gram-positive and Gram-variable cocci, and G. haemolysans was identified using whole cell matrix-assisted laser desorpition/ionization mass spectrometry (MALDI-TOF MS), with a score value of 2.12. The 16S rRNA sequencing was difficult to use as a diagnostic test because there was more than 99% sequence homology with related bacterial strains. Based on both the biochemical profiles and whole groEL sequence, we concluded that the strain in our patient was G. haemolysans. The patient was successfully treated with a 16-day course of antimicrobials. His clinical condition improved, and no evidence of a relapse of the infection was noted. Although MALDI-TOF MS and 16S rRNA sequencing are useful for identification of the species, the basic biochemical profile is also important to identify a rare species.
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Affiliation(s)
- Yoshiro Hadano
- Department of Infectious Diseases, St. Mary's Hospital, Kurume, Japan
| | | | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | | | - Miwako Isoda
- Department of Infectious Diseases, St. Mary's Hospital, Kurume, Japan
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9
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Abstract
We herein describe a case of trauma-related wound infection with a subcutaneous abscess caused by both Enterobacter cancerogenus and Aeromonas hydrophila. An 89-year-old Japanese man was admitted to our hospital because of an injury that he had suffered in a car accident. The right dorsal region of the foot around the wound was reddish and swelling. The pus culture on his right foot grew E. cancerogenus and A. hydrophila. The patient was successfully treated with a 10-day course of meropenem and a 25-day course of levofloxacin. E. cancerogenus can therefore be a causative pathogen in skin and soft tissue infections among trauma patients.
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Affiliation(s)
- Yoshiro Hadano
- Division of Infectious Diseases, St. Mary's Hospital, Japan
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10
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Ishiguro T, Yoshioka H, Kawai S, Katsumata SI, Gonoi T, Takayanagi N. A case of empyema and septic arthritis due to Nocardia farcinica. Clin Case Rep 2017; 5:1976-1979. [PMID: 29225839 PMCID: PMC5715427 DOI: 10.1002/ccr3.1228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/18/2017] [Accepted: 09/28/2017] [Indexed: 11/11/2022] Open
Abstract
Septic arthritis due to Nocardia sp. should be suspected when a patient with risk factors such as pneumoconiosis or diabetes mellitus develops joint symptoms, especially if the patient has had nocardiosis in other sites.
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Affiliation(s)
- Takashi Ishiguro
- Department of Respiratory Medicine Saitama Cardiovascular and Respiratory Center Saitama Japan
| | - Hiroaki Yoshioka
- Department of Laboratory Saitama Cardiovascular and Respiratory Center Saitama Japan
| | - Shoko Kawai
- Department of Respiratory Medicine Saitama Cardiovascular and Respiratory Center Saitama Japan
| | | | - Tohru Gonoi
- Medical Biology Research Center Chiba University Chiba Japan
| | - Noboru Takayanagi
- Department of Respiratory Medicine Saitama Cardiovascular and Respiratory Center Saitama Japan
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11
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Pantoea calida bacteremia in an adult with end-stage stomach cancer under inpatient care. J Infect Chemother 2017; 23:407-409. [DOI: 10.1016/j.jiac.2017.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/17/2016] [Accepted: 01/10/2017] [Indexed: 11/16/2022]
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12
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Nakamura I, Nagakura T, Fujita H, Fukusima S, Gonoi T. Nocardia elegans infection: a case report and literature review. Int J Infect Dis 2016; 54:15-17. [PMID: 27826114 DOI: 10.1016/j.ijid.2016.10.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 09/21/2016] [Accepted: 10/31/2016] [Indexed: 01/29/2023] Open
Abstract
A case of disseminated nocardiosis caused by Nocardia elegans in a 72-year-old man with rheumatoid arthritis, treated with tacrolimus and prednisolone, is reported herein. The patient had impaired vision and was diagnosed with endophthalmitis and an abdominal skin abscess. He was started on trimethoprim-sulfamethoxazole treatment, followed by cefepime. The patient was then switched to a combination of imipenem-cilastatin and minocycline. Although the patient survived as a result of surgery and prolonged antibiotic treatment, he eventually lost vision after the infection became resistant to antibiotic treatment. Molecular analysis of samples from the abscess and vitreous fluid confirmed the extremely rare pathogen N. elegans, which accounts for only 0.3-0.6% of infections caused by Nocardia species. This organism is almost always associated with pulmonary infection, and disseminated infections are rare. As with previously reported norcardial infections, the current case was treated successfully with trimethoprim-sulfamethoxazole, carbapenems, and aminoglycosides. However, the clinical characteristics of this organism remain unclear. Further studies are therefore required to develop more effective treatment protocols for disseminated nocardiosis caused by this problematic pathogen.
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Affiliation(s)
- Itaru Nakamura
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
| | - Tomoki Nagakura
- Department of Anesthesiology, Tokyo Medical University, Tokyo, Japan
| | - Hiroaki Fujita
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Shinji Fukusima
- Department of Infection Control and Prevention, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
| | - Tohru Gonoi
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
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13
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Kobayashi T, Nakamura I, Fujita H, Tsukimori A, Sato A, Fukushima S, Ohkusu K, Matsumoto T. First case report of infection due to Cupriavidus gilardii in a patient without immunodeficiency: a case report. BMC Infect Dis 2016; 16:493. [PMID: 27643790 PMCID: PMC5029082 DOI: 10.1186/s12879-016-1838-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 09/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cupriavidus gilardii is an aerobic, Gram-negative, glucose-nonfermenting rod that was first identified in 1999. Because of the difficulty in accurate species identification of C. gilardii, there are few case reports of infection caused by this organism. In previous reports, C. gilardii has been characterized as an organism with low pathogenicity that causes opportunistic infections. CASE PRESENTATION We encountered a case of pacemaker-associated bloodstream infection caused by C. gilardii in a 90-year old woman without obvious immunodeficiency. We identified the isolates as C. gilardii by sequencing of the 16S rRNA gene. The patient was treated with removal of the lead and administration of antimicrobial agents. Because of the acquisition of antibiotic resistance during antibiotic treatment, the antimicrobial agent was changed during the course of treatment. CONCLUSIONS To our knowledge, this is the first report of an infection caused by this organism in a patient without obvious immunodeficiency. Although the true pathogenicity of C. gilardii is unclear, the possibility that it exerts pathogenicity not only in persons with immunodeficiency but also in immunocompetent persons is suggested.
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Affiliation(s)
- Takehito Kobayashi
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Itaru Nakamura
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Hiroaki Fujita
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Ayaka Tsukimori
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.,Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Akihiro Sato
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Shinji Fukushima
- Department of Infection Prevention and Control, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Kiyofumi Ohkusu
- Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Tetsuya Matsumoto
- Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku, Shinjuku-ku, Tokyo, 160-8402, Japan
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14
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Owen H, Buckle K, Olm J, Leitner M, Pandey S, Gaughan JB, Sullivan ML, Lees AM, Gibson JS. Isolation of Nocardia mexicana from focal proliferative tenosynovitis and arthritis in a steer. Aust Vet J 2016; 93:170-3. [PMID: 25939264 DOI: 10.1111/avj.12308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/14/2014] [Accepted: 08/31/2014] [Indexed: 11/29/2022]
Abstract
CASE REPORT An 18-month-old Charolais steer was presented with lameness and fluctuant swelling of the right stifle joint, which yielded neutrophils on fine-needle aspiration. A diagnosis of bacterial proliferative tenosynovitis and arthritis was made on postmortem and histological examination. Culture and 16S rRNA sequencing identified a Nocardia sp. with 99% homology with the corresponding DNA fragment of N. mexicana DSM 44952. Antimicrobial susceptibility testing revealed the isolate was susceptible to co-trimoxazole and third-generation cephalosporins. CONCLUSION We report the first case, both in Australia and internationally, of proliferative tenosynovitis and arthritis caused by Nocardia spp. infection in a bovine and the first report of pathology attributed to N. mexicana in a veterinary patient. Given the limited susceptibility of the bacteria, the poor antimicrobial penetration that would be expected and the morphological changes that had taken place in the joint; the steer would have required protracted antimicrobial treatment in addition to invasive debridement of the lesion. This case emphasises the importance of routinely performing cytology and extended incubation of cultures in cases of arthritis in order to make ethical and economically viable treatment decisions.
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Affiliation(s)
- H Owen
- The University of Queensland, School of Veterinary Science, Gatton, Queensland, 4343, Australia
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15
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Abstract
PURPOSE Moraxella species are rare causative pathogens of severe sight-threatening keratitis. The aim of this study was to analyze the clinical presentation, predisposing risk factors, in vitro antimicrobial susceptibility, and treatment associated with Moraxella keratitis. METHODS We retrospectively reviewed 30 culture-proven cases of Moraxella keratitis from multiple centers in Japan. RESULTS The mean age of the patients was 58.4 ± 23.4 years. The most common ocular conditions were contact lens wearing (5 patients, 16.7%) and trauma (3 patients, 10.0%). Seven patients had diabetes mellitus. Sixteen patients exhibited hypopyon in association with the corneal focus. Ring-shaped infiltration was found in 9 patients (30.0%), and irregular or amoebic-shaped infiltration was observed in 13 patients (43.3%). Eight patients (26.7%) showed small round infiltrates. All Moraxella isolates were sensitive to fluoroquinolones and aminoglycosides. All were treated with a combination ophthalmic solution containing a fluoroquinolone, tobramycin, and cefmenoxime. Although no patients developed corneal perforation, the response to treatment was slow in all cases; the mean treatment period was 41.9 days. CONCLUSIONS In Japan, Moraxella keratitis occurs in patients with contact lens wear, trauma, and diabetes mellitus. It presents as a small, round, ring-shaped, irregularly shaped, or amoebic-shaped focus. Moraxella species exhibit good susceptibility to fluoroquinolones and aminoglycosides. Because the treatment response may be very slow, these agents should be continued for a long period of time.
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Chaussade H, Lebeaux D, Gras G, Catherinot E, Rammaert B, Poiree S, Lecuyer H, Zeller V, Bernard L, Lortholary O. Nocardia Arthritis: 3 Cases and Literature Review. Medicine (Baltimore) 2015; 94:e1671. [PMID: 26496274 PMCID: PMC4620750 DOI: 10.1097/md.0000000000001671] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 08/23/2015] [Accepted: 09/01/2015] [Indexed: 01/29/2023] Open
Abstract
Nocardia are Gram-positive filamentous bacteria responsible for infections ranging from opportunistic life-threatening disseminated diseases to chronic skin and soft-tissue infections.Even if virtually all organs can be infected, articular involvement is rare. Therefore, we report 3 recent cases and performed a literature review of cases of Nocardia arthritis in order to describe clinical features, therapeutic challenges, and outcome of these patients.Among 34 patients (31 in the literature plus our 3 cases), 21 (62%) were due to hematogenous dissemination, 9 (26%) were due to direct bacterial inoculation through the skin, and in 4 cases, the mechanism of infection was unknown. Four out of these 34 cases occurred on prosthetic joints.Whereas hematogenous infections mostly occurred in immunocompromised hosts (17 of 21, 81%), direct inoculation was mostly seen in immunocompetent patients.Eighty-two percent of patients (28 out of 34) received trimethoprim-sulfamethoxazole-containing regimens and median antibiotic treatment duration was 24 weeks (range, 12-120) for hematogenous infections and 12 weeks (range, 6-24) for direct inoculations. Outcome was favorable in 27 cases despite unsystematic surgical management (17 cases) without sequelae in 70% of the cases.Nocardia arthritis is rare but its management is complex and should rely on a combined approach with rheumatologist, infectious diseases expert, and surgeon.
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Affiliation(s)
- Hélène Chaussade
- From the Université Paris Descartes, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker Enfants malades, Institut Imagine, Paris, France (HC, DL, BR, OL); Service de médecine interne et maladies infectieuses, Hôpital Bretonneau, Tours, France (GG, LB); Service de Pneumologie, Hôpital Foch, Suresnes, France (EC); Service de radiologie, Hôpital Necker EM, Paris, France (SP); Service de bactériologie, Hôpital Necker EM, Paris, France (HL); and Service d'orthopédie, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France (VZ)
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17
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Nocardia Septic Arthritis Complicating an Anterior Cruciate Ligament Repair. J Clin Microbiol 2015; 53:2760-2. [PMID: 26041900 DOI: 10.1128/jcm.00754-15] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 05/26/2015] [Indexed: 01/18/2023] Open
Abstract
Nocardia infection following anterior cruciate ligament (ACL) allograft reconstruction is a rare occurrence. We report a case of Nocardia infection of an allograft ACL reconstruction and septic arthritis of the knee joint due to an organism most similar to the novel Nocardia species Nocardia aobensis.
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18
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Kachuei R, Emami M, Mirnejad R, Khoobdel M. Diversity and frequency of Nocardia spp. in the soil of Isfahan province, Iran. Asian Pac J Trop Biomed 2015; 2:474-8. [PMID: 23569953 DOI: 10.1016/s2221-1691(12)60079-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/05/2011] [Accepted: 12/03/2011] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To isolate and identify Nocardia spp. from soil in different regions of Isfahan province in the center of Iran. METHODS This study was conducted in 32 districts (16 cities and 16 villages) in Isfahan province during two years. A total of 800 soil samples from these regions were studied by using kanamycin. The isolated Nocardia species were examined by gram and acid-fast staining and were identified biochemically and morphologically. The frequency and distribution of Nocardia spp. were determined in relation to different factors such as soil pH and temperate climate. RESULTS From 153 (19.1%) Nocardia isolates identified, Nocardia asteroids (N. asteroids) complex (45.5%) and Nocardia brasiliensis (N. brasiliensis) (24.7%) were the most frequently isolated species, followed by Nocardia otitidiscaviarum (2.2%), Nocardiopsis dassonvillei, Actinomadura actinomadura (each 1.7%) and Nocardia transvalensis (1.1%) and also unknown spp. (23.0%). In this study, most species (54.4%) of Nocardia, especially N. asteroides complex were isolated from soils with pH: 7.01-8, whereas in pH: 8.01-9 more N. brasiliensis was isolated. The most Nocardia spp. was detected from regions with semi-nomadic and temperate climate (41.1%). CONCLUSIONS N. asteroids complex is more prevalent in Isfahan province and soil can be a potential source of nocardiosis infections. It is to be considering that climate and soil pH are involved in the frequency and diversity of aerobic Actinomycetes.
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Affiliation(s)
- R Kachuei
- Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Ooi Y, Shiba H, Nagai K, Higashiyama T, Nakanishi T, Nakano T, Ukimura A, Gonoi T. Lung Nocardia elegans infection diagnosed on matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Intern Med 2014; 53:2111-3. [PMID: 25224198 DOI: 10.2169/internalmedicine.53.2387] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 73-year-old man with adultonset Still's disease developed a high fever, coughing, dyspnea and bloody sputum and was therefore admitted to our hospital. Thoracic X-ray and CT scans revealed oval lesions in the bilateral lungs. A bacterial isolate from the sputum was identified to be Nocardia elegans (N. elegans) on comparative 16S rRNA gene sequencing and Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS). The patient recovered following treatment with imipenem/cilastatin and amikacin. To the best of our knowledge, this is the first case of nocardiosis caused by N. elegans identified on MALDI-TOF MS.
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Affiliation(s)
- Yukimasa Ooi
- Infection Control Office, Osaka Medical College Hospital, Japan
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20
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Nakayama A, Yamanaka K, Hayashi H, Ohkusu K. Moraxella lacunata infection associated with septicemia, endocarditis, and bilateral septic arthritis in a patient undergoing hemodialysis: a case report and review of the literature. J Infect Chemother 2013; 20:61-4. [PMID: 24462428 DOI: 10.1016/j.jiac.2013.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/09/2013] [Accepted: 06/19/2013] [Indexed: 02/07/2023]
Abstract
We report the first case of both endocarditis and bilateral septic arthritis in a patient caused by Moraxella lacunata and successful management of the infection with antimicrobial therapy. The route of entry leading to bacteremia may have been the oral cavity given the poor oral hygiene of the patient as evidenced by bleeding gums. We hypothesize that the bacteremia led to septic arthritis and mitral valve infective endocarditis. In this case report, we also review the literature on M. lacunata infections and conclude that this organism should be considered in bilateral septic arthritis in a patient with underlying heart abnormalities and/or with renal failure.
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Affiliation(s)
- Asami Nakayama
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University, School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan; Division of Clinical Laboratory, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Katsuo Yamanaka
- Department of General Internal Medicine, Fujita Health University School of Medicine, Japan
| | - Hiroki Hayashi
- Department of Nephrology, Fujita Health University School of Medicine, Japan
| | - Kiyofumi Ohkusu
- Department of Microbiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.
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Suzuki J, Sugiyama T, Ito K, Hadano Y, Kawamura I, Okinaka K, Kurai H, Ohkusu K, Ohmagari N. Campylobacter showae bacteremia with cholangitis. J Infect Chemother 2012. [PMID: 23183773 DOI: 10.1007/s10156-012-0524-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of Campylobacter showae bacteremia associated with cholangitis. A 71-year-old man with advanced bile duct cancer was admitted to our hospital because of cholangitis with shock, hypoglycemia, and impaired renal function. After replacement of the biliary drainage tube, pus was drained from the tube. Specimens for blood and bile cultures were obtained, and fluid resuscitation and antimicrobial treatment were then begun. Although anaerobic blood culture yielded small curved gram-negative rods, the isolate could not be identified by conventional identification methods. The isolate was identified as C. showae by 16S rRNA gene sequencing analysis. We consider here the pathogenicity of C. showae and the association of C. showae with cholangitis.
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Affiliation(s)
- Jun Suzuki
- Division of Infectious Diseases, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan,
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