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Morjane Y, Sebestyen A, Lejeune S, Salvat M, Piliero N, Martin C, Abaziou T, Chavanon O. [Constrictive pericarditis and disseminated nocardiosis]. Ann Cardiol Angeiol (Paris) 2023; 72:101584. [PMID: 36898929 DOI: 10.1016/j.ancard.2023.02.005] [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: 01/23/2023] [Accepted: 02/13/2023] [Indexed: 03/12/2023]
Abstract
Human nocardiosis usually involves the respiratory tract or the skin but may disseminate to virtually any organ, it occurs in immunocompromised hosts as well as individuals with no apparent predisposition. Involvement of the pericardium is uncommon, having been reported infrequently in the past, but mandates a special management. This report describes the first case in Europe of a patient with chronic constrictive pericarditis from nocardia brasiliens, successfully treated with pericardiectomy and appropriate antibiotic therapy.
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Affiliation(s)
- Y Morjane
- Service de Chirurgie Cardiaque, CHU Grenoble-Alpes, La Tronche, France.
| | - A Sebestyen
- Service de Chirurgie Cardiaque, CHU Grenoble-Alpes, La Tronche, France
| | - S Lejeune
- Service de Maladies Infectieuses et Tropicales, CHU Grenoble-Alpes, La Tronche, France
| | - M Salvat
- Service de Cardiologie, CHU Grenoble-Alpes, La Tronche, France
| | - N Piliero
- Service de Cardiologie, CHU Grenoble-Alpes, La Tronche, France
| | - C Martin
- Service de Chirurgie Cardiaque, CHU Grenoble-Alpes, La Tronche, France
| | - T Abaziou
- Service d'Anesthésie-Réanimation, CHU Grenoble-Alpes, La Tronche, France
| | - O Chavanon
- Service de Chirurgie Cardiaque, CHU Grenoble-Alpes, La Tronche, France
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2
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Griessel R, Mitton B, Rule R, Said M. A case report of Nocardia asiatica constrictive pericarditis in a patient with Human Immunodeficiency Virus. Cardiovasc Pathol 2021; 58:107403. [PMID: 34954072 DOI: 10.1016/j.carpath.2021.107403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 11/03/2022] Open
Abstract
Nocardiosis commonly affects the respiratory system and is a rare cause of purulent pericarditis. Invasive nocardial infections occur more frequently in patients with immunosuppression. A misdiagnosis as tuberculosis infection is not uncommon, especially in the context of immunosuppression in high burden tuberculosis settings. The risk factors and clinical features of the two disease entities overlap substantially. Misdiagnosis may lead to a delay in appropriate treatment and may result in poor outcomes. It is important to note that these conditions may also co-exist in the same patient. We describe, to the best of our knowledge, the first case of Nocardia asiatica pericarditis in a 32-year-old man with Human Immunodeficiency Virus infection. The patient was initially diagnosed in September 2020 with a lower respiratory tract infection and pulmonary tuberculosis was suspected. A chest radiograph, performed at admission, revealed a pericardial effusion and N. asiatica was cultured from a pericardial fluid specimen that was collected 5 days following admission. Despite a good initial clinical response to a combination of trimethoprim/sulfamethoxazole and imipenem/cilastatin, the patient demised after 16 weeks of treatment. Previous reports of laboratory confirmed nocardial pericarditis are also reviewed and summarized.
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Affiliation(s)
- Rosemary Griessel
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; Department of Medical Microbiology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa.
| | - Barend Mitton
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; Department of Medical Microbiology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Roxanne Rule
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; Department of Medical Microbiology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
| | - Mohamed Said
- Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; Department of Medical Microbiology, Tshwane Academic Division, National Health Laboratory Service, Pretoria, South Africa
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3
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Martínez-Barricarte R. Isolated Nocardiosis, an Unrecognized Primary Immunodeficiency? Front Immunol 2020; 11:590239. [PMID: 33193422 PMCID: PMC7606290 DOI: 10.3389/fimmu.2020.590239] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/31/2020] [Indexed: 01/19/2023] Open
Abstract
Nocardiosis is an infectious disease caused by the gram-positive bacterium Nocardia spp. Although it is commonly accepted that exposure to Nocardia is almost universal, only a small fraction of exposed individuals develop the disease, while the vast majority remain healthy. Nocardiosis has been described as an "opportunistic" disease of immunocompromised patients, suggesting that exposure to the pathogen is necessary, but a host predisposition is also required. Interestingly, increasing numbers of nocardiosis cases in individuals without any detected risk factors, i.e., without overt immunodeficiency, are being reported. Furthermore, a growing body of evidence have shown that selective susceptibility to a specific pathogen can be caused by a primary immunodeficiency (PID). This raises the question of whether an undiagnosed PID may cause nocardiosis affecting otherwise healthy individuals. This review summarizes the specific clinical and microbiological characteristics of patients with isolated nocardiosis published during the past 30 years. Furthermore, it gives an overview of the known human immune mechanisms to fend off Nocardia spp. obtained from the study of PIDs and patients under immunomodulatory therapies.
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Affiliation(s)
- Rubén Martínez-Barricarte
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Pathology, Microbiology, and Immunology, Vanderbilt Center for Immunobiology, Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center, Nashville, TN, United States
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4
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Abreu C, Rocha-Pereira N, Sarmento A, Magro F. Nocardia infections among immunomodulated inflammatory bowel disease patients: A review. World J Gastroenterol 2015; 21:6491-6498. [PMID: 26074688 PMCID: PMC4458760 DOI: 10.3748/wjg.v21.i21.6491] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
Human nocardiosis, caused by Nocardia spp., an ubiquitous soil-borne bacteria, is a rare granulomatous disease close related to immune dysfunctions. Clinically can occur as an acute life-threatening disease, with lung, brain and skin being commonly affected. The infection was classically diagnosed in HIV infected persons, organ transplanted recipients and long term corticosteroid treated patients. Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario. Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings. We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals. Eleven cases of nocardiosis associated with anti-tumor necrosis factor (TNF) prescription (9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease (IBD), 4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients, lung disease in 4 patients, hepatic in one and disseminated disease in 3 patients. From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine. In conclusion, nocardiosis requires high levels of clinical suspicion and experience of laboratory staff, in order to establish a timely diagnosis and by doing so avoid worst outcomes. Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential. The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated.
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5
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Nocardia mikamiia Novel Species Causing Disseminated Nocardiosis: A Literature Review of Disseminated Nocardiosis. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:869153. [PMID: 27437492 PMCID: PMC4897366 DOI: 10.1155/2014/869153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 07/10/2014] [Indexed: 11/18/2022]
Abstract
Nocardiais an uncommon Gram-positive organism. It typically appears as delicate filamentous Gram-positive branching rods. In the United States it was estimated to be approximately 500 to 1000 new cases per year. The organism causes disease in immunocompromised individuals with pulmonary infection representing the most common site of infection.Nocardia mikamiihas been a recently isolated pathogen and not many cases of disseminated infection with this organism has been reported in the literature; we present a case of disseminated nocardiosis (mikamii sp.) in an immunocompromised patient. We also present a literature review on nocardiosis.
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Roubille F, Maxant G, Serre I, Colson P, Battistella P, Calvet B, Albat B, Pasquié JL. Fatal systemic nocardia infection revealed by cardiac tamponade. Intern Med 2010; 49:135-7. [PMID: 20075577 DOI: 10.2169/internalmedicine.49.2478] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report the case of a 50-year-old man admitted for cardiac tamponade. He was diagnosed with acute pneumonia. He had no previous medical history, but exhibited a body mass index of 41. Two days before admission, he complained of chest pain irradiating to the neck lateral side. Massive cardiac tamponade developed over 48 hours. There was no obvious cause for immunodepression. Pericardial puncture was ineffective, due to obesity and fluid high viscosity. Surgery was undertaken (Marfan intervention). Pericardial fluid was found to be purulent; direct examination revealed nocardia as bacteria with typical filamentous, branching rods. Despite adapted antibiotic treatment the patient died within a few hours. Acute pericarditis due to Nocardia is discussed.
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Affiliation(s)
- Francois Roubille
- Department of Cardiology, Arnaud de Villeneuve University Hospital, Montpellier, France.
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7
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McPhee L, Stogsdill P, Vella J. Nocardia farcinicapericarditis after kidney transplantation despite prophylaxis. Transpl Infect Dis 2009; 11:448-53. [DOI: 10.1111/j.1399-3062.2009.00413.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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8
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Parikh SV, Memon N, Echols M, Shah J, McGuire DK, Keeley EC. Purulent pericarditis: report of 2 cases and review of the literature. Medicine (Baltimore) 2009; 88:52-65. [PMID: 19352300 DOI: 10.1097/md.0b013e318194432b] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purulent pericarditis, a localized infection within the pericardial space, has become a rare entity in the modern antibiotic era. Although historically a disease of children and young adults, this is no longer the case: the median age at the time of diagnosis has increased by nearly 30 years over the past 6 decades. Despite advances in diagnostic and treatment modalities, purulent pericarditis remains a life-threatening illness. Unfortunately, the diagnosis is made postmortem in more than half the cases. Thus, a high index of clinical suspicion is crucial. We present 2 cases of purulent pericarditis, and provide an updated review of other case series published over the past 60 years.
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Affiliation(s)
- Shailja V Parikh
- From the Departments of Internal Medicine, Divisions of Cardiology at University of Texas Southwestern Medical Center (SVP, JS, DKM), Dallas, Texas; Washington University (NM), St. Louis, Missouri; Duke University (ME), Durham, North Carolina; and University of Virginia (ECK), Charlottesville, Virginia
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Abstract
This case report describes Nocardia pericarditis in a newly diagnosed human immunodeficiency virus (HIV) patient as an initial manifestation. Previously, two cases of Nocardia pericarditis were reported in patients with established HIV infection. To our knowledge this is the first case of Nocardia pericarditis as an initial manifestation of HIV infection. This case substantiates and emphasizes the importance of identifying Nocardia as an infectious cause of pericarditis in patients with acquired immunodeficiency. Long-term survival may be achieved with a combined medical and surgical approach.
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Affiliation(s)
- P Ramanathan
- Department of Internal Medicine Education, Division of Geriatrics, Memorial Health University Medical Center, Mercer University School of Medicine, Savannah, Georgia 31403-3089, USA.
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10
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Sarzier JS, Greene JN, Sandin RL, Spiers AS, Emmanuel PJ, Valder RE, Gombert ME, Vincent AL. Disseminated Nocardia Brasiliensis Infection in an Immunocompromised Patient. Cancer Control 1998; 5:64-67. [PMID: 10761018 DOI: 10.1177/107327489800500110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- JS Sarzier
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA
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11
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Abdelkafi S, Dubail D, Bosschaerts T, Brunet A, Van Camp G, de Marneffe M, De Vaster JM, Ninane V. Superior vena cava syndrome associated with Nocardia farcinica infection. Thorax 1997; 52:492-3. [PMID: 9176548 PMCID: PMC1758564 DOI: 10.1136/thx.52.5.492] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A case is described of severe Nocardia farcinica infection which mimicked a pulmonary neoplasm with pneumonia, superior vena cava syndrome, pericarditis, and hypertrophic osteoarthropathy. Treatment with trimethoprim-sulphamethoxazole and surgery resulted in complete recovery.
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Affiliation(s)
- S Abdelkafi
- Chest Service, Saint-Pierre University Hospital, Brussels School of Medicine, Belgium
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12
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Abstract
Cases of actinomycosis, nocardiosis, and actinomycetoma are seen infrequently but consistently in the United States. When they are found, diagnosis can be difficult because of their resemblance to other bacterial, mycobacterial, and fungal infections. This article reviews the clinical presentation, therapy, and laboratory diagnosis of these actinomycetales.
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Affiliation(s)
- N G Warren
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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13
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Farina C, Boiron P, Goglio A, Provost F. Human nocardiosis in northern Italy from 1982 to 1992. Northern Italy Collaborative Group on Nocardiosis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1995; 27:23-7. [PMID: 7784809 DOI: 10.3109/00365549509018968] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We conducted a retrospective survey of nocardiosis in 9 city hospitals in northern Italy from 1982 to 1992. The medical records of 30 patients with documented nocardiosis were reviewed. Microbiological data included morphology, biochemical characteristics, serology and in vitro susceptibility testing. The 29 isolates (1 case was diagnosed on the basis of serological results) were Nocardia asteroides (n = 25) and Nocardia farcinica (n = 4). Predisposing factors including immunosuppression for organ transplant rejection prophylaxis, lung disease (silicotuberculosis and pulmonary fibrosis), solid tumours and hematological malignancies, and AIDS. Three patients had no identified risk factors. 20 cases of pulmonary nocardiosis were observed. Sites of infection in patients without previous pulmonary involvement were: brain abscesses, soft tissues, pericardium, blood, and cerebrospinal fluid. Most strains tested were susceptible to amikacin and imipenem. Resistance to several antimicrobial agents was found, particularly erythromycin, fosfomycin, pefloxacin, sulphonamides and trimethoprim. Antimicrobial chemotherapy included sulphonamides, amikacin, ceftriaxone, imipenem and minocycline. 21 patients survived, although 2 relapsed transiently. Nocardiosis appears to be more common than generally realised by physicians in northern Italy. The local species distribution and disease spectrum are similar to those described elsewhere. Nocardiosis should be part of the differential diagnosis in patients with pulmonary infiltrates or brain abscess, particularly those with predisposing factors.
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Affiliation(s)
- C Farina
- Microbiology Institute, Ospedali Riuniti, Bergamo, Italy
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14
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Affiliation(s)
- S J Tabrizi
- Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London
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15
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McNeil MM, Brown JM. The medically important aerobic actinomycetes: epidemiology and microbiology. Clin Microbiol Rev 1994; 7:357-417. [PMID: 7923055 PMCID: PMC358331 DOI: 10.1128/cmr.7.3.357] [Citation(s) in RCA: 417] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The aerobic actinomycetes are soil-inhabiting microorganisms that occur worldwide. In 1888, Nocard first recognized the pathogenic potential of this group of microorganisms. Since then, several aerobic actinomycetes have been a major source of interest for the commercial drug industry and have proved to be extremely useful microorganisms for producing novel antimicrobial agents. They have also been well known as potential veterinary pathogens affecting many different animal species. The medically important aerobic actinomycetes may cause significant morbidity and mortality, in particular in highly susceptible severely immunocompromised patients, including transplant recipients and patients infected with human immunodeficiency virus. However, the diagnosis of these infections may be difficult, and effective antimicrobial therapy may be complicated by antimicrobial resistance. The taxonomy of these microorganisms has been problematic. In recent revisions of their classification, new pathogenic species have been recognized. The development of additional and more reliable diagnostic tests and of a standardized method for antimicrobial susceptibility testing and the application of molecular techniques for the diagnosis and subtyping of these microorganisms are needed to better diagnose and treat infected patients and to identify effective control measures for these unusual pathogens. We review the epidemiology and microbiology of the major medically important aerobic actinomycetes.
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Affiliation(s)
- M M McNeil
- Emerging Bacterial and Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia 30333
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Abstract
The nocardiae are bacteria belonging to the aerobic actinomycetes. They are an important part of the normal soil microflora worldwide. The type species, Nocardia asteroides, and N. brasiliensis, N. farcinica, N. otitidiscaviarum, N. nova, and N. transvalensis cause a variety of diseases in both normal and immunocompromised humans and animals. The mechanisms of pathogenesis are complex, not fully understood, and include the capacity to evade or neutralize the myriad microbicidal activities of the host. The relative virulence of N. asteroides correlates with the ability to inhibit phagosome-lysosome fusion in phagocytes; to neutralize phagosomal acidification; to detoxify the microbicidal products of oxidative metabolism; to modify phagocyte function; to grow within phagocytic cells; and to attach to, penetrate, and grow within host cells. Both activated macrophages and immunologically specific T lymphocytes constitute the major mechanisms for host resistance to nocardial infection, whereas B lymphocytes and humoral immunity do not appear to be as important in protecting the host. Thus, the nocardiae are facultative intracellular pathogens that can persist within the host, probably in a cryptic form (L-form), for life. Silent invasion of brain cells by some Nocardia strains can induce neurodegeneration in experimental animals; however, the role of nocardiae in neurodegenerative diseases in humans needs to be investigated.
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Affiliation(s)
- B L Beaman
- Department of Medical Microbiology and Immunology, University of California, Davis 95616
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Clenney TL, Hammond MD, McKeown PP, Holt DA, Wallach PM. Cardiac tamponade due to Nocardia asteroides. Chest 1993; 103:641-2. [PMID: 8432179 DOI: 10.1378/chest.103.2.641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Pericarditis with hemodynamic compromise is a rare manifestation of infection with Nocardia asteroides. To our knowledge, only six cases have been reported previously. In contrast to other cases of pericardial disease due to Nocardia, culture of the pericardial fluid in our case was negative while culture of pericardial tissue led to the diagnosis. Surgical intervention and appropriate antibiotic therapy are essential in the treatment of Nocardia pericarditis.
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Affiliation(s)
- T L Clenney
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612
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