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Clinical characteristics, outcomes, and factors associated with mortality in Nocardia pneumonia: 18 years' real-world data from a tertiary care hospital in Karachi, Pakistan. Respir Investig 2023; 61:254-260. [PMID: 36539312 DOI: 10.1016/j.resinv.2022.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 11/03/2022] [Accepted: 11/19/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Pulmonary nocardiosis is a rare pulmonary infection with high morbidity and mortality. Limited real-world data on pulmonary nocardiosis patients are available from developing countries like Pakistan. METHODS This retrospective observational study was conducted at the Aga Khan University Hospital, Karachi, Pakistan, from August 2003 to June 2020. Demographics, immune status, underlying diseases, laboratory data, treatment, and outcomes of all nocardiosis patients were recorded in predesigned proforma. RESULTS Sixty-six patients with smear/culture-proven pulmonary nocardiosis were identified. Most patients (83.3%) were treated with trimethoprim-sulfamethoxazole alone or in combination with other medicines. The overall mortality rate in our study was 33.3% (n = 22/66). Factors significantly associated with mortality were respiratory failure (p < 0.001), raised procalcitonin levels (p = 0.01), concomitant fungal infections (p = 0.01), concomitant TB (p = 0.03), and patients on combination therapy (p < 0.001). Respiratory failure (odds ratio [OR] 46.94 [95% confidence intervals [CI]: 5.01-439.03] p < 0.001), concomitant fungal infection (OR 17.09 [95% CI: 1.47-197.88] p- = 0.02) and patients on combination therapy (OR 6.90 [95% CI: 1.23-38.61] p = 0.02) were also identified as independent risk factors for mortality on multivariate analysis. CONCLUSIONS This study provides essential information on the clinical characteristics and risk factors, outcomes, and factors associated with mortality for pulmonary nocardial infections.
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Velidakis A, Degaitis F, Tsorbatzoglou G, Ioannou P. Infective endocarditis by Nocardia species: a systematic review. J Chemother 2022:1-8. [PMID: 35787151 DOI: 10.1080/1120009x.2022.2095154] [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: 10/17/2022]
Abstract
Nocardiosis, is a potentially life-threatening disease, especially in immunocompromised individuals where it manifests as a disseminated disease. Infective Endocarditis (IE) is a rare disease with significant morbidity and mortality. Importantly, even though there are scarce data of IE by Nocardia spp. in the literature, a review adequately summarizing systematically all available evidence on the topic is lacking. The aim of this study was to systematically review all cases of IE by Nocardia spp. and describe the epidemiology, microbiology, clinical characteristics, treatment and outcomes of this infection. A systematic review of PubMed, Scopus and Cochrane library (through 7 December 2021) for studies providing epidemiological, clinical, microbiological as well as treatment data and outcomes of patients with IE by Nocardia spp. was performed. A total of 25 studies providing data for 26 patients were included. A prosthetic valve was present in 30.8%, while the most common microorganism was N. asteroides. Aortic valve was the most commonly infected intracardiac site, followed by the mitral valve. Diagnosis was most commonly performed with transthoracic echocardiography, while the diagnosis was made at autopsy in 11.5%. Co-trimoxazole, aminoglycosides and carbapenems were the most commonly used antimicrobials. Clinical cure was noted in 73.1%, while mortality was 26.9%. This systematic review thoroughly describes IE by Nocardia and provides information on epidemiology, clinical presentation, treatment and outcomes.
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Affiliation(s)
- Antonios Velidakis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Fotios Degaitis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - George Tsorbatzoglou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
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Yu MH, Wu XX, Chen CL, Tang SJ, Jin JD, Zhong CL, Fu J, Shi JQ, Li LJ. Disseminated Nocardia infection with a lesion occupying the intracranial space complicated with coma: a case report. BMC Infect Dis 2020; 20:856. [PMID: 33203355 PMCID: PMC7672916 DOI: 10.1186/s12879-020-05569-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 10/31/2020] [Indexed: 01/13/2023] Open
Abstract
Background Disseminated Nocardia infection is a disease that is easily overlooked in patients with lesions occupying the intracranial space complicated with coma. Early diagnosis and treatment are crucial. Case presentation A 65-year-old man was admitted to the First Affiliated Hospital of Zhejiang University in October 2018 with weakness in the right limbs for 3 days and altered consciousness for 1 day. Five months earlier, he had been diagnosed with membranous kidney disease and had received cyclophosphamide and prednisone. At admission, the white blood cell count was 1.37 × 1010/L (with 86.4% neutrophils), and C-reactive protein was 115.60 mg/L. Imaging examinations revealed a lesion occupying the intracranial space, lung infection, and multiple abscesses in the rhomboid muscle. The abscesses were drained. Pus culture confirmed Nocardia cyriacigeorgica infection. With antibiotics and vacuum-sealed drainage of the back wound, the patient improved and was discharged from the hospital. Conclusions This case report shows that infection should be considered during the differential diagnosis of lesions in the intracranial space, especially in patients receiving immunosuppressive treatment. In patients with disseminated N. cyriacigeorgica infection, combination antibiotic therapy and surgical drainage of localised abscesses can be effective.
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Affiliation(s)
- Mei-Hong Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Xiao-Xin Wu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Chun-Lei Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Song-Jia Tang
- Department of Plastic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, 261 Huansha Road, Hangzhou, 310000, Zhejiang, China
| | - Jian-Di Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Cheng-Li Zhong
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Jing Fu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Jie-Qin Shi
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
| | - Lan-Juan Li
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
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Tan YE, Chen SCA, Halliday CL. Antimicrobial susceptibility profiles and species distribution of medically relevant Nocardia species: Results from a large tertiary laboratory in Australia. J Glob Antimicrob Resist 2019; 20:110-117. [PMID: 31400449 DOI: 10.1016/j.jgar.2019.06.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/18/2019] [Accepted: 06/21/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES There are limited surveillance studies on the epidemiology and resistance rates ofNocardia spp. in Australia, particularly in the jurisdiction of New South Wales. This study aimed to investigate the species distribution and antimicrobial susceptibility of a large number of contemporary (2011-2016) clinical Nocardia spp. referred to a large tertiary hospital in Sydney, Australia. METHODS A total of 270Nocardia spp. isolates identified to species level by dual-target gene sequencing were investigated. Antimicrobial susceptibility testing was performed using a Sensititre™ RAPMYCOI panel, with the minimum inhibitory concentration (MIC) range and geometric mean MIC obtained for each species and drug combination. Antimicrobial susceptibility profiles and species distribution were analysed. RESULTS The respiratory system is the most affected site in nocardiosis. In this study, Nocardia nova complex was the most frequently isolated Nocardia spp. (n = 80; 29.6%), followed by Nocardia cyriacigeorgica (n = 61; 22.6%), Nocardia brasiliensis (n = 52; 19.3%) and Nocardia farcinica (n = 38; 14.1%). Of the tested isolates, 9.3% and 59.3% displayed resistance to trimethoprim/sulfamethoxazole (SXT) and imipenem, respectively. Nocardia farcinica accounted for the highest number of SXT-resistant isolates. High imipenem resistance in N. cyriacigeorgica is atypical to its drug pattern but has been reported elsewhere. All tested isolates remained susceptible to linezolid, with only 0.7% exhibiting resistance to amikacin. CONCLUSION Linezolid and amikacin remain good empirical options for treatment of nocardiosis. Routine antimicrobial susceptibility testing ofNocardia is advisable with the detection of sulfonamide resistance and atypical antibiograms in this study.
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Affiliation(s)
- Yen Ee Tan
- Department of Microbiology, Singapore General Hospital, 20 College Road, 169856, Singapore.
| | - Sharon C-A Chen
- Clinical Mycology Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, Institute for Clinical Pathology and Medical Research (ICPMR), New South Wales Health Pathology, Westmead Hospital, Westmead, NSW, Australia; Centre for Infectious Diseases and Microbiology, University of Sydney, Sydney, NSW, Australia
| | - Catriona L Halliday
- Clinical Mycology Reference Laboratory, Centre for Infectious Diseases and Microbiology Laboratory Services, Institute for Clinical Pathology and Medical Research (ICPMR), New South Wales Health Pathology, Westmead Hospital, Westmead, NSW, Australia; Centre for Infectious Diseases and Microbiology, University of Sydney, Sydney, NSW, Australia
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Zia K, Nafees T, Faizan M, Salam O, Asad SI, Khan YA, Altaf A. Ten Year Review of Pulmonary Nocardiosis: A Series of 55 Cases. Cureus 2019; 11:e4759. [PMID: 31363440 PMCID: PMC6663111 DOI: 10.7759/cureus.4759] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Introduction Nocardiosis is a rare opportunistic bacterial infection usually seen in immunosuppressed patients. It is caused by gram-positive, aerobic actinomycetes of the Nocardia genus. The most common site of infection is lungs; but it may affect other organs or even disseminate into blood. Methods In this a 10-year retrospective review, all diagnosed cases of Pulmonary Nocardiosis in a tertiary care hospital were included. The clinical and radiological characteristics, course of complications and lifesaving interventions, and disease outcome were evaluated. Results Among the 55 identified cases, most common risk factor was chronic steroid therapy (n=38; 69.1%). Among respiratory diseases, chronic obstructive pulmonary disease (n=13; 23.6%) and tuberculosis (n=12; 21.8%) were the most common. On chest radiograph, pleural effusion (n=23; 41.8%) and consolidation (n=22; 40.0%) were the common findings. Complications were observed in 32 (58.2%) patients with septicemia and respiratory failure being the most common (n=15; 46.8% in each). Dissemination occurred in 10 (31.2%) patients. The mortality rate of Nocardia is 34.5% (n=19). Conclusion The disease burden of Nocardia is underestimated by clinicians and researchers. Pulmonary Nocardia should always be a differential diagnosis of signs of lower respiratory tract infection and must be excluded in patients not responding to treatment of chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis. Early recognition and individualized management plan can ensure successful recovery.
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Affiliation(s)
- Khurram Zia
- Internal Medicine, Liaquat College of Medicine and Dentistry, Karachi, PAK
| | - Taha Nafees
- Internal Medicine, Karachi Medical and Dental College, Karachi, PAK
| | - Muhammad Faizan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Osama Salam
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Syeda Ifra Asad
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Yasir A Khan
- Miscellaneous, Dow University of Health Sciences, Karachi, PAK
| | - Ahmed Altaf
- Internal Medicine, Dr. Ziauddin Hospital, Karachi, PAK
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