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Zhao L, Yao L, Liu M, Qiu S, He J, Lin J, Tao Z, Lu Y, Deng S, Chen H, Qiu SX. Longistylin A from Cajanus cajan (L.) Millsp. disturbs glycerophospholipid metabolism and cytokinin biosynthesis of Nocardia seriolae. JOURNAL OF ETHNOPHARMACOLOGY 2024; 330:118199. [PMID: 38631486 DOI: 10.1016/j.jep.2024.118199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 04/03/2024] [Accepted: 04/12/2024] [Indexed: 04/19/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Nocardiosis is an uncommon infectious disease that bears certain similarities to tuberculosis, with a continuous increase in its incidence and a poor prognosis. In traditional Chinese medicine, the leaves of Cajanus cajan (L.) Millsp. are employed to treat wounds, malaria, coughs, and abdominal pain. AIM OF THE STUDY In this study, we investigated the effects and mechanisms of longistylin A (LGA), a natural stilbene isolated from C. cajan, as a potential antibiotic against nocardiosis. MATERIALS AND METHODS LGA was isolated from the leaves of C. cajan and assessed using a minimum bactericidal concentration (MBC) determination against Nocardia seriolae. Multi-omics analysis encompassing genes, proteins, and metabolites was conducted to investigate the impact of LGA treatment on N. seriolae. Additionally, quantitative analysis of 40 cytokinins in N. seriolae mycelium was performed to assess the specific effects of LGA treatment on cytokinin levels. Cryo-scanning electron microscopy was utilized to examine morphological changes induced by LGA treatment, particularly in the presence of exogenous trans-zeatin-O-glucoside (tZOG). The therapeutic effect of LGA was investigated by feeding N. seriolae-infected largemouth bass. RESULTS LGA exhibited significant efficacy against N. seriolae, with MBC value of 2.56 μg/mL. Multi-omics analysis revealed that LGA disrupted glycerophospholipid metabolism and hormone biosynthesis by notably reducing the expression of glycerol-3-phosphate dehydrogenase and calmodulin-like protein. Treatment with LGA markedly disrupted 12 distinct cytokinins in N. seriolae mycelium. Additionally, the addition of exogenous tZOG counteracted the inhibitory effects of LGA on filamentous growth, resulting in mycelial elongation and branching. Furthermore, LGA treatment improved the survival rate of largemouth bass infected with N. seriolae. CONCLUSIONS We found for the first time that LGA from C. cajan exhibited significant efficacy against N. seriolae by interfering with glycerophospholipid metabolism and cytokinin biosynthesis.
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Affiliation(s)
- Liyun Zhao
- State Key Laboratory of Plant Diversity and Specialty Crops & Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, 510650, China
| | - Liyuan Yao
- State Key Laboratory of Plant Diversity and Specialty Crops & Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, 510650, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Meilan Liu
- State Key Laboratory of Plant Diversity and Specialty Crops & Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, 510650, China; College of Life Science and Engineering, Foshan University, Foshan, 528231, China; Guangzhou Leader Biotechnology Co., LTD, Guangzhou, 510650, China
| | - Silin Qiu
- State Key Laboratory of Plant Diversity and Specialty Crops & Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, 510650, China
| | - Jiani He
- State Key Laboratory of Plant Diversity and Specialty Crops & Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, 510650, China; University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jindong Lin
- Guangzhou Leader Biotechnology Co., LTD, Guangzhou, 510650, China
| | - Zhengguo Tao
- Guangzhou Leader Biotechnology Co., LTD, Guangzhou, 510650, China
| | - Yu Lu
- Guangzhou Leader Biotechnology Co., LTD, Guangzhou, 510650, China
| | - Shulin Deng
- State Key Laboratory of Plant Diversity and Specialty Crops & Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, 510650, China
| | - Hongfeng Chen
- State Key Laboratory of Plant Diversity and Specialty Crops & Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, 510650, China
| | - Sheng-Xiang Qiu
- State Key Laboratory of Plant Diversity and Specialty Crops & Guangdong Provincial Key Laboratory of Applied Botany, South China Botanical Garden, Chinese Academy of Sciences, Guangzhou, 510650, China.
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Thipmontree W, Suputtamonkol Y. Comparison of clinical outcomes of pulmonary nocardiosis between AIDS and non-AIDS patients. BMC Infect Dis 2024; 24:649. [PMID: 38943055 PMCID: PMC11212375 DOI: 10.1186/s12879-024-09519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 06/17/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Nocardia species can affect both immunocompetent and immunocompromised people. METHOD This retrospective study, from 2009 to 2022, aims to compare the survival analyses of pulmonary nocardiosis in AIDS and non-AIDS patients in northeastern Thailand. RESULTS A total of 215 culture-confirmed cases of pulmonary nocardiosis: 97 with AIDS and 118 without AIDS. The median CD4 count of AIDS patients was 11 cells/µL (range: 1-198), and 33% had concurrent opportunistic infections. 63.6% of 118 non-AIDS patients received immunosuppressive medications, 28.8% had comorbidities, and 7.6% had no coexisting conditions. Disseminated nocardiosis and pleural effusion were more prevalent among AIDS patients, whereas non-AIDS patients revealed more shock and respiratory failure. One hundred-fifty patients underwent brain imaging; 15 (10%) had brain abscesses. Patients with pulmonary nocardiosis have overall 30-day and 1-year mortality rates of 38.5% (95% CI: 32.3%, 45.4%) and 52.1% (95% CI: 45.6%, 58.9%), respectively. The Cox survival analysis showed that AIDS patients with disseminated nocardiosis had a 7.93-fold (95% CI: 2.61-24.02, p < 0.001) increased risk of death within 30 days compared to non-AIDS patients when considering variables such as age, Charlson comorbidity index, concurrent opportunistic infections, duration of illness, shock, respiratory failure, multi-lobar pneumonia, lung abscesses, and combination antibiotic therapy. While AIDS and pulmonary nocardiosis had a tendency to die within 30 days (2.09 (95% CI, 0.74-5.87, p = 0.162)). CONCLUSION AIDS with pulmonary nocardiosis, particularly disseminated disease, is a serious opportunistic infection. Early diagnosis and empiric treatment with a multidrug regimen may be the most appropriate approach in a resource-limited setting.
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Affiliation(s)
- Wilawan Thipmontree
- Department of Medicine, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, 30000, Thailand.
| | - Yupin Suputtamonkol
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
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Inthasot S, Leemans S, Hing M, Vanderhulst J. Fever of unknown origin revealing testicular nocardiosis: a case report and literature review. BMC Infect Dis 2024; 24:614. [PMID: 38907186 PMCID: PMC11191271 DOI: 10.1186/s12879-024-09521-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/17/2024] [Indexed: 06/23/2024] Open
Abstract
BACKGROUND Nocardia is an ubiquitous soil organism. As an opportunistic pathogen, inhalation and skin inoculation are the most common routes of infection. Lungs and skin are the most frequent sites of nocardiosis. Testis is a highly unusual location for nocardiosis. CASE PRESENTATION We report the case of an immunocompromised 75-year-old-man admitted for fever of unknown origin. He presented with skin lesions after gardening and was first suspected of Mediterranean spotted fever, but he did not respond to doxycycline. Then, physical examination revealed new left scrotal swelling that was compatible with a diagnosis of epididymo-orchitis. The patient's condition did not improve despite empirical antibiotic treatment with the onset of necrotic scrotal abscesses requiring surgery. Nocardia brasiliensis yielded from the removed testis culture. High-dose trimethoprim-sulfamethoxazole and ceftriaxone were started. Multiple micro-abscesses were found in the brain and spinal cord on imaging studies. After 6 weeks of dual antibiotic therapy for disseminated nocardiosis, slight regression of the brain abscesses was observed. The patient was discharged after a 6-month course of antibiotics and remained relapse-free at that time of writing these lines. Trimethoprim-sulfamethoxazole alone is meant to be pursued for 6 months thereafter. We undertook a literature review on previously reported cases of genitourinary and urological nocardiosis; to date, only 36 cases have been published with predominately involvement of kidney, prostate and testis. CONCLUSIONS To the best of our knowledge, this is the first case of Nocardia brasiliensis simultaneously infecting skin, testis, brain and spinal cord in an immunocompromised patient. Knowledge on uncommon forms of nocardiosis remains scarce. This case report highlights the difficulty of diagnosing atypical nocardiosis and the importance of prompt bacteriological sampling in case of empirical antibiotics failure.
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Affiliation(s)
- Saohoine Inthasot
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | - Sophie Leemans
- Department of Infectious Diseases, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Mony Hing
- Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles-Universitair Laboratorium Brussel (LHUB-ULB), Université Libre de Bruxelles, Brussels, Belgium
| | - Julien Vanderhulst
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Pan W, Zhuo B, Wang S, Long J, Xu W, Chen M, Hong X, Ge Y. First report of Nocardia wallacei infection in an immunocompetent patient in Zhejiang province. Open Life Sci 2024; 19:20220891. [PMID: 38911931 PMCID: PMC11193390 DOI: 10.1515/biol-2022-0891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/09/2024] [Accepted: 05/18/2024] [Indexed: 06/25/2024] Open
Abstract
Nocardiosis is an infectious disease caused by Nocardia spp., mainly affecting immunocompromised hosts. Nocardia infection is not common; especially Nocardia wallacei infection is even rarer. The patient, female, 61 years old, farmer, has been working in the field for a long time and has normal immune function. Her main clinical manifestation was persistent back pain. Chest-enhanced computed tomography showed pulmonary inflammation. Rare pathogen Nocardia wallacei was detected in alveolar lavage fluid using matrix-assisted laser destructive ionization time-of-flight mass spectrometry. She received treatment with linezolid and was discharged after her condition improved.
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Affiliation(s)
- Wei Pan
- Department of Clinical Laboratory, Haiyan People’s Hospital, Haiyan, Zhejiang, 314300, China
| | - Bingqian Zhuo
- School of Public Health, Hangzhou Medical College, Hangzhou, 310053, China
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Sumei Wang
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Jieping Long
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Wei Xu
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Mengyuan Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Xin Hong
- Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, 310014, China
| | - Yumei Ge
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
- Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, 310014, China
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Schmid A, Ahmad N, Haubitz S, Speth MM. Disseminated nocardiosis presenting as a superinfected thyroglossal duct cyst in a patient with diabetes. BMJ Case Rep 2024; 17:e259725. [PMID: 38890116 PMCID: PMC11191010 DOI: 10.1136/bcr-2024-259725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/20/2024] Open
Abstract
We introduce the case of a male patient in his 60s who was admitted to our emergency department with a persisting sore throat for the last 3 weeks and dysphagia. Fibre-endoscopic evaluation revealed an asymmetry at the base of the tongue. In combination with elevated white cell count and C reactive protein, a computerized tomography showed a superinfected thyroglossal duct cyst. Intravenous antibiotics were initiated, and the patient was taken to the operating room for cervicotomy. The microbiological swab taken intraoperatively detected Nocardia paucivorans Additional imaging revealed disseminated nocardiosis with cerebral and pulmonary manifestations.The patient was treated with oral trimethoprim/sulfamethoxazole and, over time, showed complete remission of central nervous system lesions and improvement of pulmonary involvement. Following this, the treatment was stopped 8 months after the initial diagnosis. In this report, we discuss treatment standards and outcomes of nocardiosis based on our management strategies of our patient.
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Affiliation(s)
| | - Nader Ahmad
- HNO, Kantonsspital Aarau AG, Aarau, Switzerland
| | | | - Marlene Maria Speth
- University Hospital Basel, Basel, Switzerland
- Kantonsspital Aarau AG, Aarau, Switzerland
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Eichorn FC, Kameda-Smith M, Fong C, Graham AK, Main C, Lu JQ. Polymicrobial brain abscesses: A complex condition with diagnostic and therapeutic challenges. J Neuropathol Exp Neurol 2024:nlae058. [PMID: 38874452 DOI: 10.1093/jnen/nlae058] [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: 06/15/2024] Open
Abstract
Brain abscesses (BA) are focal parenchymal infections that remain life-threatening conditions. Polymicrobial BAs (PBAs) are complex coinfections of bacteria or bacterial and nonbacterial pathogens such as fungi or parasites, with diagnostic and therapeutic challenges. In this article, we comprehensively review the prevalence, pathogenesis, clinical manifestations, and microbiological, histopathological, and radiological features of PBAs, as well as treatment and prognosis. While PBAs and monomicrobial BAs have some similarities such as nonspecific clinical presentations, PBAs are more complex in their pathogenesis, pathological, and imaging presentations. The diagnostic challenges of PBAs include nonspecific imaging features at early stages and difficulties in identification of some pathogens by routine techniques without the use of molecular analysis. Imaging of late-stage PBAs demonstrates increased heterogeneity within lesions, which corresponds to variable histopathological features depending on the dominant pathogen-induced changes in different areas. This heterogeneity is particularly marked in cases of coinfections with nonbacterial pathogens such as Toxoplasma gondii. Therapeutic challenges in the management of PBAs include initial medical therapy for possibly underrecognized coinfections prior to identification of multiple pathogens and subsequent broad-spectrum antimicrobial therapy to eradicate identified pathogens. PBAs deserve more awareness to facilitate prompt and appropriate treatment.
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Affiliation(s)
- Frances-Claire Eichorn
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
| | | | - Crystal Fong
- Department of Radiology/Neuroradiology, McMaster University, Hamilton, Canada
| | - Alice K Graham
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
| | - Cheryl Main
- Department of Pathology and Molecular Medicine/Microbiology, McMaster University, Hamilton, Canada
| | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine/Diagnostic and Molecular Pathology, McMaster University, Hamilton, Canada
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Zhang L, Zhou M, Wang Z, Zhu H, Lin J, Lu M, Ge Y, Xu Y, Li T, Liu Z. Comparison of Clinical Characteristics and Treatment Outcome Between Localized and Disseminated Nocardiosis in a Tertiary Hospital in China. Infect Drug Resist 2024; 17:2379-2387. [PMID: 38894887 PMCID: PMC11185256 DOI: 10.2147/idr.s458124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024] Open
Abstract
Background In China, due to the large population, infections caused by Nocardia may not be as rare. Unfortunately, there is still inadequate knowledge of the clinical impact caused by Nocardia. This study aimed to compare the clinical characteristics and treatment of localized and disseminated nocardiosis. Methods The clinical and microbiological data of patients diagnosed with nocardiosis in a tertiary hospital in Beijing from July 2011 to July 2021 were collected and retrospectively analyzed. Results Among the 54 nocardiosis cases, 34 cases were in the localized infection group, while 20 cases in the disseminated infection group. The proportion of patients with chronic structural lung disease was higher in the localized group (P=0.010). In contrast, patients with disseminated infections were more prone to receive long-term glucocorticoids and/or immunosuppressants (P=0.027). Pulmonary nodules were prominent features of imaging changes in patients with disseminated infections (P=0.027) whereas bronchial dilatation was more common in patients with localized infections (P=0.025). In addition, the disseminated group had longer average hospitalization days relative to the localized group (P=0.016), but there was no significant difference in mortality between them (P=0.942). Conclusion There were differences in the clinical profiles between patients with localized and disseminated nocardiosis in terms of clinical presentation, infection site, radiological features, treatment, and prognosis. These findings may provide references for the management and treatment of patients with nocardiosis.
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Affiliation(s)
- Li Zhang
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Menglan Zhou
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Ziran Wang
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Hongqiong Zhu
- Department of Infectious Disease, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Jing Lin
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Minya Lu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Ying Ge
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yingchun Xu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Taisheng Li
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Zhengyin Liu
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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Fan N, Fang H, Huang F, Zhou J, Liu P, Li MJ, Ding YY. Metagenome next-generation sequencing plays a key role in the diagnosis and selection of effective antibiotics on the treatment of Nocardia pneumonia: a case report. Front Med (Lausanne) 2024; 11:1373319. [PMID: 38860208 PMCID: PMC11163097 DOI: 10.3389/fmed.2024.1373319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
Nocardia disease is an opportunistic infection, the occurrence is rare and mostly occurs in patients with immune deficiency. Even if the patient is immunocompetent, it can still be life-threatening. This case report describes a previously healthy 78-year-old male farmer with lung lesions discovered on a computerized tomography scan. Combined with the patient's history of fever and the results of elevated laboratory markers associated with inflammation, the patient was diagnosed with a lung infection. After escalating empirical broad-spectrum antibiotics, antiviral and antifungal therapy, the patient continued to deteriorate to septic shock. In the meanwhile, the patient's sputum was cultured repeatedly, and no obvious positive pathogenic bacteria were found. Considering the patient was elderly and that these lesions were solid with burr signs, as well as the progression after antimicrobial therapy cancer was considered in the differential diagnosis. Artificial intelligence (YITU, Hangzhou Yitu Medical Technology Limited Company) was also applied, and it also calculated that these lesions were cancerous. The patient received a puncture biopsy of the largest lung lesion. During the puncture pus was withdrawn from largest lung lesion. Culture and metagenome next-generation sequencing (mNGS) detection performed on pus indicated Nocardia otitidiscaviarum. The test report of the mNGS is also attached with a susceptibility report of commonly used clinical antibiotics to this Nocardia spp. Using this result, the patient's disease was quickly controlled after selecting the targeted drug compound sulfamethoxazole and intravenous meropenem for treatment. In view of the high misdiagnosis rate and poor sensitivity of culture for Nocardia spp., this case emphasized mNGS playing a key role in the diagnosis and selection of effective antibiotics for the treatment of Nocardia spp. lung infections.
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Affiliation(s)
- Na Fan
- Department of Respiratory Oncology, Renmin Hospital of Qingxian, Cangzhou, China
| | - Huang Fang
- Department of Neurology, General Hospital of Central Theater Command of the People’s Liberation Army, Wuhan, China
| | - Fang Huang
- Department of Laboratory Medicine, Renmin Hospital of Qingxian, Cangzhou, China
| | - Jie Zhou
- Department of Respiratory Oncology, Renmin Hospital of Qingxian, Cangzhou, China
| | - Peng Liu
- Department of Respiratory Oncology, Renmin Hospital of Qingxian, Cangzhou, China
| | - Meng-Jie Li
- Department of Respiratory Oncology, Renmin Hospital of Qingxian, Cangzhou, China
| | - Ye-Ying Ding
- Department of Infectious Diseases, Hospital 902 of Joint Logistics Support Force of People’s Liberation Army, Bengbu, China
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Yamamoto H, Kuroda H, Hiramoto N, Hasuike T, Doi A, Nishioka H. Successful maintenance treatment of disseminated nocardiosis with cerebral abscess in a severely immunocompromised patient allergic to trimethoprim-sulfamethoxazole using moxifloxacin and high-dose minocycline: A case report. J Infect Chemother 2024:S1341-321X(24)00121-1. [PMID: 38670455 DOI: 10.1016/j.jiac.2024.04.008] [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: 11/08/2023] [Revised: 03/08/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
Nocardiosis in patients after allogeneic hematopoietic stem cell transplantation (HSCT) is rare, but is associated with a significant mortality risk. Although trimethoprim-sulfamethoxazole (TMP/SMX) remains the cornerstone of nocardiosis treatment, optimal alternative therapies for patients intolerant to TMP/SMX are not well-established. Herein, we report a case of disseminated nocardiosis with bacteremia and multiple lesions in the lungs and brain caused by Nocardia farcinica, in a 60-year-old man who had previously undergone allogeneic HSCT and was receiving immunosuppressants for severe chronic graft-versus-host disease. The patient received atovaquone for the prophylaxis of Pneumocystis pneumonia because of a previous serious allergic reaction to TMP/SMX. The patient was initially treated with imipenem/cilastatin and amikacin, which were later switched to ceftriaxone and amikacin based on the results of antimicrobial susceptibility testing. After switching to oral levofloxacin and a standard dose of minocycline, the patient experienced a single recurrence of brain abscesses. However, after switching to oral moxifloxacin and high-dose minocycline, the patient did not experience any relapses during the subsequent two years and seven months of treatment. In treating nocardiosis with brain abscesses, it is crucial to select oral antibiotics based on the antimicrobial susceptibility test results and pharmacokinetics, especially when TMP/SMX is contraindicated. A combination of oral moxifloxacin and high-dose minocycline could be a promising alternative therapy.
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Affiliation(s)
- Hiroshi Yamamoto
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Hirokazu Kuroda
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Nobuhiro Hiramoto
- Department of Hematology, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Toshikazu Hasuike
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Asako Doi
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
| | - Hiroaki Nishioka
- Department of Infectious Diseases, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.
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Song RJ, Zhang GL. A Rare Case Report of Disseminated Nocardia Farcinica Granulomatous Hepatitis and Clinical Management Experience. Infect Drug Resist 2024; 17:1523-1528. [PMID: 38645888 PMCID: PMC11032677 DOI: 10.2147/idr.s461494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024] Open
Abstract
Background Nocardiosis is primarily an opportunistic infection affecting immunocompromised individuals, with a predilection for the lungs, brain, or skin in those with compromised immune function. Granulomatous hepatitis caused by Nocardia is a rare clinical manifestation. This study aims to provide a systematic overview of the clinical features of Nocardiosis caused by Nocardia farcinica, enhancing our understanding of this disease. Methods We report a case of a 75-year-old male with no underlying diseases presenting with a history of "recurrent fever for more than 4 months", along with fatigue, poor appetite, and pleural and abdominal effusion. Despite treatment at multiple hospitals, the patient showed little improvement. Chest CT revealed chronic inflammation, small nodules, bilateral pleural effusion, and pleural thickening. Abdominal CT indicated multiple low-density lesions in the liver, multiple small calcifications, and abdominal effusion. Results Liver biopsy suggested inflammatory changes, with focal granuloma formation. Metagenomic next-generation sequencing (mNGS) of liver tissue indicated Nocardia farcinica, leading to the final diagnosis of disseminated Nocardia farcinica granulomatous hepatitis. Conclusion Nocardia infection is a rare disease primarily observed in immunocompromised patients but can also occur in those with normal immune function. The clinical and radiological features lack specificity; however, the utilization of mNGS technology enables rapid identification of the pathogenic microorganism. Nocardia farcinica is generally susceptible to sulfonamide drugs and amikacin, offering viable treatment options.
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Affiliation(s)
- Rui Juan Song
- Department of Infectious Diseases, Anhui Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Hefei, People’s Republic of China
| | - Guang Lin Zhang
- Department of Infectious Diseases, Anhui Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Hefei, People’s Republic of China
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Wang D, Hu MT, Liu WJ, Zhao Y, Xu YC. Bacteremia caused by Nocardia farcinica: a case report and literature review. BMC Infect Dis 2024; 24:381. [PMID: 38589778 PMCID: PMC11003049 DOI: 10.1186/s12879-024-09230-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 03/17/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Nocardia farcinica is one of the most common Nocardia species causing human infections. It is an opportunistic pathogen that often infects people with compromised immune systems. It could invade human body through respiratory tract or skin wounds, cause local infection, and affect other organs via hematogenous dissemination. However, N. farcinica-caused bacteremia is uncommon. In this study, we report a case of bacteremia caused by N. farcinica in China. CASE PRESENTATION An 80-year-old woman was admitted to Peking Union Medical College Hospital with recurrent fever, right abdominal pain for one and a half month, and right adrenal gland occupation. N. farcinica was identified as the causative pathogen using blood culture and plasma metagenomics next-generation sequencing (mNGS). The clinical considerations included bacteremia and adrenal gland abscess caused by Nocardia infection. As the patient was allergic to sulfanilamide, imipenem/cilastatin and linezolid were empirically administered. Unfortunately, the patient eventually died less than a month after the initiation of anti-infection treatment. CONCLUSION N. farcinica bacteremia is rare and its clinical manifestations are not specific. Its diagnosis depends on etiological examination, which can be confirmed using techniques such as Sanger sequencing and mNGS. In this report, we have reviewed cases of Nocardia bloodstream infection reported in the past decade, hoping to improve clinicians' understanding of Nocardia bloodstream infection and help in its early diagnosis and timely treatment.
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Affiliation(s)
- Di Wang
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Meng-Ting Hu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wen-Jing Liu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Ying Zhao
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Ying-Chun Xu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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12
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O'Brien A, Hart J, Higgins A, Arthur I, Lee GH, Leung M, Kennedy K, Bradbury S, Foster S, Warren S, Korman TM, Abbott IJ, Heney C, Bletchley C, Warner M, Wells N, Wilson D, Varadhan H, Stevens R, Lahra M, Newton P, Maley M, van Hal S, Ingram PR. Nocardia species distribution and antimicrobial susceptibility within Australia. Intern Med J 2024; 54:613-619. [PMID: 37929813 DOI: 10.1111/imj.16234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Nocardia is a ubiquitous saprophyte capable of causing human disease. Disease is primarily respiratory or cutaneous, usually acquired via inhalation or inoculation. Under the influence of environmental and host factors, Nocardia incidence and species distribution demonstrate geographical variation. AIMS To examine for differences in Nocardia incidence within Western Australia (WA) and analyse species distribution in the context of prior published studies. To analyse antibiogram data from a nationwide passive antimicrobial resistance surveillance program. METHODS Retrospective extraction of laboratory data for Western Australian Nocardia isolates over a 21-year period. Analysis of Nocardia antimicrobial susceptibility testing data submitted to the Australian Passive Antimicrobial Resistance Surveillance (APAS) program between 2005 and 2022. RESULTS Nine hundred sixty WA isolates were identified, giving an annual incidence of 3.03 per 100 000 population with apparent latitudinal variation. The four most common species identified within WA and amongst APAS isolates were N. nova, N. cyriacigeorgica, N. brasiliensis and N. farcinica. APAS data demonstrated that all species exhibited high rates of susceptibility to linezolid (100%) and trimethoprim-sulfamethoxazole (98%). Amikacin (>90% susceptibility for all species except N. transvalensis) was the next most active parenteral agent, superior to both carbapenems and third-generation cephalosporins. Susceptibility to oral antimicrobials (other than linezolid) demonstrated significant interspecies variation. CONCLUSIONS We demonstrate geographical variation in the distribution of Nocardia incidence. Four species predominate in the Australian setting, and nationwide data confirm a high in vitro susceptibility to trimethoprim-sulphamethoxazole and linezolid, justifying their ongoing role as part of first-line empiric therapy.
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Affiliation(s)
- Aine O'Brien
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Julie Hart
- Department of Infectious Diseases, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Ammie Higgins
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Ian Arthur
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Gar-Hing Lee
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Michael Leung
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Karina Kennedy
- ACT Health, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Susan Bradbury
- ACT Health, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Sarah Foster
- Launceston General Hospital, Tasmanian Health Service (THS), Hobart, Tasmania, Australia
| | - Sanchia Warren
- Royal Hobart Hospital, Department of Microbiology and Infectious Diseases, Hobart, Tasmania, Australia
| | - Tony M Korman
- Monash Health, Monash Infectious Diseases, Melbourne, Victoria, Australia
| | | | - Claire Heney
- Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | - Morgyn Warner
- Infectious Diseases and Microbiology Department, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Nicholas Wells
- South Australia Pathology, Adelaide, South Australia, Australia
| | - Desley Wilson
- South Australia Pathology, Adelaide, South Australia, Australia
| | - Hemalatha Varadhan
- Hunter New England, NSW Health Pathology, Newcastle, New South Wales, Australia
| | - Robert Stevens
- South Eastern Sydney, NSW Health Pathology, Sydney, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Monica Lahra
- NSW Health Pathology, Newcastle, New South Wales, Australia
| | - Peter Newton
- Illawarra-Shoalhaven, NSW Health Pathology, Wollongong, New South Wales, Australia
| | - Michael Maley
- South Western Sydney, NSW Health Pathology, Sydney, New South Wales, Australia
- Microbiology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Sebastian van Hal
- NSW Health Pathology, Newcastle, New South Wales, Australia
- Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paul R Ingram
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
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13
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Han Y, Cheng M, Li Z, Chen H, Xia S, Zhao Y, Wang Y, He W, Wang W. Clinical characteristics and drug resistance of Nocardia in Henan, China, 2017-2023. Ann Clin Microbiol Antimicrob 2024; 23:23. [PMID: 38449006 PMCID: PMC10919010 DOI: 10.1186/s12941-024-00677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical features of Nocardia infections, antibiotic resistance profile, choice of antibiotics and treatment outcome, among others. In addition, the study compared the clinical and microbiological characteristics of nocardiosis in bronchiectasis patients and non-bronchiectasis patients. METHODS Detailed clinical data were collected from the medical records of 71 non-duplicate nocardiosis patients from 2017 to 2023 at a tertiary hospital in Zhengzhou, China. Nocardia isolates were identified to the species level using MALDI-TOF MS and 16S rRNA PCR sequencing. Clinical data were collected from medical records, and drug susceptibility was determined using the broth microdilution method. RESULTS Of the 71 cases of nocardiosis, 70 (98.6%) were diagnosed as pulmonary infections with common underlying diseases including bronchiectasis, tuberculosis, diabetes mellitus and chronic obstructive pulmonary disease (COPD). Thirteen different strains were found in 71 isolates, the most common of which were N. farcinica (26.8%) and N. cyriacigeorgica (18.3%). All Nocardia strains were 100% susceptible to both TMP-SMX and linezolid, and different Nocardia species showed different patterns of drug susceptibility in vitro. Pulmonary nocardiosis is prone to comorbidities such as bronchiectasis, diabetes mellitus, COPD, etc., and Nocardia is also frequently accompanied by co-infection of the body with pathogens such as Mycobacterium and Aspergillus spp. Sixty-one patients underwent a detailed treatment regimen, of whom 32 (52.5%) received single or multi-drug therapy based on TMP-SMX. Bronchiectasis was associated with a higher frequency of Nocardia infections, and there were significant differences between the bronchiectasis and non-bronchiectasis groups in terms of age distribution, clinical characteristics, identification of Nocardia species, and antibiotic susceptibility (P < 0.05). CONCLUSIONS Our study contributes to the understanding of the species diversity of Nocardia isolates in Henan, China, and the clinical characteristics of patients with pulmonary nocardiosis infections. Clinical and microbiologic differences between patients with and without bronchiectasis. These findings will contribute to the early diagnosis and treatment of patients.
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Affiliation(s)
- Yungang Han
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Meijin Cheng
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Zheng Li
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Huihui Chen
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Shuang Xia
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yue Zhao
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yali Wang
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Wenyi He
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Wei Wang
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China.
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China.
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14
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Toyokawa M, Ohana N, Tanno D, Imai M, Takano Y, Ohashi K, Yamashita T, Saito K, Takahashi H, Shimura H. In vitro activity of tedizolid against 43 species of Nocardia species. Sci Rep 2024; 14:5342. [PMID: 38438563 PMCID: PMC10912709 DOI: 10.1038/s41598-024-55916-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/28/2024] [Indexed: 03/06/2024] Open
Abstract
The purpose of the present study was to evaluate the in vitro activity of tedizolid against several clinically significant species of Nocardia by comparing with that of linezolid. A total of 286 isolates of Nocardia species, including 236 clinical isolates recovered from patients in Japan and 50 strains (43 species) purchased from NITE Biological Resource Center, were studied. Antimicrobial susceptibility testing was performed using the broth microdilution method. For the 286 Nocardia isolates, the minimal inhibitory concentration (MIC)50 and MIC90 values of tedizolid were 0.25 and 0.5 μg/ml, and those of linezolid were 2 and 2 μg/ml, respectively. The distribution of the linezolid/tedizolid ratios (MICs of linezolid/MICs of tedizolid) showed that tedizolid had four- to eight-fold higher activity than linezolid in 96.1% (275/286) of Nocardia isolates. Both the tedizolid and linezolid MIC90 values for Nocardia brasiliensis were two-fold higher than those for the other Nocardia species. Both tedizolid and linezolid had low MIC values, 0.25-1 μg/ml and 0.5-4 μg/ml, respectively, even against nine isolates (five species) that were resistant to trimethoprim/sulfamethoxazole. One Nocardia sputorum isolate showed reduced susceptibility to tedizolid (4 μg/ml). Bioinformatics analysis suggests different resistance mechanisms than the oxazolidinone resistance seen in enterococci and staphylococci.
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Affiliation(s)
- Masahiro Toyokawa
- Department of Clinical Laboratory Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, 10-6, Sakaemachi, Fukushima City, Fukushima, 960-8516, Japan.
- Department of Laboratory Medicine, Fukushima Medical University, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan.
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Noboru Ohana
- Department of Laboratory Medicine, Fukushima Medical University, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Daiki Tanno
- Department of Clinical Laboratory Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, 10-6, Sakaemachi, Fukushima City, Fukushima, 960-8516, Japan
- Department of Laboratory Medicine, Fukushima Medical University, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Minako Imai
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Yukiko Takano
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Kazutaka Ohashi
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Tomonari Yamashita
- Clinical Testing Department, MicroSKY Lab, Inc., Center Building Kanamachi 2F, 6-6-5 Higashikanamachi, Katsushika-ku, Tokyo, 125-0041, Japan
| | - Kyoichi Saito
- Department of Laboratory Medicine, Fukushima Medical University, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Hiroki Takahashi
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8673, Japan
- Molecular Chirality Research Center, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan
- Plant Molecular Science Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8675, Japan
| | - Hiroki Shimura
- Department of Laboratory Medicine, Fukushima Medical University, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
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15
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Zhu W, Shu Z, Song H. A rare case of a hard-to-heal ulcer caused by pulmonary Nocardia infection. J Wound Care 2024; 33:197-200. [PMID: 38451789 DOI: 10.12968/jowc.2024.33.3.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
- Wei Zhu
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Ziqin Shu
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Huapei Song
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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16
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Feng Y, Zuo CL, Shi JX. Brucella infection combined with Nocardia infection: A case report and literature review. Open Life Sci 2024; 19:20220815. [PMID: 38465335 PMCID: PMC10921472 DOI: 10.1515/biol-2022-0815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 03/12/2024] Open
Abstract
Human brucellosis is an infectious disease caused by Brucella and is often misdiagnosed for atypical manifestations including fever of unknown origin, headache, weakness, among else. Nocardiosis is a zoonotic disease caused by the genus Nocardia, which usually spreads through the respiratory tract, skin, and digestive tract. Limited research has documented cases of co-infection involving both Brucella and Nocardia pathogens in patients. A 55-year-old male was admitted to our hospital with intermittent high-grade fever. Following sputum and blood cultures, as well as other laboratory examinations, the patient was diagnosed with concurrent brucellosis and nocardiosis. According to recommendations of previous studies and reports, the patient was successively treated with levofloxacin, doxycycline, piperacillin sodium and sulbactam sodium, trimethoprim-sulfamethoxazole, rifampicin, and tigecycline, after which the patient recovered and was discharged. Brucella and Nocardia are both opportunistic pathogens and simultaneous infection of Brucella and Nocardia is relatively rare. If patients continue to experience persistent fever despite receiving empirical antibiotic therapy, it becomes necessary to conduct examinations to identify potential atypical pathogens, including Brucella and Nocardia. Sputum staining, sputum culture, and blood culture are critical auxiliary examinations during clinical practice. The treatment plan should be selected based on guidelines and the individual patient's condition. Regular reevaluation should be conducted, and antimicrobial agents should be adjusted accordingly.
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Affiliation(s)
- Yan Feng
- Department of Pulmonary and Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, Lianyungang First People’s Hospital, 6 East Zhenhua Road, Lianyungang, 222006, China
| | - Chun-Lei Zuo
- Laboratory Department, Lianyungang Clinical College of Nanjing Medical University, Lianyungang First People’s Hospital, 6 East Zhenhua Road, Lianyungang, 222006, China
| | - Jia-Xin Shi
- Department of Pulmonary and Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, Lianyungang First People’s Hospital, 6 East Zhenhua Road, Lianyungang, 222006, China
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17
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He S, Lin Y. Primary cutaneous nocardiosis in an immunocompetent host. Clin Case Rep 2024; 12:e8516. [PMID: 38374880 PMCID: PMC10875629 DOI: 10.1002/ccr3.8516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/21/2024] Open
Abstract
Nocardiosis is a rare opportunistic infection that is classically observed in immunocompromised patients but can also affect immunocompetent individuals. It tends to involve the lung, central nervous system, and skin and is often misdiagnosed.
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Affiliation(s)
- Shihuan He
- Department of Dermatology and VenereologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
| | - Youkun Lin
- Department of Dermatology and VenereologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
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18
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Amano T, Nishikawa T, Oka K, Ota K, Shimizu T. How an Antimicrobial Stewardship Team Treated a Nocardia farcinica-Associated Brain Abscess: A Case Report. Cureus 2024; 16:e54605. [PMID: 38523941 PMCID: PMC10958982 DOI: 10.7759/cureus.54605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Nocardia species, which are ubiquitous in the environment, form lesions primarily in immunocompromised patients via oral or cutaneous infection. Some of these Nocardia species, such as N. farcinica, also infect the central nervous system via hematogenous dissemination, which rarely results in brain abscesses. Notably, N. farcinica is resistant to numerous antimicrobial drugs used in empirical therapy, necessitating the intervention of an infectious disease specialist. To date, no case of antimicrobial stewardship teams (ASTs) playing a central role in community hospitals without an infectious disease specialist has been reported. Here, we describe a case of N. farcinica-associated brain abscess in a small-to-medium-sized hospital with no infectious disease department or specialist, in which the AST assisted in the identification of the causative organism and in selecting appropriate therapeutic agents, ultimately leading to a cure. The patient was an 88-year-old man with a high fever. He had been taking prednisolone (10-15 mg/day) for approximately 1 year for pemphigoid. Considering the possibility of fever owing to bacteremia of cutaneous origin, ampicillin/sulbactam antimicrobial therapy at 6 g/day was initiated. A subsequent close examination led to the diagnosis of a brain abscess. Emergency abscess drainage was performed by a neurosurgeon, and postoperative antimicrobial combination therapy comprising ceftriaxone (4 g/day), vancomycin (2 g/day), and metronidazole (1,500 mg/day) was commenced. The AST suspected Nocardia infection earlier, but further testing was difficult to perform at this facility. Therefore, by requesting assistance from Nagoya University Hospital, we performed early bacterial identification by mass spectrometry and appropriate antimicrobial susceptibility testing by a custom panel on day 11. The patient was non-responsive to all the previously used antibiotics at the time of admission. On day 13 after admission, the patient was successfully treated with trimethoprim-sulfamethoxazole (TMP-SMX) and imipenem/cilastatin sodium, and the patient was cured. The AST can be as effective as an infectious disease specialist when a strong working relationship is established between the team and clinicians. Further, the activities of the AST can improve patient survival via active medical support in collaboration with attending physicians.
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Affiliation(s)
- Tetsushi Amano
- Antimicrobial Stewardship Team, Hekinan Municipal Hospital, Hekinan, JPN
- Department of Pharmacy, Hekinan Municipal Hospital, Hekinan, JPN
| | | | - Keisuke Oka
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, JPN
| | - Kosei Ota
- Antimicrobial Stewardship Team, Hekinan Municipal Hospital, Hekinan, JPN
- Department of Clinical Laboratory, Hekinan Municipal Hospital, Hekinan, JPN
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, JPN
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19
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Passerini M, Nayfeh T, Yetmar ZA, Coussement J, Goodlet KJ, Lebeaux D, Gori A, Mahmood M, Temesgen Z, Murad MH. Trimethoprim-sulfamethoxazole significantly reduces the risk of nocardiosis in solid organ transplant recipients: systematic review and individual patient data meta-analysis. Clin Microbiol Infect 2024; 30:170-177. [PMID: 37865337 DOI: 10.1016/j.cmi.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/06/2023] [Accepted: 10/08/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Whether trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis prevents nocardiosis in solid organ transplant (SOT) recipients is controversial. OBJECTIVES To assess the effect of TMP-SMX in the prevention of nocardiosis after SOT, its dose-response relationship, its effect on preventing disseminated nocardiosis, and the risk of TMP-SMX resistance in case of breakthrough infection. METHODS A systematic review and individual patient data meta-analysis. DATA SOURCES MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection, and Scopus up to 19 September 2023. STUDY ELIGIBILITY CRITERIA (a) Risk of nocardiosis between SOT recipients with and without TMP-SMX prophylaxis, or (b) sufficient details to determine the rate of TMP-SMX resistance in breakthrough nocardiosis. PARTICIPANTS SOT recipients. INTERVENTION TMP-SMX prophylaxis versus no prophylaxis. ASSESSMENT OF RISK OF BIAS Risk Of Bias In Non-randomized Studies-of Exposure (ROBINS-E) for comparative studies; dedicated tool for non-comparative studies. METHODS OF DATA SYNTHESIS For our primary outcome (i.e. to determine the effect of TMP-SMX on the risk of nocardiosis), a one-step mixed-effects regression model was used to estimate the association between the outcome and the exposure. Univariate and multivariable unconditional regression models were used to adjust for the potential confounding effects. Certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Individual data from three case-control studies were obtained (260 SOT recipients with nocardiosis and 519 uninfected controls). TMP-SMX prophylaxis was independently associated with a significantly decreased risk of nocardiosis (adjusted OR = 0.3, 95% CI 0.18-0.52, moderate certainty of evidence). Variables independently associated with an increased risk of nocardiosis were older age, current use of corticosteroids, high calcineurin inhibitor concentration, recent acute rejection, lower lymphocyte count, and heart transplant. Breakthrough infections (66/260, 25%) were generally susceptible to TMP-SMX (pooled proportion 98%, 95% CI 92-100). CONCLUSIONS In SOT recipients, TMP-SMX prophylaxis likely reduces the risk of nocardiosis. Resistance appears uncommon in case of breakthrough infection.
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Affiliation(s)
- Matteo Passerini
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy; Department of Infectious Disease, ASST FBF SACCO Fatebenefratelli, Milan, Lombardia, Italy.
| | - Tarek Nayfeh
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zachary A Yetmar
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA; Department of Infectious Diseases, Respiratory Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Julien Coussement
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia; Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Guadeloupe, Les Abymes, Guadeloupe, France
| | - Kellie J Goodlet
- Department of Pharmacy Practice, Midwestern University, Glendale, AZ, USA; Norton Thoracic Institute, Dignity Health - St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - David Lebeaux
- Institut Pasteur, Université Paris Cité, CNRS UMR 6047, Genetics of Biofilms Laboratory, Paris, France; Département de Maladies Infectieuses et Tropicales, AP-HP, Hôpital Saint-Louis, Lariboisière, Paris, France
| | - Andrea Gori
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy; Department of Infectious Disease, ASST FBF SACCO Fatebenefratelli, Milan, Lombardia, Italy; Centre for Multidisciplinary Research in Health Science (MACH), University of Milan, Milan, Italy
| | - Maryam Mahmood
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zelalem Temesgen
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohammad H Murad
- Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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Xu Y, Qian H, Qian W, Dong L, Liu W, Zhu Y, Mei Y, Xu Y, Wang L, Xia Y, Qi X, Mei H, Xu X, Mao H, Xing C, Wang N. Successful rescue of disseminated Nocardia infection with multiple abscesses in a patient with membranous nephropathy after cardiopulmonary resuscitation: A three-year follow-up. J Biomed Res 2024; 38:189-194. [PMID: 38268134 PMCID: PMC11001588 DOI: 10.7555/jbr.37.20230107] [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: 04/23/2023] [Revised: 09/25/2023] [Accepted: 10/07/2023] [Indexed: 01/26/2024] Open
Abstract
Nocardiosis manifests as an opportunistic infection, primarily affecting individuals who are immunocompromised and susceptible to the infection. We present a case study of one patient with nephrotic syndrome and membranous nephropathy, who underwent treatment with prednisone and cyclosporine in 2016. In early 2017, the patient was diagnosed with a "fungal infection" and discontinued the use of cyclosporine. After one month of anti-infection therapy, a cranial magnetic resonance imaging scan showed multiple abscesses in the right temporal region. The diagnosis of nocardiosis was confirmed based on the presence of metastatic abscess masses, multiple lung and brain lesions, and a positive culture of Nocardia in the drainage. We changed the anti-infection therapy to a combination of trimethoprim-sulfamethoxazole (TMP-SMX), minocycline, and voriconazole. However, the patient experienced a sudden cardiac arrest and subsequently recovered after cardiopulmonary resuscitation. During the five-month follow-up period following the discharge, the patient displayed an enhanced nutritional status and stable renal function. The focal infection ultimately resolved during the subsequent three years. Neuro-infection caused by Nocardia should be considered in immunocompromised patients, and TMP-SMX is the preferred initial therapy; however, because of the high mortality rate, a long-term combination therapy with imipenem, cefotaxime, amikacin, and TMP-SMX is suggested.
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Affiliation(s)
- Yili Xu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Hanyang Qian
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
- Department of Nephrology, Nanjing Tongren Hospital, Nanjing, Jiangsu 211102, China
| | - Wen Qian
- Department of Image, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Li Dong
- Department of Infectious Disease, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Weiying Liu
- Department of Nephrology, the Second Hospital of Nanjing, Nanjing, Jiangsu 210029, China
| | - Yan Zhu
- Department of Nephrology, the Second Hospital of Nanjing, Nanjing, Jiangsu 210029, China
| | - Yaning Mei
- Department of Microorganism, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Yi Xu
- Department of Image, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Ling Wang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Yi Xia
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Xu Qi
- Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Huanping Mei
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Xueqiang Xu
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Huijuan Mao
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Changying Xing
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
| | - Ningning Wang
- Department of Nephrology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, Jiangsu 210029, China
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21
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Kisiel M, Bass VM, Fong C, Graham AK, Yahya S, Eichorn FC, Lannon M, Kameda-Smith M, Reddy KKV, Lu JQ. Clinicopathologic characteristics of Nocardia brain abscesses: Necrotic and non-necrotic foci of various stages. J Neurol Sci 2024; 456:122850. [PMID: 38142539 DOI: 10.1016/j.jns.2023.122850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/09/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
Nocardia brain abscesses are rare bacterial infections associated with a high mortality rate, and their preoperative diagnosis can be difficult for various reasons including a nonspecific clinical presentation. While late-stage nocardial brain abscesses may be radiologically characteristic, early-stage lesions are nonspecific and indistinguishable from another inflammatory/infectious process and other mimics. Despite the paucity of previous histopathological descriptions, histopathological examination is critical for the identification of the pathogen, lesion stage(s), and possible coexisting pathology. In this study, we examined the clinical, radiological and histopathological features of 10 patients with brain nocardiosis. Microscopic findings were analysed in correlation with clinical and radiological features in 9 patients, which revealed that brain nocardiosis was characterized by numerous necrotic and non-necrotic foci of various stages (I-IV) along with Nocardia identification, as well as the leptomeningeal involvement in most cases, and co-infection of brain nocardiosis with toxoplasmosis in 2 patients. The imaging features were characteristic with a multilobulated/bilobed ring-enhancing appearance in 8 patients including 2 patients with multiple lobulated and non-lobulated lesions and 1 patient showing the progression from a non-lobulated to lobulated lesion. These findings suggest that nocardial brain abscesses particularly at late-stages share common characteristics. Nevertheless, given the complex pathologic features, including possible co-infection by other pathogens, nocardial brain abscesses remain a therapeutic challenge.
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Affiliation(s)
- Marta Kisiel
- Department of Pathology and Molecular Medicine, Canada
| | | | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Sultan Yahya
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, Canada.
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22
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Stellern JJ, Plaisted J, Welles C. Disseminated nocardiosis with persistent neurological disease. BMJ Case Rep 2024; 17:e257935. [PMID: 38195189 PMCID: PMC10806866 DOI: 10.1136/bcr-2023-257935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
A man in his 80s with a history of sarcoidosis on chronic prednisone presented to the emergency department with several days of dyspnoea. A chest X-ray showed signs of pneumonia, and the patient was admitted. Blood and pleural fluid cultures grew Nocardia farcinica; therefore, the patient was started on treatment with trimethoprim-sulbactam and imipenem. Brain imaging showed evidence of dissemination of the infection to the central nervous system (CNS). The patient's admission was complicated by pleural effusions, acute kidney injury and pancytopenia, and therefore, his antibiotic regimen was ultimately transitioned from trimethoprim-sulfamethoxazole (TMP-SMX), meropenem and linezolid to imipenem and tedizolid. The patient received imipenem and tedizolid for the remainder of the admission. A repeat MRI of the brain was performed after 6 weeks of this dual antibiotic therapy, which unfortunately revealed persistent CNS disease. His regimen was then broadened to TMP-SMX, linezolid and imipenem. Despite these measures, however, the patient ultimately passed away from the infection.
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Affiliation(s)
| | - Jacob Plaisted
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Christine Welles
- University of Colorado School of Medicine, Aurora, Colorado, USA
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23
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Tajima Y, Tashiro T, Furukawa T, Murata K, Takaki A, Sugahara K, Sakagami A, Inaba M, Marutsuka T, Hirata N. Pulmonary Nocardiosis With Endobronchial Involvement Caused by Nocardiaaraoensis. Chest 2024; 165:e1-e4. [PMID: 38199738 DOI: 10.1016/j.chest.2023.07.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 01/12/2024] Open
Abstract
We report a rare case of pulmonary nocardiosis with endobronchial involvement caused by Nocardia araoensis. A 79-year-old man with a history of asthma and a previous right upper lobectomy for lung cancer and organizing pneumonia presented with cough and dyspnea. He presented with right bronchial stenosis associated with various mucosal lesions, including ulcerative and exophytic lesions. N araoensis was detected in sputum samples collected via bronchoscopy. The mucosal lesions improved after a 2-week course of meropenem. After a further 6 months of oral sulfamethoxazole-trimethoprim treatment, the mucosal lesions completely disappeared. Based on bronchoscopic and pathophysiologic findings, the patient was diagnosed with pulmonary nocardiosis with endobronchial involvement. Nocardiosis should be considered in the differential diagnosis of endobronchial mucosal lesions.
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Affiliation(s)
- Yuka Tajima
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan.
| | - Takahiro Tashiro
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Tsuguhiro Furukawa
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Katsumi Murata
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Akira Takaki
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Kazuaki Sugahara
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Akiko Sakagami
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Megumi Inaba
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Takashi Marutsuka
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Naomi Hirata
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
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24
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Feuillard J, Couston J, Benito Y, Hodille E, Dumitrescu O, Blaise M. Biochemical and structural characterization of a class A β-lactamase from Nocardia cyriacigeorgica. Acta Crystallogr F Struct Biol Commun 2024; 80:13-21. [PMID: 38168018 PMCID: PMC10833343 DOI: 10.1107/s2053230x23010671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024] Open
Abstract
Nocardia are Gram-positive bacteria from the Actinobacteria phylum. Some Nocardia species can infect humans and are usually considered to be opportunist pathogens, as they often infect immunocompromised patients. Although their clinical incidence is low, many Nocardia species are now considered to be emerging pathogens. Primary sites of infection by Nocardia are the skin or the lungs, but dissemination to other body parts is very frequent. These disseminated infections are very difficult to treat and thus are tackled with multiple classes of antibiotics, in addition to the traditional treatment targeting the folate pathway. β-Lactams are often included in the regimen, but many Nocardia species present moderate or strong resistance to some members of this drug class. Genomic, microbiological and biochemical studies have reported the presence of class A β-lactamases (ABLs) in a handful of Nocardia species, but no structural investigation of Nocardia β-lactamases has yet been performed. In this study, the expression, purification and preliminary biochemical characterization of an ABL from an N. cyriacigeorgica (NCY-1) clinical strain are reported. The crystallization and the very high resolution crystal structure of NCY-1 are also described. The sequence and structural analysis of the protein demonstrate that NCY-1 belongs to the class A1 β-lactamases and show its very high conservation with ABLs from other human-pathogenic Nocardia. In addition, the presence of one molecule of citrate tightly bound in the catalytic site of the enzyme is described. This structure may provide a solid basis for future drug development to specifically target Nocardia spp. β-lactamases.
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Affiliation(s)
| | - Julie Couston
- IRIM, Montpellier University, CNRS, Montpellier, France
| | - Yvonne Benito
- Institut des Agents Infectieux, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Centre de Biologie Nord, Lyon, France
| | - Elisabeth Hodille
- Institut des Agents Infectieux, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Centre de Biologie Nord, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, ENS Lyon, Université Lyon 1, Lyon, France
| | - Oana Dumitrescu
- Institut des Agents Infectieux, Hospices Civils de Lyon, Hôpital de la Croix-Rousse, Centre de Biologie Nord, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), INSERM U1111, CNRS UMR5308, ENS Lyon, Université Lyon 1, Lyon, France
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25
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Maccio U, Gianolio A, Rets AV. Granulomas in bone marrow biopsies: clinicopathological significance and new perspectives. J Clin Pathol 2023; 77:8-15. [PMID: 37640519 DOI: 10.1136/jcp-2023-209104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
Bone marrow granulomas in trephine biopsies are a rare and usually incidental finding. Possible causes include infectious (especially tuberculous and rarer non-tuberculous mycobacteria, but also many other bacterial, viral, fungal and parasitic agents) and non-infectious causes (especially medications, autoimmune disease, sarcoidosis, haematological and non-haematological malignancy). Necrotising granulomas are generally suggestive of an infectious aetiology (tuberculosis being the most common), whereas fibrin ring granulomas are associated with Q-fever and Epstein Barr Virus, although exceptions are possible. Every case suspicious for infectious aetiology should undergo further analysis like special staining (Ziehl-Neelsen for acid-fast rods) or molecular studies. The histomorphology should always be clinically correlated. In cases in which no infectious cause can be identified, untargeted metagenomics may represent a valid diagnostic tool that may become standard in the near future for bone marrow diagnostics. In this review, we have analysed the published data from 1956 up to today, and we report aspects of epidemiology, aetiology, diagnostic algorithms, differential diagnosis and the role of metagenomics in bone marrow biopsies with granulomas.
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Affiliation(s)
- Umberto Maccio
- Pathology and Molecular Pathology, University Hospital Zurich, Zürich, Switzerland
| | - Alessandra Gianolio
- Department of Medical Sciences, University of Turin, Torino, Piemonte, Italy
| | - Anton V Rets
- Department of Hematopathology, ARUP Laboratories Inc, Salt Lake City, Utah, USA
- Pathology, The University of Utah School of Medicine, Salt Lake City, Utah, USA
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26
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Ji Y, Su F, Hong X, Chen M, Zhu Y, Cheng D, Ge Y. Successful treatment with amoxicillin-clavulanic acid: cutaneous nocardiosis caused by Nocardia brasiliensis. J DERMATOL TREAT 2023; 34:2229467. [PMID: 37394975 DOI: 10.1080/09546634.2023.2229467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/04/2023] [Indexed: 07/04/2023]
Abstract
AIM To emphasize the role of non-sulfonamides in the treatment of Nocardia infection and reduce the adverse reactions caused by sulfonamides. METHODS We retrospectively analyzed a case of cutaneous nocardiosis in an immunocompetent individual. The colonies obtained by staining the pus in the lesion with antacid and culturing the agar plates were identified by flight mass spectrometry. The pathogenic identification showed Nocardia brasiliensis infection and the patient was treated with amoxicillin-clavulanic acid. RESULTS After treatment with amoxicillin and clavulanic acid, the ulcer gradually peeled and crusted, leaving dark pigmentation. The patient has finally recovered. CONCLUSION Sulfonamides are the first-line antibacterial agents for years in treatment of nocardiosis but are of great toxicity and side effects. This patient was successfully treated with amoxicillin-clavulanic acid and it provided a reference protocol for patients with sulfonamide-resistant Nocardia or sulfonamides intolerance.
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Affiliation(s)
- Youqi Ji
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Fang Su
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Xin Hong
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
- Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Mengyuan Chen
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Yongze Zhu
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
| | - Dongqing Cheng
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yumei Ge
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, China
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
- Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, China
- Key Laboratory of Biomarkers and In Vitro Diagnosis Translation of Zhejiang province, Hangzhou, Zhejiang, China
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27
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Gupta S, Grant LM, Powers HR, Kimes KE, Hamdi A, Butterfield RJ, Gea-Banacloche J, Vijayvargiya P, Hata DJ, Meza Villegas DM, Dumitrascu AC, Harris DM, Chirila RM, Zhang N, Razonable RR, Kusne S, Alvarez S, Vikram HR. Invasive Nocardia Infections across Distinct Geographic Regions, United States. Emerg Infect Dis 2023; 29. [PMID: 37987603 PMCID: PMC10683819 DOI: 10.3201/eid2912.230673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
We reviewed invasive Nocardia infections in 3 noncontiguous geographic areas in the United States during 2011–2018. Among 268 patients with invasive nocardiosis, 48.2% were from Minnesota, 32.4% from Arizona, and 19.4% from Florida. Predominant species were N. nova complex in Minnesota (33.4%), N. cyriacigeorgica in Arizona (41.4%), and N. brasiliensis in Florida (17.3%). Transplant recipients accounted for 82/268 (30.6%) patients overall: 14 (10.9%) in Minnesota, 35 (40.2%) in Arizona, and 33 (63.5%) in Florida. Manifestations included isolated pulmonary nocardiosis among 73.2% of transplant and 84.4% of non–transplant patients and central nervous system involvement among 12.2% of transplant and 3.2% of non–transplant patients. N. farcinica (20.7%) and N. cyriacigeorgica (19.5%) were the most common isolates among transplant recipients and N. cyriacigeorgica (38.0%), N. nova complex (23.7%), and N. farcinica (16.1%) among non–transplant patients. Overall antimicrobial susceptibilities were similar across the 3 study sites.
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Kim S, Shi HJ, Jeon CH, Kim SB, Yi J, Kim AR, Kim KH, Lim S. Clinical Characteristics of Nocardiosis: a Multicenter Retrospective Study in Korea. Infect Chemother 2023; 55:431-440. [PMID: 37674336 PMCID: PMC10771949 DOI: 10.3947/ic.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/21/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Nocardiosis is a rare, but potentially life-threatening condition. It is difficult to diagnose, and bacterial culture identification can be time consuming. We investigated the characteristics of nocardiosis and the suitability of the treatment approach in Korea. MATERIALS AND METHODS This retrospective study was conducted at 5 medical institutions between 2011 and 2021. We reviewed the medical records of patients with microbiologically confirmed nocardiosis. Appropriate antibiotic selection was defined as follows: (1) selecting antibiotics according to the species, (2) if the species of Nocardia was unknown, trimethoprim-sulfamethoxazole-based therapy or linezolid-based therapy was administered, and (3) selection of antibiotics using the antibiotic susceptibility test. The appropriate treatment periods for antibiotics were defined as treatment maintained from 3 to 12 months, depending on involvement of the organs. Descriptive analysis and Fisher exact test were used. Statistical significance was set at P-values of <0.05. RESULTS Thirty patients were enrolled. Of these patients, 18 (60.0%) were male. The median age was 70.5 years. Among the diagnosed patients, 12 (40.0%) had an immunocompromised status. Eight (30.0%) patients received optimal treatment for the appropriate treatment period. Appropriate dosing duration was observed in 3 of the 12 (25.0%) immunocompromised patients. There was no significant difference between the presence or absence of immunosuppression and the adequacy of treatment for nocardiosis (P = 1.000). Skin and soft tissue (14 patients) were most frequently involved in this study. Nocardia species (spp.) were isolated from culture at a median of 6.0 days. There were 7 cases with N. farcinica (23.3%). CONCLUSION We found that 60.0% of the patients with nocardiosis did not have an immunocompromised status. Further, 26.7% of the total patients received adequate treatment for nocardiosis. The reasons for suboptimal management of nocardiosis in Korea are presumed to be diagnostic difficulties, lack of awareness about nocardiosis, and difficulties in selecting antibiotics for Nocardia spp. among clinicians. The lack of antibiotic susceptibility tests for Nocardia spp. could be the source of these problems. Nocardiosis should be suspected in cases of recurrent infections with skin and soft tissue, musculoskeletal, or respiratory system involvement with or without an immunocompromised status. Clinical microbiological support is required for the diagnosis and selection of antibiotics in Korea. High clinical index of suspicion and clinical microbiological support are required for the accurate diagnosis of nocardiosis in Korea.
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Affiliation(s)
- Seulki Kim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hye Jin Shi
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Cheon-Hoo Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - A Reum Kim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kye-Hyung Kim
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
| | - Seungjin Lim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
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29
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Sun H, Xie X, Wang Y, Wang J, Deng T. Clinical screening of Nocardia in sputum smears based on neural networks. Front Cell Infect Microbiol 2023; 13:1270289. [PMID: 38094748 PMCID: PMC10716215 DOI: 10.3389/fcimb.2023.1270289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Objective Nocardia is clinically rare but highly pathogenic in clinical practice. Due to the lack of Nocardia screening methods, Nocardia is often missed in diagnosis, leading to worsening the condition. Therefore, this paper proposes a Nocardia screening method based on neural networks, aiming at quick Nocardia detection in sputum specimens with low costs and thereby reducing the missed diagnosis rate. Methods Firstly, sputum specimens were collected from patients who were infected with Nocardia, and a part of the specimens were mixed with new sputum specimens from patients without Nocardia infection to enhance the data diversity. Secondly, the specimens were converted into smears with Gram staining. Images were captured under a microscope and subsequently annotated by experts, creating two datasets. Thirdly, each dataset was divided into three subsets: the training set, the validation set and the test set. The training and validation sets were used for training networks, while the test set was used for evaluating the effeteness of the trained networks. Finally, a neural network model was trained on this dataset, with an image of Gram-stained sputum smear as input, this model determines the presence and locations of Nocardia instances within the image. Results After training, the detection network was evaluated on two datasets, resulting in classification accuracies of 97.3% and 98.3%, respectively. This network can identify Nocardia instances in about 24 milliseconds per image on a personal computer. The detection metrics of mAP50 on both datasets were 0.780 and 0.841, respectively. Conclusion The Nocardia screening method can accurately and efficiently determine whether Nocardia exists in the images of Gram-stained sputum smears. Additionally, it can precisely locate the Nocardia instances, assisting doctors in confirming the presence of Nocardia.
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Affiliation(s)
- Hong Sun
- Department of Laboratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xuanmeng Xie
- Effect, Jianying, Intelligent Creation Lab, Bytedance Inc., Hangzhou, China
| | - Yaqi Wang
- College of Media Engineering, Communication University of Zhejiang, Hangzhou, China
| | - Juan Wang
- Department of Laboratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Tongyang Deng
- Department of Laboratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Pino-Rosa S, Medina-Pascual MJ, Carrasco G, Garrido N, Villalón P, Valiente M, Valdezate S. Focusing on Gordonia Infections: Distribution, Antimicrobial Susceptibilities and Phylogeny. Antibiotics (Basel) 2023; 12:1568. [PMID: 37998770 PMCID: PMC10668661 DOI: 10.3390/antibiotics12111568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
The immunosuppression conditions and the presence of medical devices in patients favor the Gordonia infections. However, the features of this aerobic actinomycete have been little explored. Strains (n = 164) were characterized with 16S rDNA and secA1 genes to define their phylogenetic relationships, and subjected to broth microdilution to profile the antimicrobial susceptibilities of Gordonia species that caused infections in Spain during the 2005-2021 period. Four out of the eleven identified species were responsible for 86.0% of the infections: Gordonia sputi (53.0%), Gordonia bronchialis (18.3%), Gordonia terrae (8.5%) and Gordonia otitidis (6.1%). Respiratory tract infections (61.6%) and bacteremia (21.9%) were the most common infections. The secA1 gene resolved the inconclusive identification, and two major clonal lineages were observed for G. sputi and G. bronchialis. Species showed a wide antimicrobial susceptibility profile. Cefoxitin resistance varies depending on the species, reaching 94.2% for G. sputi and 36.0% for G. terrae. What is noteworthy is the minocycline resistance in G. sputi (11.5%), the clarithromycin resistance in G. bronchialis secA1 lineage II (30.0%) and the amoxicillin-clavulanate and cefepime resistance in G. terrae (21.4% and 42.8%, respectively). G. sputi and G. bronchialis stand out as the prevalent species causing infections in Spain. Resistance against cefoxitin and other antimicrobials should be considered.
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Affiliation(s)
| | | | | | | | | | | | - Sylvia Valdezate
- Reference and Research Laboratory for Taxonomy, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, 28220 Madrid, Spain; (S.P.-R.); (M.J.M.-P.); (G.C.); (N.G.); (P.V.); (M.V.)
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Fernández Vecilla D, Roche Matheus MP, Urrutikoetxea Gutiérrez MJ, Calvo Muro FE, Aspichueta Vivanco C, López Azkarreta I, Grau García M, Díaz de Tuesta Del Arco JL. Disseminated Nocardia farcinica infection associated with bacteraemia and osteomyelitis pubis in an elderly patient. Infect Dis (Lond) 2023; 55:738-743. [PMID: 37376969 DOI: 10.1080/23744235.2023.2229425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE We describe a rare case of a disseminated Nocardia farcinica infection associated with hip osteomyelitis. METHODS A 91-year-old female patient was admitted with oedema of her right leg, fever of 38 °C and data consistent with ruptured Baker's cyst. A disseminated Nocardia farcinica infection including bloodstream infection, pneumonia and multiple abscesses along both lower limbs was observed. RESULTS After a four-week course of 320 mg/1600 mg/12 h of intravenous trimethoprim/sulfamethoxazole and multiple chirurgic drainages the patient was discharged with oral trimethoprim/sulfamethoxazole. Nevertheless, the patient expired done month after being discharged from the hospital. CONCLUSIONS The implementation of a combination of intravenous antibiotics and drainages resulted in an initial improvement in the patient's condition. However, despite these interventions, the patient ultimately passed away probably due to natural causes.
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Affiliation(s)
| | - Mary Paz Roche Matheus
- Clinical Microbiology Service, Basurto University Hospital, Bilbao, Biscay, Spain
- Biocruces Bizkaia Health Research Institute, Biscay, Spain
| | | | - Felicitas Elena Calvo Muro
- Clinical Microbiology Service, Basurto University Hospital, Bilbao, Biscay, Spain
- Biocruces Bizkaia Health Research Institute, Biscay, Spain
| | - Cristina Aspichueta Vivanco
- Clinical Microbiology Service, Basurto University Hospital, Bilbao, Biscay, Spain
- Biocruces Bizkaia Health Research Institute, Biscay, Spain
| | | | - Mikel Grau García
- Radiodiagnosis Service of Basurto University Hospital, Bilbao, Biscay, Spain
| | - José Luis Díaz de Tuesta Del Arco
- Clinical Microbiology Service, Basurto University Hospital, Bilbao, Biscay, Spain
- Biocruces Bizkaia Health Research Institute, Biscay, Spain
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Yu W, Lu Z, Zhang J, Wang Z. Cerebellar abscess caused by Nocardia brasiliensis in a patient with pneumoconiosis. Asian J Surg 2023; 46:4655-4656. [PMID: 37211435 DOI: 10.1016/j.asjsur.2023.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 05/23/2023] Open
Affiliation(s)
- Weijie Yu
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Zhenwei Lu
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Jinsen Zhang
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China; The School of Clinical Medicine, Fujian Medical University, Fuzhou, China
| | - Zhanxiang Wang
- Department of Neurosurgery, Xiamen Key Laboratory of Brain Center, The First Affiliated Hospital of Xiamen University, Xiamen, China; The Department of Neuroscience, Institute of Neurosurgery, School of Medicine, Xiamen University, Xiamen, China; Department of Neurosurgery Quality Control Center, The First Affiliated Hospital of Xiamen University, Xiamen, China.
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Wu S, Guo T, Zhang H, He Z, Zhang J, Zeng W. Brain Nocardiosis and Pulmonary Talaromycosis Infection in a Patient with Anti-IFN-γ Autoantibodies: A Case Report. Infect Drug Resist 2023; 16:5421-5425. [PMID: 37638063 PMCID: PMC10455842 DOI: 10.2147/idr.s424212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/16/2023] [Indexed: 08/29/2023] Open
Abstract
Adult-onset acquired immunodeficiency caused by anti-IFN-γ autoantibodies is associated with severe opportunistic infection. Due to lack of specific symptoms and different manifestations, this form of infection can be easily misdiagnosed or overlooked. Herein, we present a case of Nocardia farcinica and Talaromyces marneffei co-infection in a patient with anti-IFN-γ autoantibodies (AIGAs). The patient, a 54-year-old man, presented with a 1-month history of fever, coughing and expectoration, dizziness, headache and gait imbalance. Laboratory workup revealed increased inflammatory markers, negative anti-HIV antibody and a high positive titer of AIGAs. Chest computed tomography (CT) showed multiple patches of high-density shadows in both lungs, and brain enhanced magnetic resonance imaging (MRI) showed an irregular lesion. The patient underwent a craniotomy for resection of the lesion. Pulmonary T. marneffei infection was diagnosed through sputum and bronchoalveolar lavage fluid culture, and brain nocardiosis was confirmed via purulent fluid culture of brain tissue. With regular antibiotic therapy, his symptoms improved and there was no recurrence during 18-month follow-up. This may be the first detailed case report detailing infection with these two distinct pathogens in disparate anatomical locations.
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Affiliation(s)
- Siyao Wu
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Ting Guo
- Department of Dermatology and Venereology, the First Affiliated Hospital of Guangxi Medical University, Nanning, 530021, People’s Republic of China
| | - Hui Zhang
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Zhiyi He
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
| | - Jianquan Zhang
- Department of Respiratory and Critical Medicine, the Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, Guangdong, 518000, People’s Republic of China
| | - Wen Zeng
- Department of Pulmonary and Critical Care Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, 530021, People’s Republic of China
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Qin L, Wang S, Zheng Z, Zhang W, Qu Q, Li J, Tan Y, Cao L. A complicated infection by cutaneous Nocardia wallacei and pulmonary Mycobacterium abscessus in a Chinese immunocompetent patient: a case report. Front Cell Infect Microbiol 2023; 13:1229298. [PMID: 37655298 PMCID: PMC10467026 DOI: 10.3389/fcimb.2023.1229298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
Nocardiosis is an infectious disease caused by Nocardia that primarily affects immunocompromised hosts. Mycobacterium abscessus is a common opportunistic pathogen that causes disease in humans, including pulmonary and extrapulmonary infection. Nocardia spp. infection is uncommon, and infection with Nocardia wallacei and Mycobacterium abscessus is even rarer. A 59-year-old immunocompetent woman with risk factors for environmental exposure developed nocardiosis and presented to the hospital with a cough, shortness of breath, hemoptysis, and a back abscess. An enhanced computed tomography (CT) of the chest revealed partial destruction of the right lung, as well as consolidation of the right upper lobe. Rare pathogens N. wallacei and Mycobacterium abscessus were detected by metagenomic next-generation sequencing (mNGS) from abscess on the back and lung puncture tissue, respectively. She was treated with a combination of antibiotics and was finally discharged with a good prognosis. In this case, we present a patient who was successfully diagnosed with N. wallacei and Mycobacterium abscessus infection using mNGS. This importance of using mNGS in pathogen detection and the effective use of antibiotics in treating patients with long-term rare infections is highlighted in this report.
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Affiliation(s)
- Ling Qin
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Sidan Wang
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Zhifen Zheng
- BGI Genomics, Shenzhen, China
- Clinical Laboratories, BGI Genomics, Wuhan, China
| | - Wenqian Zhang
- BGI Genomics, Shenzhen, China
- Clinical Laboratories, BGI Genomics, Wuhan, China
| | - Qiang Qu
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
| | - Jun Li
- Department of Laboratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yurong Tan
- Department of Medical Microbiology, School of Basic Medical Sciences, Central South University, Changsha, Hunan, China
| | - Liming Cao
- Department of Respiratory Medicine, National Key Clinical Specialty, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Clinical Research Center for Respiratory Diseases, Xiangya Hospital, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China
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Zeng P, Zhang X, Wu H, Wang L, Xiao N, Mu X. Bronchiectasis with Nocardia infection was designated as Lady Windermere-like syndrome: a retrospective study. Chin Med J (Engl) 2023; 136:1864-1866. [PMID: 37279387 PMCID: PMC10406060 DOI: 10.1097/cm9.0000000000002553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Indexed: 06/08/2023] Open
Affiliation(s)
- Pu Zeng
- Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Xiaofei Zhang
- Center for Clinical Epidemiology & Biostatistics, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
- Beijing Center for Quality Control & Improvement for Clinical Investigation & Study at Tsinghua Changgung Hospital, Beijing 102218, China
| | - Huaxu Wu
- Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Lijun Wang
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Nan Xiao
- Department of Clinical Laboratory, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Xiangdong Mu
- Department of Respiratory and Critical Care Medicine, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
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Yetmar ZA, Khodadadi RB, Chesdachai S, McHugh JW, Challener DW, Wengenack NL, Bosch W, Seville MT, Beam E. Mortality After Nocardiosis: Risk Factors and Evaluation of Disseminated Infection. Open Forum Infect Dis 2023; 10:ofad409. [PMID: 37577117 PMCID: PMC10422863 DOI: 10.1093/ofid/ofad409] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023] Open
Abstract
Background Nocardia primarily infects patients who are immunocompromised or those with chronic lung disease. Although disseminated infection is widely recognized as an important prognostic factor, studies have been mixed on its impact on outcomes of nocardiosis. Methods We performed a retrospective cohort study of adults with culture-confirmed nocardiosis. Advanced infection was defined as disseminated infection, cavitary pulmonary infection, or pleural infection. The primary outcome was 1-year mortality, as analyzed by multivariable Cox regression. Results Of 511 patients with culture growth of Nocardia, 374 (73.2%) who had clinical infection were included. The most common infection sites were pulmonary (82.6%), skin (17.9%), and central nervous system (14.2%). In total, 117 (31.3%) patients had advanced infection, including 74 (19.8%) with disseminated infection, 50 (13.4%) with cavitary infection, and 18 (4.8%) with pleural infection. Fifty-nine (15.8%) patients died within 1 year. In multivariable models, disseminated infection was not associated with mortality (hazard ratio, 1.16; 95% CI, .62-2.16; P = .650) while advanced infection was (hazard ratio, 2.48; 95% CI, 1.37-4.49; P = .003). N. farcinica, higher Charlson Comorbidity Index, and culture-confirmed pleural infection were also associated with mortality. Immunocompromised status and combination therapy were not associated with mortality. Conclusions Advanced infection, rather than dissemination alone, predicted worse 1-year mortality after nocardiosis. N. farcinica was associated with mortality, even after adjusting for extent of infection. While patients who were immunocompromised had high rates of disseminated and advanced infection, immunocompromised status did not predict mortality after adjustment. Future studies should account for high-risk characteristics and specific infection sites rather than dissemination alone.
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Affiliation(s)
- Zachary A Yetmar
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan B Khodadadi
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Supavit Chesdachai
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jack W McHugh
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas W Challener
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nancy L Wengenack
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Elena Beam
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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37
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Zhang J, Zhu Y, Sun Y, Han X, Mao Y. Pathogenic Nocardia amamiensis infection: A rare case report and literature review. Heliyon 2023; 9:e17183. [PMID: 37449159 PMCID: PMC10336398 DOI: 10.1016/j.heliyon.2023.e17183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
Background To date, only six cases of Nocardia amamiensis infection have been reported, including two ocular cases, three pulmonary cases, and one disseminated case. However, no Nocardia amamiensis pulmonary infection cases have been reported in immunocompetent patients without structural pulmonary disease. This study describes a rare case and provides a detailed review of all previous cases. Methods A pulmonary infection caused by Nocardia amamiensis in a 64-year-old man with low-grade fever, night sweats, and weight loss was reported. All previously reported cases of Nocardia amamiensis infection were searched and reviewed. Results The pathogen was identified as Nocardia amamiensis using bronchoalveolar lavage fluid (BALF) mNGS, and the current case was successfully treated with trimethoprim-sulfamethoxazole (ST) monotherapy. mNGS and 16S rRNA PCR are standard tests to identify Nocardia.Conclusion: mNGS has high diagnostic performance for Nocardia amamiensis. Further studies are needed to clarify the clinical characteristics and explore more effective treatment protocols for this rare pathogen.
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Affiliation(s)
- Jing Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yingwei Zhu
- Department of Respiratory Medicine, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yuxia Sun
- Department of Respiratory Medicine, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xuewei Han
- China Aviation Industry Corporation Luoyang Institute of Electro-Optical Devices, Luoyang, China
| | - Yimin Mao
- Department of Respiratory Medicine, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
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Hu Y, Zhu Y, Li C, Shi H, Zhang Y, Zhao J, Fan Y, Wu Y, Li Z, Liu X, Zhang F, Lu B. Evaluation of BACTEC MGIT 960 system for recovery of Nocardia from clinical specimens. Diagn Microbiol Infect Dis 2023; 106:115989. [PMID: 37269756 DOI: 10.1016/j.diagmicrobio.2023.115989] [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: 10/07/2022] [Revised: 04/09/2023] [Accepted: 05/09/2023] [Indexed: 06/05/2023]
Abstract
Nocardia spp. is an aerobic Gram-positive bacillus responsible for nocardiosis. Herein, we performed a retrospective study to evaluate the performance of BACTEC MGIT 960 system, in comparison with smear microscopy and blood agar plate (BAP) culture, to recover Nocardia from different clinical specimens. Furthermore, the inhibitory effect of antibiotics contained in MGIT 960 tube on Nocardia was also evaluated. The sensitivities for Nocardia recovery using smear microscopy, BAP culture, and MGIT 960 were 39.4% (54/137), 46.1% (99/215), and 81.3% (156/192), respectively. N. farcinica was the most detected species (60.4%, 136/225). In MGIT 960-recovered Nocardia strains, N. farcinica accounted for 76.9%. Furthermore, trimethoprim in MGIT 960 tube inhibited less N. farcinica growth than that of other Nocardia species, partially explaining why MGIT 960 recovered more N. farcinica from sputa. The current study demonstrated that MGIT 960 could recover Nocardia strains from heavily-contaminated samples if its components and antibiotics are redesigned.
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Affiliation(s)
- Yanning Hu
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University Health Science Center, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yue Zhu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Chen Li
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University Health Science Center, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Department of Clinical Laboratory, Liuyang Traditional Chinese Medicine Hospital, Changsha, Hunan, China
| | - Huihui Shi
- Department of Clinical Laboratory, Affiliated Nantong Hospital of Shanghai University, Nantong, China
| | - Yulin Zhang
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiankang Zhao
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yanyan Fan
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yongli Wu
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Ziyao Li
- Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital
| | - Xinmeng Liu
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University Health Science Center, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Feilong Zhang
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University Health Science Center, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Binghuai Lu
- Peking University China-Japan Friendship School of Clinical Medicine, Peking University Health Science Center, Beijing, China; Laboratory of Clinical Microbiology and Infectious Diseases, Department of Pulmonary and Critical Care Medicine, National Center for Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China; Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China; Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China; Institute of Clinical Medical Sciences, China-Japan Friendship Hospital.
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Wang S, Wang P, Liu J, Yang C, Li T, Yang J, Gu L, Wei M. Molecular detection of Nocardia: development and application of a real-time PCR assay in sputum and bronchoalveolar lavage fluid samples. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04619-4. [PMID: 37156981 DOI: 10.1007/s10096-023-04619-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
The diagnosis of pulmonary nocardiosis remains challenging. Rapid detection of Nocardia is of primary importance for early diagnosis and precise treatment of nocardiosis. In this study, our objective was to develop and validate a new TaqMan real-time PCR (qPCR) assay for rapidly detecting Nocardia spp. in respiratory samples. Based on published sequence data, primers in a conserved region of the 16S rRNA gene and a probe within that region that was specific for Nocardia were designed. The distinction effect of the qPCR assay was assessed between Nocardia and other respiratory-associated bacteria. Furthermore, the specificity and sensitivity of the assay were evaluated in respiratory clinical samples (n = 205), compared to the results of 16S rRNA gene amplicon sequencing and clinical diagnosis. The qPCR assay exhibited high specificity, sensitivity, repeatability, and reproducibility. The limit of detection of standard plasmid DNA was 3 × 102 copies/mL. Additionally, the qPCR assay was applied to the direct detection of 205 clinical respiratory samples. The specificity and sensitivity of the qPCR were all 100% compared to 16S rRNA gene amplicon sequencing, as well as 98.4% and 100% compared to clinical diagnosis respectively. The qPCR yielded results within 3 h of sample processing, compared to several days for culture, significantly reducing turnaround time. The results suggest that the new qPCR assay developed in this study provides reliable and rapid detection of Nocardia spp. in the respiratory tracts and is expected to reduce the time required for diagnosing and treating nocardiosis.
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Affiliation(s)
- Shuai Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jun Liu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chunxia Yang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Tianmeng Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jingxian Yang
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, China
| | - Li Gu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Ming Wei
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Chen Y, Hu W. Co-infection with Mycobacterium tuberculosis and Nocardia farcinica in a COPD patient: a case report. BMC Pulm Med 2023; 23:136. [PMID: 37087417 PMCID: PMC10122200 DOI: 10.1186/s12890-023-02434-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/13/2023] [Indexed: 04/24/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by persistent airflow limitation. Infection with either Mycobacterium tuberculosis or Nocardia in COPD patients has been reported. However, co-infection with Mycobacterium tuberculosis and Nocardia is rare. Herein, we described such a patient with COPD in a primary hospital, and the diagnosis process. CASE PRESENTATION A 79-year-old female farmer with COPD was consecutively admitted to two hospitals with chief complaints of worsening cough, sputum and gasping since January10, 2022. Microbiological examination was not performed at the first hospital due to unknown reasons, and empirical antibiotic treatment was not effective. The patient was subsequently referred to our hospital. After screening the source of infection and the pathogen, she was diagnosed with tuberculosis. However, the patient did not benefit from antituberculosis treatment, with no remission of respiratory tract symptoms. Cerebrospinal fluid and bronchoalveolar lavage fluid specimens were subsequently sent for microbiological examination. The results indicated Mycobacterium tuberculosis and Nocardia.spp. After four days of bacterial culture, Nocardia.spp grew on medium, and Nocardia.farcinica was identified by the MALDI-TOF MS system and 16 s RNA. The patient was prescribed trimethoprim sulfamethoxazole (TMP/SMX) in combination with anti-tuberculosis drugs to treat the co-infection. She showed gradual improvement and was discharged from the hospital on February 19, 2022. However, the follow-up results were unclear. CONCLUSIONS Co-infection with Nocardia and Mycobacterium tuberculosis should be considered in COPD patients. Repeated microbiological and microscopy examinations are essential in primary hospitals.
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Affiliation(s)
- Yingzhu Chen
- Department of Laboratory Medicine, Traditional Chinese Medicine Hospital of Dianjiang County, Chongqing, Chongqing, 408300, China
| | - Wei Hu
- Department of Renal Medicine, People's Hospital of Dianjiang County, Chongqing, Chongqing, 408300, China.
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LaHue SC, Guterman EL, Mikhail M, Li Y, Cha S, Richie MB. Clinical and Radiographic Characteristics of Nocardia vs Non- Nocardia Brain Abscesses. Neurol Clin Pract 2023; 13:e200134. [PMID: 37064583 PMCID: PMC10101715 DOI: 10.1212/cpj.0000000000200134] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/18/2022] [Indexed: 04/18/2023]
Abstract
Background and Objectives Diagnosis and treatment of CNS nocardiosis is challenging and often delayed, which increases morbidity and mortality. The primary objective was to compare the clinical and radiographic characteristics of patients with CNS nocardiosis with non-Nocardia bacterial brain abscesses. Methods We performed a case-control study of patients with brain abscesses diagnosed between 1998 and 2018 at a tertiary academic center. We identified 56 patients with brain MRI demonstrating brain abscess from the institutional imaging database: 14 with culture-confirmed nocardiosis and 42 randomly selected prevalent controls with culture-confirmed non-Nocardia bacterial infection. The primary outcomes were the diagnosis of concomitant lung infection and history of immunosuppression. Secondary outcomes included abscess radiographic characteristics: multifocality, occipital lobe and/or infratentorial location, and bilobed morphology. Results Compared with patients with non-Nocardia brain abscesses, patients with CNS nocardiosis were older (median 61 years [IQR 59-69] vs 48 years [IQR 34-61]; p = 0.03), more likely to be immunosuppressed [71% (10) vs 19% (8); p < 0.001), have diabetes (36% (5) vs 10% [4]; p = 0.03), or a concomitant lung infection (86% [12] vs 2% [1]; p < 0.001). Radiographically, more cases of CNS nocardiosis exhibited multifocal abscesses (29% [4] vs 2% [1]; p = 0.01), which were located in the infratentorial (43% [6] vs 10% (4); p = 0.01) or occipital (36% [5] vs 5% [2]; p = 0.008) regions and had a bilobed (as opposed to unilobed) morphology (79% [11] vs 19% [8]; p < 0.001). Blood and CSF cultures were negative in most of the cases and controls, whereas neurosurgical specimen culture yielded a diagnosis in 100% of specimens. Discussion Patients with CNS nocardiosis were more likely to be older, have a history of diabetes or immunosuppression, or have a concomitant lung infection compared with those with non-Nocardia brain abscesses. Abscesses because of CNS nocardiosis were more likely to be multifocal, affect the infratentorial region or occipital lobe, or have a bilobed appearance. Neurosurgical specimen culture was most likely to yield a diagnosis for both Nocardia and non-Nocardia abscesses. The combination of clinical and imaging findings may suggest CNS nocardiosis and inform early initiation of targeted empiric treatment.
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Affiliation(s)
- Sara C LaHue
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
| | - Elan L Guterman
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
| | - Mathew Mikhail
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
| | - Yi Li
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
| | - Soonmee Cha
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
| | - Megan B Richie
- Department of Neurology (SCL, ELG, MBR), School of Medicine; Weill Institute for Neurosciences (SCL, ELG, MBR), Department of Neurology; and Department of Radiology and Biomedical Imaging (MM, YL, SC), University of California, San Francisco, CA
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Pérez-Gilaberte JB, García-Arceiz E, Viñuales-Aranda MD. Nocardia and Tuberculosis Pulmonary Coinfection Mimicking Pancoast Tumor in an Immunocompetent Host. Arch Bronconeumol 2023:S0300-2896(23)00100-X. [PMID: 36966030 DOI: 10.1016/j.arbres.2023.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/27/2023]
Affiliation(s)
| | - Elisa García-Arceiz
- Dept. of Internal Medicine, Miguel Servet University Hospital, Zaragoza, Spain
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Hodille E, Prudhomme C, Dumitrescu O, Benito Y, Dauwalder O, Lina G. Rapid, Easy, and Reliable Identification of Nocardia sp. by MALDI-TOF Mass Spectrometry, VITEK®-MS IVD V3.2 Database, Using Direct Deposit. Int J Mol Sci 2023; 24:ijms24065469. [PMID: 36982540 PMCID: PMC10049377 DOI: 10.3390/ijms24065469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
The reference methods for Nocardia identification are based on gene sequencing. These methods are time-consuming and not accessible for all laboratories. Conversely, matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry is easy to use and widely available in clinical laboratories, but for Nocardia identification, the VITEK®-MS manufacturer recommends a tedious step of colony preparation that is difficult to integrate into a laboratory workflow. This study aimed to evaluate Nocardia identification by MALDI-TOF VITEK®-MS using direct deposit with the VITEK®-PICKMETM pen and a formic acid-based protein extraction directly onto the bacterial smear on a 134 isolates collection; this identification was compared to the results from molecular reference methods. For 81.3% of the isolates, VITEK®-MS delivered an interpretable result. The overall agreement with the reference method was 78.4%. Taking only the species included in the VITEK®-MS in vitro diagnostic V3.2 database into account, the overall agreement was significantly higher, 93.7%. VITEK®-MS rarely misidentified isolates (4/134, 3%). Among the 25 isolates that produced no result with the VITEK®-MS, 18 were expected, as Nocardia species were not included in the VITEK®-MS V3.2 database. A rapid and reliable Nocardia identification using direct deposit by VITEK®-MS is possible by combining the use of the VITEK®-PICKMETM pen and a formic acid-based protein extractiondirectly onto the bacterial smear.
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Deng ZF, Tang YJ, Yan CY, Qin ZQ, Yu N, Zhong XB. Pulmonary nocardiosis with bloodstream infection diagnosed by metagenomic next-generation sequencing in a kidney transplant recipient: A case report. World J Clin Cases 2023; 11:1634-1641. [PMID: 36926398 PMCID: PMC10011981 DOI: 10.12998/wjcc.v11.i7.1634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/28/2023] [Accepted: 02/13/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Pulmonary nocardiosis is difficult to diagnose by culture and other conventional testing, and is often associated with lethal disseminated infections. This difficulty poses a great challenge to the timeliness and accuracy of clinical detection, especially in susceptible immunosuppressed individuals. Metagenomic next-generation sequencing (mNGS) has transformed the conventional diagnosis pattern by providing a rapid and precise method to assess all microorganisms in a sample.
CASE SUMMARY A 45-year-old male was hospitalized for cough, chest tightness and fatigue for 3 consecutive days. He had received a kidney transplant 42 d prior to admission. No pathogens were detected at admission. Chest computed tomography showed nodules, streak shadows and fiber lesions in both lung lobes as well as right pleural effusion. Pulmonary tuberculosis with pleural effusion was highly suspected based on the symptoms, imaging and residence in a high tuberculosis-burden area. However, anti-tuberculosis treatment was ineffective, showing no improvement in computed tomography imaging. Pleural effusion and blood samples were subsequently sent for mNGS. The results indicated Nocardia farcinica as the major pathogen. After switching to sulphamethoxazole combined with minocycline for anti-nocardiosis treatment, the patient gradually improved and was finally discharged.
CONCLUSION A case of pulmonary nocardiosis with an accompanying bloodstream infection was diagnosed and promptly treated before the dissemination of the infection. This report emphasizes the value of mNGS in the diagnosis of nocardiosis. mNGS may be an effective method for facilitating early diagnosis and prompt treatment in infectious diseases, which overcomes the shortcomings of conventional testing.
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Affiliation(s)
- Zhen-Feng Deng
- Clinical Genome Center, Guangxi KingMed Diagnostics, Nanning 530007, Guangxi Zhuang Autonomous Region, China
| | - Yan-Jiao Tang
- Graduate School, Guangxi University of Chinese Medicine, Nanning 530001, Guangxi Zhuang Autonomous Region, China
| | - Chun-Yi Yan
- Department of Organ Transplantation, No. 923 Hospital of Chinese People's Liberation Army, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zi-Qian Qin
- Clinical Genome Center, Guangxi KingMed Diagnostics, Nanning 530007, Guangxi Zhuang Autonomous Region, China
| | - Ning Yu
- Clinical Genome Center, Guangxi KingMed Diagnostics, Nanning 530007, Guangxi Zhuang Autonomous Region, China
| | - Xiong-Bo Zhong
- Department of Urology Surgery, Ruikang Hospital Affiliated to Guangxi University of Chinese Medicine, Nanning 530011, Guangxi Zhuang Autonomous Region, China
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Villanueva DDH, El Helou G. First Report of Clivus Osteomyelitis Caused by Nocardia veterana in a Lung Transplant Recipient. Cureus 2023; 15:e36487. [PMID: 37090387 PMCID: PMC10115658 DOI: 10.7759/cureus.36487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Nocardia species have been implicated as a cause of pulmonary, cutaneous, ocular, and disseminated central nervous system disease. Dissemination to the bones, commonly the spine, has also been described in the literature. However, isolated osteomyelitis of the skull base is rare. Additionally, advances in the use of molecular techniques have identified many new Nocardia species, including Nocardia veterana that was thought to be clinically insignificant when it was first identified. Here, we report the clinical features and treatment approach for a lung transplant patient who developed N. veterana clivus osteomyelitis secondary to sphenoid sinusitis. It is the first case of skull base osteomyelitis caused by this rare species of Nocardia.
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Affiliation(s)
| | - Guy El Helou
- Infectious Diseases, University of Florida, Gainesville, USA
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Lestin-Bernstein F, Tietke M, Schmiedel S, Dreimann M, Heese O. Meningitis and spondylodiscitis due to Nocardia nova in an immunocompetent patient. BMC Infect Dis 2023; 23:112. [PMID: 36823551 PMCID: PMC9951400 DOI: 10.1186/s12879-023-08067-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Disseminated nocardiosis is a very rare disease. By now only few cases of meningitis and spondylodiscitis have been reported. To our knowledge, this is the first case of meningitis caused by Nocardia nova. CASE PRESENTATION We report on a case of bacteraemia, meningitis and spondylodiscitis caused by N. nova in an immunocompetent patient. We describe the long, difficult path to diagnosis, which took two months, including all diagnostic pitfalls. After nocardiosis was diagnosed, intravenous antibiotic therapy with ceftriaxone, later switched to imipenem/cilastatin and amikacin, led to rapid clinical improvement. Intravenous therapy was followed by oral consolidation with co-trimoxazole for 9 months without any relapse within 4 years. CONCLUSIONS Establishing a diagnosis of nocardiosis is a precondition for successful antibiotic therapy. This requires close communication between clinicians and laboratory staff about the suspicion of nocardiosis, than leading to prolonged cultures and specific laboratory methods, e.g. identification by 16S rDNA PCR.
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Affiliation(s)
- F. Lestin-Bernstein
- grid.461732.5Clinical Hygiene and Infectiology, Helios Clinics of Schwerin - University Campus of Medical School Hamburg (MSH - University of Applied Sciences and Medical University), Wismarsche Str. 393-397, 19049 Schwerin, Germany
| | - M. Tietke
- grid.461732.5Radiology and Neuroradiology, Helios Clinics of Schwerin - University Campus of Medical School Hamburg (MSH - University of Applied Sciences and Medical University), Schwerin, Germany
| | - S. Schmiedel
- grid.13648.380000 0001 2180 3484Infectiology and Tropical Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - M. Dreimann
- grid.13648.380000 0001 2180 3484Trauma Surgery and Orthopaedics, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - O. Heese
- grid.461732.5Neurosurgery and Spinal Surgery, Helios Clinics of Schwerin - University Campus of Medical School Hamburg (MSH - University of Applied Sciences and Medical University), Schwerin, Germany
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Hong X, Ji YQ, Chen MY, Gou XY, Ge YM. Nocardia cyriacigeorgica infection in a patient with repeated fever and CD4 + T cell deficiency: A case report. World J Clin Cases 2023; 11:1175-1181. [PMID: 36874428 PMCID: PMC9979296 DOI: 10.12998/wjcc.v11.i5.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/07/2023] [Accepted: 01/16/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Nocardia pneumonia shares similar imaging and clinical features with pulmonary tuberculosis and lung neoplasms, but the treatment and anti-infective medication are completely different. Here, we report a case of pulmonary nocardiosis caused by Nocardia cyriacigeorgica (N. cyriacigeorgica), which was misdiagnosed as community-acquired pneumonia (CAP) with repeated fever.
CASE SUMMARY A 55-year-old female was diagnosed with community-acquired pneumonia in the local hospital because of repeated fever and chest pain for two months. After the anti-infection treatment failed in the local hospital, the patient came to our hospital for further treatment. Enhanced computed tomography showed multiple patchy, nodular and strip-shaped high-density shadows in both lungs. A routine haematological examination was performed and showed abnormalities in CD19+ B cells and CD4+ T cells. Positive acid-fast bifurcating filaments and branching gram-positive rods were observed in the bronchoalveolar lavage fluid of the patient under an oil microscope, which was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry as N. cyriacigeorgica. The patient's condition quickly improved after taking 0.96 g compound sulfamethoxazole tablets three times a day.
CONCLUSION The antibiotic treatment of Nocardia pneumonia is different from that of common CAP. Attention should be given to the pathogenic examination results of patients with recurrent fever. Nocardia pneumonia is an opportunistic infection. Patients with CD4+ T-cell deficiency should be aware of Nocardia infection.
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Affiliation(s)
- Xin Hong
- Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou 310014, Zhejiang Province, China
| | - You-Qi Ji
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Meng-Yuan Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Xiao-Yu Gou
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Yu-Mei Ge
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
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Lv H, Chen M, Ji Y, Pan L, Hong X, Ge Y. A Rare Case of a Subcutaneous Abscess Caused by Nocardia cyriacigeorgica in an Immunocompetent Patient. Infect Drug Resist 2023; 16:263-268. [PMID: 36660347 PMCID: PMC9844142 DOI: 10.2147/idr.s395333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 01/06/2023] [Indexed: 01/15/2023] Open
Abstract
Background Nocardia cyriacigeorgica, which mainly causes pleuropulmonary and disseminated nocardiosis, has been proved to be one of the most common opportunistic pathogens in patients with immunodeficiency, but the cases that cause subcutaneous abscesses in normal individuals are rare and should be paid attention to. Methods The clinical data of a patient with cutaneous nocardiosis caused by Nocardia cyriacigeorgica in Zhejiang Provincial People's Hospital were retrospectively analyzed, including clinical manifestations, laboratory examinations, imaging examinations, medication and prognosis. Results Magnetic resonance imaging (MRI) showed that there was a 26 mm × 73 mm abscess under the skin. The pus in the abscess was green. Gram staining showed positive branched rod-shaped and undivided hyphae. After culture, small wrinkle dry white small colonies were observed, and it was identified as Nocardia cyriacigeorgica by MALDI-TOF MS. Conclusion We report the first case of a subcutaneous abscess caused by Nocardia cyriacigeorgica in an immunocompetent patient. Compared with cutaneous nocardiosis of which approximately 80% caused by Nocardia brasiliensis invasion, infection of Nocardia cyriacigeorgica is more insidious and latent, the features of the lesions are also unique. For this Nocardia cyriacigeorgica clinical isolate, the tested antibacterial drugs are generally sensitive and have an ideal prognosis after treatment with linezolid and timely debridement.
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Affiliation(s)
- Huoyang Lv
- Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Mengyuan Chen
- Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China,The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China
| | - Youqi Ji
- Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China,School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China
| | - Liya Pan
- Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Xin Hong
- Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China,Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, 310014, People’s Republic of China
| | - Yumei Ge
- Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China,The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China,School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, People’s Republic of China,Center for Rehabilitation Medicine, Department of Radiology, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China,Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou, Zhejiang, 310014, People’s Republic of China,Key Laboratory of Biomarkers and in vitro Diagnosis Translation of Zhejiang Province, Hangzhou, Zhejiang, 310053, People’s Republic of China,Correspondence: Yumei Ge, Department of Clinical Laboratory, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, Zhejiang, 310014, People’s Republic of China, Email
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Spiliopoulou A, Kyriakou G, Georgiou S, Lekkou A, Leonidou L, Militsopoulou M, Papadogeorgaki E, Christofidou M, Kolonitsiou F, Paliogianni F. Acid-fast bacteria as causative agents of skin and soft tissue infections: case presentations and literature review. Rev Inst Med Trop Sao Paulo 2023; 65:e29. [PMID: 37075336 PMCID: PMC10115452 DOI: 10.1590/s1678-9946202365029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/27/2023] [Indexed: 04/21/2023] Open
Abstract
Acid-fast bacteria can be implicated in skin and soft tissue infections. Diagnostic identification can be challenging or not feasible by routine laboratory techniques, especially if there is no access to the Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) technology. Here, we present two cases of skin and soft tissue infections caused by two different acid-fast bacteria, Nocardia brasiliensis and Mycobacterium marinum. They both grew on Löwenstein-Jensen medium, Sabouraud agar medium and blood agar medium. Both bacteria appeared acid-fast by Ziehl-Neelsen stain and Gram-positive by Gram stain. The identification was performed by MALDI-TOF MS and gene analysis. N. brasiliensis and nontuberculous mycobacterium M. marinum represent rare pathogens that cause severe skin and soft tissue infections. Failure to identify the causative agent and subsequent inappropriate or inadequate treatment may lead to severe complications or even disseminated disease, especially in immunocompromised individuals.
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Affiliation(s)
| | - Georgia Kyriakou
- University General Hospital of Patras, Department of Dermatology, Patras, Greece
| | - Sophia Georgiou
- University General Hospital of Patras, Department of Dermatology, Patras, Greece
| | - Alexandra Lekkou
- University General Hospital of Patras, Department of Infectious Diseases, Patras, Greece
| | - Lydia Leonidou
- University General Hospital of Patras, Department of Infectious Diseases, Patras, Greece
| | - Maria Militsopoulou
- University General Hospital of Patras, Department of Microbiology, Patras, Greece
| | | | - Myrto Christofidou
- University General Hospital of Patras, Department of Microbiology, Patras, Greece
| | - Fevronia Kolonitsiou
- University General Hospital of Patras, Department of Microbiology, Patras, Greece
| | - Fotini Paliogianni
- University General Hospital of Patras, Department of Microbiology, Patras, Greece
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Cantón De Seoane J, Cabanillas Navarro I, Quevedo Soriano S, Lois Martínez N. Nodular lymphangitis due to nocardiosis. BMJ Case Rep 2022; 15:e252941. [PMID: 36581362 PMCID: PMC9806021 DOI: 10.1136/bcr-2022-252941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Nodular lymphangitis is an infectious disease characterised by the development of inflammatory skin nodules that follow the direction of lymphatic drainage. We present a woman in her 70s with nodular lymphangitis that developed after mild trauma with a cactus. Surgical intervention was performed on a finger abscess with isolation of Nocardia brasiliensis in the microbiological samples. Initial antibiotherapy was modified, treating with cotrimoxazole, firstly intravenous and finally oral, therapy during 3 months with a complete resolution of the infection.
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