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De Benedetto I, Curtoni A, Lupia T, Pinna SM, Scabini S, Ricciardelli G, Iannaccone M, Biancone L, Boffini M, Mangiapia M, Cavallo R, De Rosa FG, Corcione S. Nodular Cutaneous Lesions in Immune-Compromised Hosts as a Clue for the Diagnosis of Disseminated Nocardiosis: From Bedside to Microbiological Identification. Pathogens 2022; 12:pathogens12010068. [PMID: 36678416 PMCID: PMC9866504 DOI: 10.3390/pathogens12010068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Nocardia is a group of ubiquitous bacteria known to cause opportunistic infections in immunocompromised hosts, including those affected by malignancies and solid-organ or hematopoietic stem cell transplants. Pulmonary involvement, occurring in two-thirds of cases, is the most frequent presentation. Diagnosis might be challenging both because of microbiological technical issues, but also because of the variability of organ involvement and mimicry. METHODS We describe four cases of disseminated nocardiosis caused by N. farcinica observed between September 2021 and November 2021 in immune-compromised hosts presenting with nodular cutaneous lesions that had raised a high degree of clinical suspect and led to microbiological identification through MALDI-TOF MS. RESULTS Cutaneous involvement is typically reported in immunocompetent hosts with primary cutaneous nocardiosis with multiple forms of manifestation; nonetheless, disseminated nocardiosis rarely involves the skin and subcutaneous tissues, and this occurs as a result of metastatic spread. Our cases were disseminated nocardiosis in which the metastatic cutaneous involvement, even if rare, provided a clue for the diagnosis. CONCLUSIONS The pathomorphosis of disseminated nocardiosis may have changed in the current years with more rapid spread due to advanced immunosuppression. For this reason, after clinical suspicion, the prompt start of an active targeted therapy based on rapid microbiological identification might potentially open the way to hopeful results, even in the most immune-compromised patients.
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Affiliation(s)
- Ilaria De Benedetto
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- Correspondence: ; Tel.: +39-347-5850220
| | - Antonio Curtoni
- Microbiology Laboratory, “Città della Salute e della Scienza”, Hospital of Turin, 10126 Turin, Italy
| | - Tommaso Lupia
- Infectious Diseases Unit, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Simone Mornese Pinna
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Silvia Scabini
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
| | - Guido Ricciardelli
- Microbiology Laboratory, “Città della Salute e della Scienza”, Hospital of Turin, 10126 Turin, Italy
| | - Marco Iannaccone
- Microbiology Laboratory, “Città della Salute e della Scienza”, Hospital of Turin, 10126 Turin, Italy
| | - Luigi Biancone
- Division of Nephrology Dialysis and Transplantation, Department of Medical Sciences, “Città Della Salute e Della Scienza Hospital”, University of Turin, 10126 Turin, Italy
| | - Massimo Boffini
- Department of Cardiac Surgery, “Città Della Salute e Della Scienza Hospital”, University of Turin, 10126 Turin, Italy
| | - Mauro Mangiapia
- Division of Pneumonology, “Città della Salute e della Scienza Hospital”, University of Turin, 10126 Turin, Italy
| | - Rossana Cavallo
- Microbiology Laboratory, “Città della Salute e della Scienza”, Hospital of Turin, 10126 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- Infectious Diseases Unit, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10126 Turin, Italy
- School of Medicine, Tufts University, Boston, MA 02153, USA
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Gkrinia E, Bizaki-Vallaskangas A, Rautiainen M, Kivekäs I. Nocardia Farcinica Mastoiditis and Epidural Abscess in an Immunocompetent Patient: A Rare Entity. EAR, NOSE & THROAT JOURNAL 2022:1455613221139400. [PMID: 36453208 DOI: 10.1177/01455613221139400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Abstract
Nocardia is regarded as an opportunistic pathogen primarily affecting the respiratory system, whereas Nocardia farcinica is the species of the Nocardia family that is most frequently blamed for central nervous system impairment. The authors present the first case of mastoiditis caused by Nocardia farcinica, accompanied by intracranial complications. An immunocompetent 74-year-old woman who reported a three-week left ear discharge and a two-week facial nerve palsy was referred to our department. MRI revealed mastoiditis and epidural abscess. The bacterial cultures obtained during the surgical management of the patient confirmed the presence of Nocardia farcinica. Targeted antibiotic therapy was subsequently administrated, gradually resulting in favourable outcomes. Nocardia species provoke a disseminated infection that emerges not only among the immunosuppressed individuals but can also affect the healthy population. The nonspecific clinical manifestations in addition to the difficulties identifying the pathogen, remain obstacles to a punctual diagnosis. However, the combination of surgical debridement and antibiotic treatment with trimethoprim and sulfamethoxazole is considered the most appropriate management, leading to propitious results.
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Affiliation(s)
- Eleni Gkrinia
- Department of Ear and Oral Diseases and Otorhinolaryngology, Tampere University, Tampere, Finland
- ENT Department, University Hospital of Larissa and Department of Otorhinolaryngology - Head and Neck Surgery, University of Thessaly, Larissa, Greece
| | | | - Markus Rautiainen
- Department of Ear and Oral Diseases and Otorhinolaryngology, Tampere University, Tampere, Finland
| | - Ilkka Kivekäs
- Department of Ear and Oral Diseases and Otorhinolaryngology, Tampere University, Tampere, Finland
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Serino M, Sousa C, Redondo M, Carvalho T, Ribeiro M, Ramos A, Cruz-Martins N, Amorim A. Nocardia spp. isolation in chronic lung diseases: Are there differences between patients with Pulmonary Nocardiosis and Nocardia colonization? J Appl Microbiol 2022; 133:3239-3249. [PMID: 35957549 DOI: 10.1111/jam.15778] [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: 07/02/2021] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
AIMS Chronic lung diseases are a recognized risk factor for Nocardia spp. INFECTION Nocardia spp. isolation does not inevitably imply disease, and thus colonization must be considered. Here, we aimed to analyse the differences between pulmonary nocardiosis (PN) and Nocardia spp. colonization in patients with chronic lung diseases. METHODS AND RESULTS A retrospective study of patients with laboratory confirmation of isolation of Nocardia spp. in at least one respiratory sample was performed. Patients with PN and Nocardia spp. colonization were compared. There were 71 patients with Nocardia spp. identification, 64.8% were male, with a mean age of 67.7±11.2 years. All patients had ≥1 pre-existing chronic lung disease and 19.7% patients were immunocompromised. PN and Nocardia spp. colonization were considered in 26.8% and 73.2% of patients, respectively. Symptoms and chest CT findings were significantly more frequent in patients with PN (p<.001). During follow-up time, 12 (16.9%) patients died, 6 in PN group. Immunosuppression, constitutional symptoms, haematological malignancy and PN diagnosis were associated with significantly shorter survival times, despite only immunosuppression (HR 3.399; 95% CI 1.052-10.989) and PN diagnosis (HR 3.568; 95% CI 1.078-11.910) remained associated with a higher death risk in multivariate analysis. CONCLUSIONS PN was linked to clinical worsening, more chest CT findings and worse clinical outcomes. SIGNIFICANCE AND IMPACT OF STUDY Nocardia spp. isolation in chronic lung disease patients is more common than expected and the differentiation between colonization and disease is crucial.
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Affiliation(s)
- Mariana Serino
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Sousa
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Margarida Redondo
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Teresa Carvalho
- Clinical Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuela Ribeiro
- Clinical Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Angélica Ramos
- Clinical Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Institute of Public Health of the University of Porto (ISPUP), Portugal
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal.,Institute of Research and Advanced Training in Health Sciences and Technologies (CESPU), Rua Central de Gandra, 1317, Gandra, PRD, Portugal
| | - Adelina Amorim
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal
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Bonifaz A, Tirado-Sánchez A, Torres-Erazo D, Hernández-Castro R. Ganglionar cutaneous nocardiosis in a patient with AIDS. Int J Infect Dis 2020; 101:83-84. [DOI: 10.1016/j.ijid.2020.09.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 09/13/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022] Open
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Lee G, Robosa R, Fong G, Lee FJ, Lowe P, Pinto AN. Adult cervicofacial nocardiosis in the setting of IL-12/23 blockade. Australas J Dermatol 2019; 60:323-324. [PMID: 30945266 DOI: 10.1111/ajd.13046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Geoffrey Lee
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Dermatology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Roselle Robosa
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Gloria Fong
- Department of Dermatology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Frederick J Lee
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Patricia Lowe
- Department of Dermatology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,The University of Sydney, Sydney, New South Wales, Australia
| | - Angie N Pinto
- Department of Infectious Diseases, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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6
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Nocardia brasiliensis Preseptal Cellulitis in an Immunocompetent Patient. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Llanos Alonso N, Epalza Ibarrondo C, Carretero Vicario O, Prieto Tato LM. Niño de 7 años con celulitis preseptal de evolución tórpida. Enferm Infecc Microbiol Clin 2018; 36:662-663. [DOI: 10.1016/j.eimc.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/23/2017] [Accepted: 11/02/2017] [Indexed: 10/18/2022]
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Kobayashi K, Asakura T, Ishii M, Ueda S, Irie H, Ozawa H, Saitoh K, Kurihara I, Itoh H, Betsuyaku T. Pulmonary nocardiosis mimicking small cell lung cancer in ectopic ACTH syndrome associated with transformation of olfactory neuroblastoma: a case report. BMC Pulm Med 2018; 18:142. [PMID: 30134888 PMCID: PMC6106901 DOI: 10.1186/s12890-018-0710-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 08/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Pulmonary nocardiosis frequently develops as an opportunistic infection in cell-mediated immunosuppressive patients, and sometimes requires differentiation from pulmonary malignancy. Ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) is a neoplastic disorder which leads to impaired cell-mediated immunity, and is commonly associated with small cell lung cancer (SCLC). Because pulmonary infection and causative malignancy can appear as pulmonary lesions with EAS, differentiation of these diseases remains a critical issue for physicians. Case presentation A 52-year-old woman with progressive lower limb paralysis and general fatigue was referred to us. She had been diagnosed with olfactory neuroblastoma (ONB) and treated with surgery and radiation therapy 10 years before the referral and had required stereotactic radiosurgery and chemotherapy 4 years later for a relapse of the ONB. On referral, she presented with Cushing’s syndrome with elevated cortisol and ACTH levels. Potassium supplement improved her symptoms; however, a month later, she was urgently hospitalized due to acute pleuritic chest pain on inspiration. Chest computed tomography revealed left lower lobular consolidations and a contralateral nodule in the right middle lobe. The clinical history and laboratory work-up suggested that her Cushing’s syndrome had most likely arisen from EAS. Additionally, the lungs were suspected as the ACTH source due to high levels of progastrin-releasing peptide and progressive pulmonary consolidation with a contralateral nodule, suggesting SCLC. However, histological examination from bronchoscopy revealed no evidence of malignancy, and Nocardia cyriacigeorgica was isolated from bronchoalveolar lavage fluid. Sulfamethoxazole/trimethoprim improved her pulmonary lesions. Somatostatin receptor scintigraphy revealed strong tracer uptake in the ONB lesions, indicating that the origin of the EAS was the olfactory tumor. However, histological examination of ONB specimens resected 10 years earlier showed no intracytoplasmic immunopositivity for ACTH. Conclusions We highlight a rare case of pulmonary nocardiosis, which was associated with EAS mimicking SCLC, and was related to ONB transformation. Nocardiosis has to be considered even though anamnestic, clinical, and radiological aspects suggest the presence of metastasis. Additionally, physicians should carefully monitor patients with ONB for the development of Cushing’s symptoms because the tumor can transform into an ACTH-producing form, even after long-term follow-up.
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Affiliation(s)
- Keigo Kobayashi
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan.
| | - Soichiro Ueda
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Hidehiro Irie
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Kohei Saitoh
- Division of Endocrinology, Metabolism and Nephrology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Isao Kurihara
- Division of Endocrinology, Metabolism and Nephrology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Hiroshi Itoh
- Division of Endocrinology, Metabolism and Nephrology, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Tomoko Betsuyaku
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
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Graham JM, Bartlett KB, Gonzalez A, Messina JL, Shenefelt PD. Primary cutaneous nocardiosis in an immunocompetent host following laser resurfacing. J Am Acad Dermatol 2014; 71:e93-4. [PMID: 25128144 DOI: 10.1016/j.jaad.2014.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 02/04/2014] [Accepted: 02/05/2014] [Indexed: 10/24/2022]
Affiliation(s)
- James M Graham
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida.
| | | | - Annie Gonzalez
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Jane L Messina
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Philip D Shenefelt
- Department of Dermatology and Cutaneous Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida
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Jiménez-Gallo D, Albarrán-Planelles C, Galán-Sánchez F, Linares-Barrios M, Girón-González JA. [Primary cutaneous nocardiosis caused by Nocardia farcinica]. Rev Clin Esp 2012; 212:e49-51. [PMID: 22520872 DOI: 10.1016/j.rce.2012.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2012] [Accepted: 02/26/2012] [Indexed: 02/07/2023]
Affiliation(s)
- D Jiménez-Gallo
- Unidad de Gestión Clínica de Dermatología Médico-Quirúrgica y Venereología, Hospital Universitario Puerta del Mar, Cádiz, España.
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