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Huang L, Jia L. Disseminated nocardiosis caused by Nocardia otitidiscaviarum-A case report. Diagn Microbiol Infect Dis 2024; 110:116347. [PMID: 38878341 DOI: 10.1016/j.diagmicrobio.2024.116347] [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: 01/08/2024] [Revised: 03/19/2024] [Accepted: 05/09/2024] [Indexed: 07/30/2024]
Abstract
In this article we report a case of disseminated nocardiosis caused by Nocardia otitidiscaviarum in an immunocompetent patient with chronic obstructive pulmonary disease (COPD) who complained of a cough, followed by skin and intracranial lesions. On metagenomic next-generation sequencing (mNGS) technology of respiratory samples (bronchoalveolar lavage fluid, BALF) Nocardia otitidiscaviarum was identified. The patient was treated with therapy combined with a low dose of TMP-SMX and imipenem cilastatin sodium and had a favorable outcome. The timely diagnosis of Nocardia with the help of mNGS technology and early rational treatment of TMP-SMX can help improve the prognosis.
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Affiliation(s)
- Linyue Huang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu Sichuan 610041, PR China
| | - Lian Jia
- Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu Sichuan 610041, PR China; State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu Sichuan 610041, PR China.
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2
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Schröder J, Calligaris-Maibach R, Beer HJ, Wiggli B. ["And zebras do exist after all"! : Pulmonary nocardiosis: case series and overview]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:286-289. [PMID: 37548668 DOI: 10.1007/s00108-023-01566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 08/08/2023]
Abstract
Nocardiosis is a rare disease that occurs primarily in patients with predisposing factors (immunosuppression/chronic lung disease). It is caused by aerobic, Gram-positive bacteria that are ubiquitous in soil. Cutaneous and pulmonary manifestations are most common, but disseminated forms also occur. In terms of treatment, long-term antibiotic therapy is usually necessary. The prognosis for the cutaneous or pulmonary form is generally good.
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Affiliation(s)
- Julia Schröder
- Departement für Innere Medizin, Kantonsspital Baden, Baden, Schweiz
| | | | - Hans-Jürg Beer
- Departement für Innere Medizin, Kantonsspital Baden, Baden, Schweiz
- Molekulare Kardiologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Benedikt Wiggli
- Klinik für Infektiologie & Infektionsprävention, Kantonsspital Baden, Baden, Schweiz.
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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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Ikeda S, Uchiyama K, Moriya M, Sakurai K, Nihonyanagi S, Niimi H, Takaso M. Disseminated nocardiosis complicated by multiple abscesses of the brain and lower limbs diagnosed by the melting temperature mapping method: A case report. J Orthop Sci 2023; 28:1497-1500. [PMID: 34419319 DOI: 10.1016/j.jos.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 05/29/2021] [Accepted: 07/25/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Shinsuke Ikeda
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Mitsutoshi Moriya
- Kurokouchi Hospital, 17-36 Yutakacho, Minami-ku, Sagamihara, Kanagawa, 252-0305, Japan
| | - Keizo Sakurai
- Department of Clinical Laboratory, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Shin Nihonyanagi
- Department of Infection Control and Prevention, Kitasato University Hospital, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0375, Japan
| | - Hideki Niimi
- Department of Clinical Laboratory and Molecular Pathology, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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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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Cao L, Sun Y, Chen F. Pulmonary nocardiosis following COVID-19 in a patient with idiopathic pulmonary fibrosis and lung transplantation: a case report. Front Med (Lausanne) 2023; 10:1266857. [PMID: 37766921 PMCID: PMC10520695 DOI: 10.3389/fmed.2023.1266857] [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: 07/25/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Background Nocardiosis is an opportunistic infection that primarily affects immunocompromised patients. Pulmonary nocardiosis is the most prevalent form, but can also spread to other organs. Potential causes contributing to opportunistic infection may include immunosuppression and disruption of tight junctions, both of which can result from COVID-19. Case presentation We reported a case of a 68-year-old male patient who presented with a 10-day history of fever, cough, and productive sputum. Upon physical examination, velcro rales were detected in the right lung, while breath sounds in the left lung were clear. The patient had previously undergone left lung transplantation due to idiopathic pulmonary fibrosis four years ago. He was initially hospitalized and treated for COVID-19 but was readmitted due to worsening symptoms. Subsequently, pulmonary nocardiosis was diagnosed utilizing metagenomic next-generation sequencing of bronchoalveolar lavage fluid. The above-mentioned condition was improved following treatment with cancidas and linezolid. Now, he is under regular follow-up. Conclusion This case highlights the complexity of COVID-19 and the occurrence of secondary opportunistic infections, which require further investigation.
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Affiliation(s)
| | | | - Fei Chen
- Cancer Center, Department of Pulmonary and Critical Care Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Alqurashi R, Alobida H, Albathi A, Aldraihem M. Disseminated nocardiosis in a patient with alcoholic liver cirrhosis: a case report. BMC Infect Dis 2023; 23:445. [PMID: 37393238 DOI: 10.1186/s12879-023-08421-7] [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: 05/07/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Nocardia are Gram-positive, aerobic, filamentous bacteria that can cause localized or disseminated infections. Immunocompromised patients are at a higher risk of developing Nocardia infection and further dissemination of the disease. To date, limited data have documented the relationship between nocardiosis and alcoholic liver disease. CASE PRESENTATION We report the case of a 47-year-old man with a known history of alcoholic liver cirrhosis. The patient presented to our emergency department with redness, swelling in the left eye, and diminished bilateral vision. Fundus examination of the left eye was obscured, while that of the right eye was consistent with subretinal abscess. Therefore, endogenous endophthalmitis was suspected. Imaging revealed two ring-enhancing lesions in the brain, and multiple bilateral small cystic and cavitary lung lesions. Unfortunately, the left eye eventually eviscerated due to the rapid progression of the disease. Cultures from the left eye were positive for Nocardia farcinica. The patient was started on imipenem, trimethoprim/sulfamethoxazole, and amikacin based on culture sensitivity. The patient's hospitalization course was complicated by his aggressive and advanced condition, which led to his death. CONCLUSIONS Although the patient's condition initially improved with the recommended antibiotic regimens, it led to death owing to the patient's advanced condition. Early detection of nocardial infection in patients with typical or atypical immunosuppressive conditions may improve overall mortality and morbidity. Liver cirrhosis disrupts cell-mediated immunity and may increase the risk of Nocardia infection.
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Affiliation(s)
- Rewaa Alqurashi
- Department of Internal Medicine, King Fahad Medical City, Riyadh, Saudi Arabia.
| | - Husam Alobida
- Department of Infectious Disease, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Albathi
- Department of Radiology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Moneera Aldraihem
- Department of Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
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Reginelli A, Russo A, Pignatiello M, Patanè V, Laterza F, Monti R, Urraro F, Caliendo V, Cappabianca S. MRI findings in patient with primary cutaneous nocardiosis: A case report. Radiol Case Rep 2023; 18:2199-2203. [PMID: 37101892 PMCID: PMC10123320 DOI: 10.1016/j.radcr.2023.03.005] [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: 01/10/2023] [Revised: 02/25/2023] [Accepted: 03/01/2023] [Indexed: 04/28/2023] Open
Abstract
Nocardia is a genus of gram-positive, filamentous, aerobic bacteria that belongs to the Actinomycetales order. With over 50 species, it is ubiquitous in dust, soil, decaying organic matter, and stagnant water. Inhalation of the pathogen often leads to pulmonary nocardiosis, while extrapulmonary nocardiosis can affect the central nervous system, skin, and subcutaneous tissues. Primary cutaneous nocardiosis occurs when the pathogen is introduced through a skin lesion or insect bite, for example, this report presents a case of primary cutaneous nocardiosis in a patient with Minimal Change Glomerulonephritis and iatrogenic immunosuppression. Magnetic resonance imaging revealed extensive involvement of the skin, subcutaneous tissue, and lower limb muscles.
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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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Márquez AI, Mora E, Bernal AF, Salazar AF, Mora DP, Vargas LJ. Pulmonary and central nervous system nocardiosis: Alcoholism as an immunocompromising factor. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:37-43. [PMID: 37167467 PMCID: PMC10476646 DOI: 10.7705/biomedica.6606] [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: 05/25/2022] [Accepted: 03/04/2023] [Indexed: 05/13/2023]
Abstract
Nocardiosis is a disease with worldwide distribution. It is usually found in tropical areas and mainly affects immunocompromised patients, however, there are also cases where its infection has been reported in immunocompetent patients. This pathology is caused by bacteria known as Nocardia spp., which are gram-positive microorganisms and environmental saprophytes, and although exposure to Nocardia spp. is almost universal, only a small fraction of exposed people develops the disease. We present the case of a 47-year-old man, with no evidence of immunosuppression, from a rural area of Boyacá, who was admitted due to intense and intermittent headache accompanied by paresthesia and, finally, a decrease in consciousness. A brain magnetic resonance was performed and evidenced a fronto-temporo- occipital space-occupying lesion in the cortico-subcortical region with a compressive effect and displacement of the ventricular system cavities. It was suspected at first a neoplastic lesion or a brain abscess. The lesion was surgically resected, and its culture showed Nocardia africana/nova. In later studies a possible primary pulmonary focus was evidenced. Alcoholism was the only risk factor documented. The patient completed 6 weeks of hospital antibiotic treatment with favorable clinical and radiological evolution and was discharged with a 1-year plan of outpatient antibiotic therapy. Although Nocardia spp. mainly affects immunocompromised patients, evidence shows that this microorganism can also be a threat to individuals without traditional immunosuppression risk factors.
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Affiliation(s)
| | - Eduardo Mora
- Servicio de Radiología, Hospital Universitario San Rafael, Tunja, Colombia.
| | | | | | - Diana Patricia Mora
- Servicio de Laboratorio Clínico, Hospital Universitario San Rafael, Tunja, Colombia.
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Bouhamdani N, Comeau D, Bourque C, Saulnier N. Encephalic nocardiosis after mild COVID-19: A case report. Front Neurol 2023; 14:1137024. [PMID: 36908618 PMCID: PMC9992866 DOI: 10.3389/fneur.2023.1137024] [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: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
The COVID-19 pandemic and the associated post-acute sequelae of COVID-19 (PASC) have led to the identification of a complex disease phenotype that is associated with important changes in the immune system. Herein, we describe a unique case of Nocardia farcinica cerebral abscess in an individual with sudden immunodeficiency several months after mild COVID-19. Intravenous Bactrim and Imipenem were prescribed for 6 weeks. After this, a 12-month course of Bactrim and Clavulin was prescribed to be taken orally, given the N. farcinica infection at the level of the central nervous system. This case report highlights the need for future research into the pathophysiology of COVID-19 and PASC immune dysregulation in convalescent individuals. It also draws attention to the need for timely consideration of opportunistic infections in patients with a history of COVID-19.
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Affiliation(s)
- Nadia Bouhamdani
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, NB, Canada
| | - Dominique Comeau
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| | - Christine Bourque
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| | - Nancy Saulnier
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
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Saunier F, Grange S, Rigaill J, Lutz MF, Gagneux-Brunon A, Botelho-Nevers E. Bacteremia and adrenal gland abscess due to Nocardia cyriacigeorgica: a case report and review. BMC Infect Dis 2022; 22:966. [PMID: 36581805 PMCID: PMC9801643 DOI: 10.1186/s12879-022-07839-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/03/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Nocardia cyriacigeorgica is one of the most common Nocardia species found in human infections, recently reclassified. Even though Nocardia may affect all organs by hematogenous dissemination, bacteremia are uncommon. Among all possible dissemination sites, the involvement of the adrenal glands is particularly rare. CASE PRESENTATION We report here a rare case of Nocardia disseminated infection with notably bacteremia and adrenal gland abscess, in a 77-years-old immunocompetent man. Adrenal gland abscess diagnosis was made by imaging (computerized tomography, magnetic resonance and positron emission tomography scan). A complete regression of all lesions including the left adrenal gland was obtained after 6 months of antibiotics. A review of literature was also performed. CONCLUSION Nocardia bacteremia is a rare event but blood cultures may help to improve detection of Nocardia spp. in a non-invasive way. Adrenal abscess due to Nocardia spp. is very rare with only fourteen cases reported in the literature, but it is a true cause of adrenal masses. Our report suggests that clinician should be aware of this rare location and prioritize a non-invasive diagnosis strategy.
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Affiliation(s)
- Florian Saunier
- grid.412954.f0000 0004 1765 1491Infectious Disease Department, University Hospital of Saint Etienne, 42055 Saint-Étienne, France
| | - Sylvain Grange
- grid.412954.f0000 0004 1765 1491Department of Radiology, University Hospital of Saint Etienne, 42055 Saint-Étienne, France
| | - Josselin Rigaill
- grid.412954.f0000 0004 1765 1491Laboratory of Infectious Agents and Hygiene, University Hospital of Saint-Etienne, 42055 Saint-Étienne, France
| | - Marie-France Lutz
- grid.412954.f0000 0004 1765 1491Infectious Disease Department, University Hospital of Saint Etienne, 42055 Saint-Étienne, France
| | - Amandine Gagneux-Brunon
- grid.412954.f0000 0004 1765 1491Infectious Disease Department, University Hospital of Saint Etienne, 42055 Saint-Étienne, France
| | - Elisabeth Botelho-Nevers
- grid.412954.f0000 0004 1765 1491Infectious Disease Department, University Hospital of Saint Etienne, 42055 Saint-Étienne, France
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13
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Traxler RM, Bell ME, Lasker B, Headd B, Shieh WJ, McQuiston JR. Updated Review on Nocardia Species: 2006-2021. Clin Microbiol Rev 2022; 35:e0002721. [PMID: 36314911 PMCID: PMC9769612 DOI: 10.1128/cmr.00027-21] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
This review serves as an update to the previous Nocardia review by Brown-Elliott et al. published in 2006 (B. A. Brown-Elliott, J. M. Brown, P. S. Conville, and R. J. Wallace. Jr., Clin Microbiol Rev 19:259-282, 2006, https://doi.org/10.1128/CMR.19.2.259-282.2006). Included is a discussion on the taxonomic expansion of the genus, current identification methods, and the impact of new technology (including matrix-assisted laser desorption ionization-time of flight [MALDI-TOF] and whole genome sequencing) on diagnosis and treatment. Clinical manifestations, the epidemiology, and geographic distribution are briefly discussed. An additional section on actinomycotic mycetoma is added to address this often-neglected disease.
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Affiliation(s)
- Rita M. Traxler
- Bacterial Special Pathogens Branch (BSPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Melissa E. Bell
- Bacterial Special Pathogens Branch (BSPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Brent Lasker
- Bacterial Special Pathogens Branch (BSPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Brendan Headd
- Bacterial Special Pathogens Branch (BSPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Wun-Ju Shieh
- Infectious Diseases Pathology Branch (IDPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - John R. McQuiston
- Bacterial Special Pathogens Branch (BSPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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14
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Li T, Chen YX, Lin JJ, Lin WX, Zhang WZ, Dong HM, Cai SX, Meng Y. Successful treatment of disseminated nocardiosis diagnosed by metagenomic next-generation sequencing: A case report and review of literature. World J Clin Cases 2022; 10:10120-10129. [PMID: 36246801 PMCID: PMC9561593 DOI: 10.12998/wjcc.v10.i28.10120] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/25/2022] [Accepted: 08/21/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nocardia paucivorans is an infrequently found bacterium with the potential to cause severe infection, with a predilection for the central nervous system, both in immunocompromised and immunocompetent individuals. Rapid etiological diagnosis of nocardiosis can facilitate timely and rational antimicrobial treatment. Metagenomic next-generation sequencing (mNGS) can improve the rate and reduce the turnaround time for the detection of Nocardia.
CASE SUMMARY A 49-year-old man was admitted to hospital with cough and hemoptysis. Imaging revealed pulmonary consolidation as well as multiple brain lesions. Nocardia asiatica and Nocardia beijingensis were rapidly detected by mNGS of bronchoalveolar lavage fluid (BALF) while bacterial culture of BALF and pathological biopsy of lung tissue were negative. In early stages, he was treated with trimethoprim-sulfamethoxazole (TMP-SMZ) and linezolid by individual dose adjustment based on serum concentrations and the adverse effects of thrombocytopenia and leukopenia. The treatment was then replaced by TMP-SMZ and ceftriaxone or minocycline. He was treated with 8 mo of parenteral and/or oral antibiotics, and obvious clinical improvement was achieved with resolution of pulmonary and brain lesions on repeat imaging.
CONCLUSION mNGS provided fast and precise pathogen detection of Nocardia. In disseminated nocardiosis, linezolid is an important alternative that can give a better outcome with the monitoring of linezolid serum concentrations and platelet count.
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Affiliation(s)
- Ting Li
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Yi-Xin Chen
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Jia-Jia Lin
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Wei-Xian Lin
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Wei-Zhen Zhang
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Hang-Ming Dong
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Shao-Xi Cai
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
| | - Ying Meng
- Department of Respiratory and Critical Care Medicine, Nanfang Hospital, Southern Medical University, Guangzhou 510515, Guangdong Province, China
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15
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Serino M, Sousa C, Redondo M, Carvalho T, Ribeiro M, Ramos A, Cruz-Martins N, Amorim A. Nocardia spp. isolation in chronic lung diseases: Are there differences between patients with Pulmonary Nocardiosis and Nocardia colonization? J Appl Microbiol 2022; 133:3239-3249. [PMID: 35957549 DOI: 10.1111/jam.15778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
AIMS Chronic lung diseases are a recognized risk factor for Nocardia spp. INFECTION Nocardia spp. isolation does not inevitably imply disease, and thus colonization must be considered. Here, we aimed to analyse the differences between pulmonary nocardiosis (PN) and Nocardia spp. colonization in patients with chronic lung diseases. METHODS AND RESULTS A retrospective study of patients with laboratory confirmation of isolation of Nocardia spp. in at least one respiratory sample was performed. Patients with PN and Nocardia spp. colonization were compared. There were 71 patients with Nocardia spp. identification, 64.8% were male, with a mean age of 67.7±11.2 years. All patients had ≥1 pre-existing chronic lung disease and 19.7% patients were immunocompromised. PN and Nocardia spp. colonization were considered in 26.8% and 73.2% of patients, respectively. Symptoms and chest CT findings were significantly more frequent in patients with PN (p<.001). During follow-up time, 12 (16.9%) patients died, 6 in PN group. Immunosuppression, constitutional symptoms, haematological malignancy and PN diagnosis were associated with significantly shorter survival times, despite only immunosuppression (HR 3.399; 95% CI 1.052-10.989) and PN diagnosis (HR 3.568; 95% CI 1.078-11.910) remained associated with a higher death risk in multivariate analysis. CONCLUSIONS PN was linked to clinical worsening, more chest CT findings and worse clinical outcomes. SIGNIFICANCE AND IMPACT OF STUDY Nocardia spp. isolation in chronic lung disease patients is more common than expected and the differentiation between colonization and disease is crucial.
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Affiliation(s)
- Mariana Serino
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Sousa
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Margarida Redondo
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Teresa Carvalho
- Clinical Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuela Ribeiro
- Clinical Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Angélica Ramos
- Clinical Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Institute of Public Health of the University of Porto (ISPUP), Portugal
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal.,Institute of Research and Advanced Training in Health Sciences and Technologies (CESPU), Rua Central de Gandra, 1317, Gandra, PRD, Portugal
| | - Adelina Amorim
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal
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16
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Ong CC, Teo LL. Endemic Thoracic Infections in Southeast Asia. Radiol Clin North Am 2022; 60:445-459. [DOI: 10.1016/j.rcl.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Abdeltawab K, Denewar A, Gheith O, Zein Eldin S, Yagen J, AbdelMonem M, Elsayed Z, Nair P, Altailji S, Al-Otaibi T. Successful Management of Combined BK Nephropathy and Nocardiosis in a Renal Transplant Recipient: Case Report. EXP CLIN TRANSPLANT 2022; 20:140-144. [PMID: 35384825 DOI: 10.6002/ect.mesot2021.p67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nocardiosis is a life-threatening infection in immunocompromised patients. The prevalence of the disease ranges from 2.3% to 5% in renal allograft recipients. Here, we describe a case of BK nephropathy associating with nocardiosis with successful recovery. The 54-year-old male patient had end-stage kidney disease due to diabetic nephropathy associated with diabetic retinopathy, hypertension, and dyslipidemia. He started hemodialysis in October 2017; 2 years later, he underwent a deceased donor kidney transplant with 2 HLA mismatches and high panel reactive antibodies. He received desensitization with intravenous immunoglobulin and rituximab, received thymoglobulin as induction, and was maintained on prednisolone, mycophenolate mofetil, and tacrolimus. His serum creatinine decreased to a nadir of 90 μmol/L. He developed graft dysfunction, which was proven to be due to BK nephropathy. Therefore, mycophenolate mofetil was replaced with leflunomide in addition to intravenous immunoglobulin therapy. Ten months later, he had an accidental fall and sought an orthopedic evaluation. Magnetic resonance imaging of the lumbar spine and pelvis revealed lumbar spondylosis, avascular necrosis of the femoral head, and obturator muscle abscess. He was explored surgically, but the surgeon found no abscess or avascular hip necrosis. The patient's blood grew Nocardia, and he was readmitted and started imipenem and linezolid empirically. Brain and chest computed tomography scans ruled out any central nervous system or pulmonary involvement, but a bone scan revealed osteomyelitis of the right superior pubic ramus and prepubic swelling, which was confirmed by computed tomography to be an abscess in both obturator externus and internus. He continued the same antibiotics for 6 months based on culture and sensitivity. At follow-up, the patient has shown stable graft function (creatinine 155 μmol/L) with improved BK viremia with immunosuppression minimization. In renal transplant recipients, successful management of combined BK nephropathy and nocardiosis was feasible with minimization of immunosuppression and proper antimicrobial therapy.
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Affiliation(s)
- Khaled Abdeltawab
- From the Nephrology Department, Hamed Al-Essa Organ Transplant Center, Sabah Area, Kuwait
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18
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Chronic Relapsing Neutrophilic Meningitis as the Sole Manifestation of Nocardiosis in a Patient with Mixed Connective Tissue Disease. IDCases 2022; 28:e01473. [PMID: 35340754 PMCID: PMC8941153 DOI: 10.1016/j.idcr.2022.e01473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/07/2022] [Accepted: 03/07/2022] [Indexed: 11/20/2022] Open
Abstract
We describe a rare case of a patient with mixed connective tissue disease maintained on chronic oral corticosteroids, who was hospitalized on five occasions over five consecutive months due to persistent relapsing neutrophilic meningitis caused by Nocardia asteroides. Immunosuppression due to the chronic use of corticosteroids was identified as the underlying mechanism of susceptibility. Our report highlights the challenges associated with systemic Nocardiosis, particularly in the immunocompromised host.
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19
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Williams PCM, Bartlett AW, Palasanthiran P, McMullan B. A not so innocuous playground fall: lymphocutaneous nocardiosis in an immunocompetent boy. Arch Dis Child 2022; 107:257-258. [PMID: 34340985 DOI: 10.1136/archdischild-2021-322392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Phoebe C M Williams
- School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia .,School of Women and Children's Health, The University of NSW, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Adam William Bartlett
- School of Women and Children's Health, The University of NSW, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Pamela Palasanthiran
- School of Women and Children's Health, The University of NSW, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Brendan McMullan
- School of Women and Children's Health, The University of NSW, Sydney, New South Wales, Australia.,Department of Infectious Diseases and Immunology, Sydney Children's Hospital, Randwick, NSW, Australia
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20
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Kumar KV, Unni VN, Warrier A, Prasannan B. Disseminated nocardiosis and focal nontuberculous mycobacterial infection coexisting in a renal transplant recipient - A case report. INDIAN JOURNAL OF TRANSPLANTATION 2022. [DOI: 10.4103/ijot.ijot_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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21
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DiMeglio M, Shaikh H, Newman J, Vasquez Rubio G. Nocardiosis of the Central Nervous System: A rare complication of COVID management? IDCases 2022; 29:e01599. [PMID: 36032175 PMCID: PMC9403338 DOI: 10.1016/j.idcr.2022.e01599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
This case report examines a previously immunocompetent male that was treated with a prolonged course of corticosteroids for COVID pneumonia. He then returned with worsening headaches followed by flaccid paralysis of extremities due to cerebral and spinal cord abscesses secondary to Nocardia farcinica. A review of the literature on the mechanism of immunosuppression with COVID infection and corticosteroids is provided.
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22
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Diagnosis and Neurosurgical Management of Cerebral Nocardiosis. J Neurol Surg Rep 2021; 82:e21-e24. [PMID: 34703724 PMCID: PMC8461561 DOI: 10.1055/s-0040-1722345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/11/2020] [Indexed: 12/04/2022] Open
Abstract
Primary
Nocardia
infections are uncommon gram-positive bacterial infections caused by aerobic actinomycetes and are typically regarded as opportunistic infections (only one-third of infected patients are immunocompetent). Risk factors include: glucocorticoid therapy, malignancy, organ transplant recipients, human immunodeficiency virus infections, tumor necrosis factor-α inhibitor therapy, diabetes mellitus, alcoholism, inflammatory bowel disease, chronic obstructive pulmonary disease, chronic granulomatous disease, and tuberculosis. The organism has a predisposition to disseminate to the central nervous system and can relapse or progress despite appropriate therapy. Treatment ranges from oral antibiotic management to multiple intravenous antibiotic therapy, with surgical intervention required for severe cases. The surgical options include aspiration or complete excision of abscess contents and capsule. In the present case, we describe the use of bilateral craniotomy with assisted image guidance and multiple abscess excision in an immunocompetent patient with systemic nocardiosis.
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23
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Nso N, Nassar M, Guzman Perez LM, Shaukat T, Trandafirescu T. Localized Pulmonary Nocardia farcinica Infection As the Presenting Symptom of Acquired Immunodeficiency Syndrome. Cureus 2021; 13:e17611. [PMID: 34646662 PMCID: PMC8483601 DOI: 10.7759/cureus.17611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2021] [Indexed: 11/30/2022] Open
Abstract
Nocardiosis is an opportunistic infection that most commonly affects immunocompromised patients, with clinical presentations ranging from localized to disseminated disease. In the United States, the reported incidence is approximately 500 to 1,000 cases per year, with an observed male-to-female predominance of 3:1. We present the case of a 37-year-old male with a past medical history of malaria who presented with watery, non-bloody diarrhea for four days associated with a fever for two weeks. The human immunodeficiency virus (HIV) was positive in the emergency room before admission. Computerized tomography (CT) of the chest with contrast revealed an irregular pleural base mass in the right lower lobe with several small air foci. CT of the abdomen and pelvis revealed the right pleural base lung mass to be adherent to the diaphragm, as well as mild splenomegaly. The cluster of differentiation 4 (CD4) count was 9 cells/mm3. An acid-fast bacilli (AFB) sputum culture was positive for Nocardia farcinica. Trimethoprim-sulfamethoxazole was started for a Nocardia farcinica pulmonary infection, in addition to antiretroviral therapy. The patient was strongly encouraged to follow-up at the outpatient department.
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Affiliation(s)
- Nso Nso
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Mahmoud Nassar
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Laura M Guzman Perez
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York , USA
| | - Tanveer Shaukat
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
| | - Theo Trandafirescu
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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24
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Karaosmanoglu AD, Uysal A, Onder O, Hahn PF, Akata D, Ozmen MN, Karcaaltıncaba M. Cross-sectional imaging findings of splenic infections: is differential diagnosis possible? Abdom Radiol (NY) 2021; 46:4828-4852. [PMID: 34047800 PMCID: PMC8160561 DOI: 10.1007/s00261-021-03130-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 01/31/2023]
Abstract
The spleen plays an important role in the immunological homeostasis of the body. Several neoplastic and non-neoplastic diseases may affect this organ, and imaging is of fundamental importance for diagnosis. Infectious diseases of the spleen can be encountered in daily radiology practice, and differential diagnosis may sometimes be challenging. Infectious involvement of the spleen can be primary or secondary to a different source outside the spleen. Despite the fact that different infectious diseases may cause similar imaging findings, we believe that differential diagnosis between different causes may also be possible in certain patients with imaging. Early diagnosis may potentially enhance patients’ treatment and outcome. In this review, we aimed to increase imaging specialists’ awareness of splenic infections by describing the multimodality imaging features of common and atypical infections of the spleen with their differential diagnoses.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, Ankara, 06010, Turkey
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
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Abe S, Tanabe Y, Ota T, Fujimori F, Youkou A, Makino M. Case report: pulmonary nocardiosis caused by Nocardia exalbida in an immunocompetent patient. BMC Infect Dis 2021; 21:776. [PMID: 34372796 PMCID: PMC8351411 DOI: 10.1186/s12879-021-06416-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nocardiosis is known as an opportunistic infection in immunocompromised hosts, but it occasionally has been reported in immunocompetent patient. The Nocardia exalbida is first-reported in 2006 from Japan, and a few cases of have been reported in only immunocompromised host, and the characteristic is still unclear. We herein describe the first case of pulmonary nocardiosis caused by N. exalbida in an immunocompetent patient. CASE PRESENTATION A77 -year-old Japanese man was admitted to our hospital on November 2, 2018. He was a lifelong non-smoker with no childhood history of respiratory disease. He had a medical history of dyslipidemia. One month before this admission fevers, sputum, mild cough were developed and he was evaluated in a clinic near our hospital. His diagnosis was community acquired pneumonia within his right middle lobe. He was treated with ceftriaxone 1 g/day intravenously for a week, however his symptoms relapsed a few days later. So, the physician retried ceftriaxone for another 3 days, but his symptoms did not improve. He was referred to our hospital. He was treated with sitafloxacin as an outpatient for a week, however his symptoms got worse. The chest CT showed consolidation and atelectasis in his right middle lobe. Low density area was scattered in consolidation, and right pleural effusion was observed. The patient was diagnosed with pulmonary abscess and he was admitted. Administration of piperacillin/tazobactam improved his condition. We switched antibiotics to amoxicillin/clavulanate, and he was discharged. After 2 weeks, he relapsed and was admitted again. After administration of piperacillin/tazobactam for 3 weeks, we perform bronchoscopy and Nocardia species were cultured from samples of the bronchial wash. The isolates were identified as N. exalbida using 16S rRNA gene sequencing. We prescribed Trimethoprim / Sulfamethoxazole (TMP/SMX) for 4 months. Then we switched to minocycline for renal dysfunction caused from TMP-SMX for 1 more month. After 5 months therapy, Consolidation on CT disappeared, and Nocardiosis was cured. CONCLUSION we reported the first case of pulmonary nocardiosis caused by N. exalbida in an immunocompetent patient. N. exalbida infection might be associated with a good response to treatment.
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Affiliation(s)
- Seitaro Abe
- Department of Respiratory Medicine, Niigata prefecturasl Shibata hospital, 1-2-8 Shibata, Niigata, 957-8588, Japan
| | - Yoshinari Tanabe
- Department of Respiratory Medicine, Niigata prefecturasl Shibata hospital, 1-2-8 Shibata, Niigata, 957-8588, Japan.
| | - Takeshi Ota
- Department of Respiratory Medicine, Niigata prefecturasl Shibata hospital, 1-2-8 Shibata, Niigata, 957-8588, Japan
| | - Fumio Fujimori
- Department of Respiratory Medicine, Niigata prefecturasl Shibata hospital, 1-2-8 Shibata, Niigata, 957-8588, Japan
| | - Akira Youkou
- Department of Infectious Disease, Niigata City general hospital, Niigata, Japan
| | - Masato Makino
- Department of Respiratory Medicine, Niigata prefecturasl Shibata hospital, 1-2-8 Shibata, Niigata, 957-8588, Japan
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26
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Lee EK, Kim J, Park DH, Lee CK, Kim SB, Sohn JW, Yoon YK. Disseminated nocardiosis caused by Nocardia farcinica in a patient with colon cancer: A case report and literature review. Medicine (Baltimore) 2021; 100:e26682. [PMID: 34398037 PMCID: PMC8294930 DOI: 10.1097/md.0000000000026682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Nocardiosis is an uncommon and potentially life-threatening infection that usually affects immunocompromised hosts. No clinical guidelines have been established for managing this rare disease, and the optimal treatment modality remains unclear. Nocardia farcinica, a relatively infrequent pathogen of nocardiosis, causes a clinically aggressive infection. In addition to our patient data, our search of the literature for patients who presented with empyema caused by N. farcinica will provide fundamental information for optimal treatment modalities. PATIENT CONCERNS A 64-year-old man was diagnosed with empyema, 4 days following surgery for sigmoid colon cancer. Brain lesions were evaluated only after N. farcinica was isolated and identified as the causative pathogen through repeated culture tests. DIAGNOSES N. farcinica was isolated from the pleural effusion and confirmed as the pathogen through 16S rRNA sequencing. INTERVENTIONS The patient was successfully treated with tube thoracotomy, neurosurgical evacuation, and a combination of trimethoprim/sulfamethoxazole plus imipenem. Long-term antibiotic therapy was required to prevent recurrence. OUTCOMES Pyothorax showed a good clinical response to antimicrobial therapy and drainage of pleural effusion, whereas brain abscess did not respond to medical therapy and required surgery. The patient eventually recovered and continued chemotherapy as treatment for sigmoid colon cancer. LESSONS Although extremely rare, this report demonstrates the importance of considering Nocardia infection as the differential diagnosis in immunocompromised patients who present with empyema. In particular, because of the N. farcinica infection's tendency to spread and the resistance of the organism to antibiotics, aggressive evaluation of metastatic lesions and standardized support from microbiological laboratories are important. Surgery may be required in some patients with brain abscesses to improve the chance of survival.
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Affiliation(s)
- Eung Kyum Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Jin Kim
- Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Dong-Hyuk Park
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Chang Kyu Lee
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
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Hazarika K, Sahoo RR, Ekbote D, Dixit AK, Marak RS, Wakhlu A. Multidrug-resistant novel Nocardia neocaledoniensis brain abscess in sarcoidosis. BMJ Case Rep 2021; 14:e240123. [PMID: 33875499 PMCID: PMC8057541 DOI: 10.1136/bcr-2020-240123] [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: 03/21/2021] [Indexed: 11/04/2022] Open
Abstract
Central nervous system nocardiosis is a rare, life-threatening infection seen commonly in immunocompromised individuals. Nocardia neocaledoniensis is a novel species seldom causing infections in humans. We describe a patient of sarcoidosis on immunosuppression, who presented with altered sensorium due to a frontal lobe abscess secondary to N. neocaledoniensis infection. Despite appropriate and adequate antibiotic coverage, and timely surgical intervention, the patient succumbed to her illness on day 6 of hospitalisation. This case warrants the consideration of novel infections in patients on immunosuppression and the need for aggressive management.
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Affiliation(s)
- Kasturi Hazarika
- Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rasmi Ranjan Sahoo
- Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Digvijay Ekbote
- Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ajai Kumar Dixit
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rungmei S Marak
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anupam Wakhlu
- Clinical Immunology and Rheumatology, King George's Medical University, Lucknow, Uttar Pradesh, India
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Lenskaya V, DeChavez V, Kaufman B, Caplivski D. Primary cutaneous nocardiosis caused by Nocardia nova with possible Apremilast contribution. IDCases 2021; 24:e01078. [PMID: 33850720 PMCID: PMC8024659 DOI: 10.1016/j.idcr.2021.e01078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
Primary cutaneous nocardiosis accounts for 5-8 % of all nocardiosis cases and represents a diagnostic dilemma among immunocompetent and immunocompromised hosts. Herein, we present a case of a 30-year-old male with history of psoriasis with recent addition of Apremilast. Patient received intralesional triamcinolone injections for psoriatic plaques on the hands and abdomen prior to traveling to warm climate vacation. While on vacation, patient developed hand swelling and painful, red nodules on the dorsal hands and abdomen, sites where he received intralesional injections. Patient was empirically given doxycycline, but continued to develop new nodules. An abdominal lesion was biopsied for H&E and tissue culture. Tissue culture revealed beaded gram-positive rods identified as Nocardia nova by MALDI-TOF. Patient was switched to trimethoprim-sulfamethoxazole with significant improvement. This case represents an atypical primary cutaneous nocardiosis with Nocardia nova most likely in the setting of intralesional steroid injections and possible contribution of Apremilast.
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Affiliation(s)
- Volha Lenskaya
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, 10129, NY, United States
- Corresponding author at: 1468 Madison Ave, Annenberg, 15th floor, New York, NY, 10029, United States.
| | - Vincent DeChavez
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, 10129, NY, United States
| | - Bridget Kaufman
- Department of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, 10129, NY, United States
| | - Daniel Caplivski
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, 10129, NY, United States
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Weheba I, Abdelsayed A, Alrajhi AA, Al-Thawadi SI, Mobeireek A. Nocardiosis at an Organ Transplant Center in Saudi Arabia: 15 years' experience. J Glob Infect Dis 2021; 13:7-12. [PMID: 33911446 PMCID: PMC8054793 DOI: 10.4103/jgid.jgid_66_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/09/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Nocardiosis is a rare infection that affects immunocompromised patients on immunosuppressive medications used for transplantation and cancer therapy. Such therapies are becoming more widely available in the Middle East region. Yet, reports on nocardiosis are scarce. Materials and Methods: This was a retrospective analysis of patients who were diagnosed with nocardiosis from 2004 to 2018 at a transplantation and cancer center. Nocardiosis were defined per the European Organization for Research and Treatment of Cancer criteria. Results: During the study period, 35 patients with nocardiosis (male: 68.5%) were identified. The most common underlying associated condition was transplantation 11 (31.4%), followed by malignancy 7 (20%), connective tissue disease and sarcoidosis 7 (20%), chronic lung disease 5 (14%), miscellaneous conditions 4 (11%), and one patient with human immunodeficiency virus. Nocardia was disseminated in 8 patients (22.9%) and isolated in 27 (77.1%); the latter included 13 patients (37.1%) with bronchial form, 11 (31.4%) with isolated visceral form, and 3 (8.6%) with cutaneous form. Pulmonary involvement occurred in 90% of the cases with cough, fever, and dyspnea being the most common symptoms. The main strain isolate was Nocardia asteroides, and the cure rate was 90%. Mortality related to nocardiosis occurred in 3 transplant patients (8.6%). Conclusion: Wider use of immunosuppressive therapy warrants vigilance to nocardiosis, which can present in a myriad of clinical forms. In our series, mortality was confined to the transplantation group, probably because of the relatively heavy immunosuppression. Nonetheless, prognosis is favorable if the infection is recognized and treated early.
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Affiliation(s)
- Ihab Weheba
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Department of Medicine, National Research Centre, Cairo, Egypt
| | - Abeer Abdelsayed
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Department of Medicine, Ain Shams University, Cairo, Egypt
| | - Abdulrahman A Alrajhi
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Sahar I Al-Thawadi
- Department of Laboratory Medicine and Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Abdullah Mobeireek
- Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Luo N, Tan S, Li X, Liu S, Singh S, Chen M, Yang W, He Y, Chen C, Liang M. Pulmonary nocardiosis in a patient with pemphigus foliaceus: case report and literature review. BMC Infect Dis 2021; 21:8. [PMID: 33407179 PMCID: PMC7788831 DOI: 10.1186/s12879-020-05673-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 11/30/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Nocardiosis is an uncommon opportunistic infection seen in immunocompromised patients or those with a dysfunctional immune system. Nocardia asteroides infection in patients with Pemphigus foliaceus (PF) has never been reported. CASE PRESENTATION We report an interesting case of nocardiosis-characterized by pulmonary intra-cavitary infection, in a 54-year-old man with PF and diabetes mellitus. The man finally recovered from the infection. CONCLUSIONS This is the first case reporting pulmonary nocardiosis in a patient with PF. We recommend that physicians be aware of nocardiosis in patients with pemphigus as a possible cause of underlying infectious disease to avoid misdiagnoses and mismanagement.
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Affiliation(s)
- Ning Luo
- Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, MaoNanQu, WeiMing Road 101 Hao, Maoming City, Guangdong, China
| | - Shifan Tan
- Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, MaoNanQu, WeiMing Road 101 Hao, Maoming City, Guangdong, China
| | - Xiaocai Li
- Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, MaoNanQu, WeiMing Road 101 Hao, Maoming City, Guangdong, China
| | - Si Liu
- Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, MaoNanQu, WeiMing Road 101 Hao, Maoming City, Guangdong, China
| | | | - Mafeng Chen
- Department of Otorhinolaryngology, Maoming People's Hospital, Maoming, China
| | - Weiye Yang
- Department of Laboratory Medicine, Maoming People's Hospital, Maoming, China
| | - Yanhong He
- Department of Scientific Research, Maoming People's Hospital, Maoming, China
| | - Chunna Chen
- Department of Dermatology, Maoming People's Hospital, Maoming, China
| | - Min Liang
- Department of Respiratory and Critical Care Medicine, Maoming People's Hospital, MaoNanQu, WeiMing Road 101 Hao, Maoming City, Guangdong, China.
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Ghandour M, Shereef H, Homida H, Revankar S, Zachariah MS. Disseminated Nocardiosis in a Renal Transplant Recipient. Cureus 2021; 13:e12497. [PMID: 33564506 PMCID: PMC7861065 DOI: 10.7759/cureus.12497] [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] [Indexed: 11/16/2022] Open
Abstract
Nocardiosis is an uncommon opportunistic Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia can cause localized or systemic suppurative diseases involving eyes, kidneys, skin, lungs, bone, and central nervous system. Disseminated nocardiosis is a rare condition, seen among immunocompromised patients. We report the case of a 55-year-old African American, kidney transplant male recipient on maintenance immunosuppression, who was diagnosed with cutaneous and pulmonary nocardiosis. Presenting symptoms were shortness of breath, and bilateral lower extremities pain and swelling. Tissue culture grew Gram-positive bacilli specified as Nocardia farcinica from thigh and gluteal abscesses. CT thorax showed bilateral reticulonodular opacities. The patient was managed with immunosuppression reduction and specific treatment with high-dose trimethoprim-sulfamethoxazole (TMP-SMX) in conjunction with linezolid. Combination antibiotics were continued for four weeks, and thereafter, TMP-SMX alone was continued for 12 months, at which point all lesions had healed. Nocardiosis with systemic involvement carries a poor prognosis. However, early diagnosis and appropriate antibiotic coverage had a favorable outcome in a renal transplant recipient. Recommended treatment duration is 6 to 12 months.
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Affiliation(s)
- Mohamedanwar Ghandour
- Internal Medicine/Nephrology, Wayne State University Detroit Medical Center, Detroit, USA
| | | | - Hassan Homida
- Internal Medicine, Advocate Aurora Health Care, Detroit, USA
| | - Sanjay Revankar
- Infectious Diseases, Wayne State University Detroit Medical Center, Detroit, USA
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32
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Galar A, Martín-Rabadán P, Marín M, Cercenado E, Sánchez-Carrillo C, Valerio M, Bouza E, Muñoz P. Revisiting nocardiosis at a tertiary care institution: Any change in recent years? Int J Infect Dis 2020; 102:446-454. [PMID: 33157288 DOI: 10.1016/j.ijid.2020.10.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To analyse relevant changes in incidence, clinical and microbiological characteristics of nocardiosis over the last 24 years at the current institution. MATERIALS AND METHODS The clinical records of patients with nocardiosis (2006-2018) were reviewed and then compared with a previous cohort (1995-2006). Nocardia isolates were identified by 5'-end-16S-rRNA-gene-PCR targeting the first 500 bp of the gene and sequencing. Susceptibility tests were determined by broth microdilution (CLSI guidelines). RESULTS Forty-two patients (64.3% male) with nocardiosis were evaluated in the recent cohort: 51.2% had COPD, 43.9% were on corticosteroid therapy and 31.7% had cancer. The incidence of nocardiosis varied from 6.3 to 7.1/100,000 admissions (p = 0.62). There was a decrease in HIV patients (27% vs. 4.9%, p = 0.01) and solid organ transplantation (SOT) recipients (18.9% vs. 2 .4%, p = 0.01). Cases with pulmonary involvement had increased (70.3% vs. 90.5%, p = 0.04). Nocardia species were similar but the most common were N. cyriacigeorgica (32.4% vs. 40.5%, p = 0.49) and N. farcinica (24.3% vs. 14.3%, p = 0.39). Antibiotic resistance remained stable: cotrimoxazole (10.8% vs. 5.7%, p = 0.68), imipenem (5.4% vs. 5.6%, p = 1.0); amikacin and linezolid were 100% active. No differences were found in breakthrough nocardiosis (21.6% vs. 9.8%, p = 0.21) or related mortality (21.6% vs. 21.4%, p = 1.0). The multivariate analysis confirmed that nocardiosis caused by N. farcinica is a risk factor for poor outcome (p = 0.045). CONCLUSIONS Nocardiosis incidence has remained stable. It mainly affected elderly patients with chronic respiratory conditions and those on corticosteroid treatment. Infections in HIV and SOT patients have practically disappeared. Pulmonary involvement remains the most common area to be affected. Nocardiosis caused by N. farcinica is apparently a risk factor for poor clinical outcome.
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Affiliation(s)
- Alicia Galar
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Pablo Martín-Rabadán
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CIBER de Enfermedades Respiratorias(CIBERES CB06/06/0058), Madrid, Spain
| | - Mercedes Marín
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CIBER de Enfermedades Respiratorias(CIBERES CB06/06/0058), Madrid, Spain
| | - Emilia Cercenado
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CIBER de Enfermedades Respiratorias(CIBERES CB06/06/0058), Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Maricela Valerio
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CIBER de Enfermedades Respiratorias(CIBERES CB06/06/0058), Madrid, Spain
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; CIBER de Enfermedades Respiratorias(CIBERES CB06/06/0058), Madrid, Spain.
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33
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Langmaid T, Jassal K, Meher-Homji Z, Lee JC, Serpell J, Yeung M, McMahon J, Grodski S. Disseminated nocardiosis with adrenal abscess masquerading as metastatic adrenal cancer in an immunocompetent adult. ANZ J Surg 2020; 91:E396-E398. [PMID: 33137243 DOI: 10.1111/ans.16423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/17/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Tess Langmaid
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Karishma Jassal
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Zaal Meher-Homji
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - James C Lee
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Jonathan Serpell
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Meei Yeung
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - James McMahon
- Department of Infectious Diseases, Alfred Hospital, Melbourne, Victoria, Australia
| | - Simon Grodski
- Department of General Surgery, Breast and Endocrine Unit, Alfred Hospital, Melbourne, Victoria, Australia.,Monash University Endocrine Surgery Unit, Alfred Hospital, Melbourne, Victoria, Australia
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34
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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: 25] [Impact Index Per Article: 6.3] [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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35
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Rahman MT, Sobur MA, Islam MS, Ievy S, Hossain MJ, El Zowalaty ME, Rahman AMMT, Ashour HM. Zoonotic Diseases: Etiology, Impact, and Control. Microorganisms 2020; 8:microorganisms8091405. [PMID: 32932606 PMCID: PMC7563794 DOI: 10.3390/microorganisms8091405] [Citation(s) in RCA: 191] [Impact Index Per Article: 47.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023] Open
Abstract
Most humans are in contact with animals in a way or another. A zoonotic disease is a disease or infection that can be transmitted naturally from vertebrate animals to humans or from humans to vertebrate animals. More than 60% of human pathogens are zoonotic in origin. This includes a wide variety of bacteria, viruses, fungi, protozoa, parasites, and other pathogens. Factors such as climate change, urbanization, animal migration and trade, travel and tourism, vector biology, anthropogenic factors, and natural factors have greatly influenced the emergence, re-emergence, distribution, and patterns of zoonoses. As time goes on, there are more emerging and re-emerging zoonotic diseases. In this review, we reviewed the etiology of major zoonotic diseases, their impact on human health, and control measures for better management. We also highlighted COVID-19, a newly emerging zoonotic disease of likely bat origin that has affected millions of humans along with devastating global consequences. The implementation of One Health measures is highly recommended for the effective prevention and control of possible zoonosis.
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Affiliation(s)
- Md. Tanvir Rahman
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh; (M.A.S.); (M.S.I.); (S.I.); (M.J.H.)
- Correspondence: (M.T.R.); (H.M.A.)
| | - Md. Abdus Sobur
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh; (M.A.S.); (M.S.I.); (S.I.); (M.J.H.)
| | - Md. Saiful Islam
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh; (M.A.S.); (M.S.I.); (S.I.); (M.J.H.)
| | - Samina Ievy
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh; (M.A.S.); (M.S.I.); (S.I.); (M.J.H.)
| | - Md. Jannat Hossain
- Department of Microbiology and Hygiene, Faculty of Veterinary Science, Bangladesh Agricultural University, Mymensingh 2202, Bangladesh; (M.A.S.); (M.S.I.); (S.I.); (M.J.H.)
| | - Mohamed E. El Zowalaty
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, UAE;
- Zoonosis Science Center, Department of Medical Biochemistry and Microbiology, Uppsala University, SE 75123 Uppsala, Sweden
| | | | - Hossam M. Ashour
- Department of Integrative Biology, College of Arts and Sciences, University of South Florida, St. Petersburg, FL 33701, USA
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
- Correspondence: (M.T.R.); (H.M.A.)
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36
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Balachandar A, Zhabokritsky A, Matukas LM. Disseminated nocardiosis with multisite involvement in an immunocompetent patient. CMAJ 2020; 192:E956-E959. [PMID: 32816999 DOI: 10.1503/cmaj.200153] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Arjun Balachandar
- Departments of Medicine (Balachandar, Zhabokritsky, Matukas) and Laboratory Medicine & Pathobiology (Matukas), University of Toronto; Division of Microbiology (Matukas), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.
| | - Alice Zhabokritsky
- Departments of Medicine (Balachandar, Zhabokritsky, Matukas) and Laboratory Medicine & Pathobiology (Matukas), University of Toronto; Division of Microbiology (Matukas), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
| | - Larissa M Matukas
- Departments of Medicine (Balachandar, Zhabokritsky, Matukas) and Laboratory Medicine & Pathobiology (Matukas), University of Toronto; Division of Microbiology (Matukas), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont
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37
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Song HZ, Gao L, Xu LL, Wang T, Ni X, Yang JM. [Nocardia infection after allogeneic hematopoietic stem cell transplantation: two cases report and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2020; 40:768-770. [PMID: 31648481 PMCID: PMC7342440 DOI: 10.3760/cma.j.issn.0253-2727.2019.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H Z Song
- Department of Hematology, Changhai Hospital, Naval Medical University, Shanghai 200433, China; Department of General Medicine, Haining People's Hospital, Haining 314400, China
| | - L Gao
- Department of Hematology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - L L Xu
- Department of Hematology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - T Wang
- Department of Hematology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - X Ni
- Department of Hematology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
| | - J M Yang
- Department of Hematology, Changhai Hospital, Naval Medical University, Shanghai 200433, China
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38
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Williams E, Jenney AW, Spelman DW. Nocardia bacteremia: A single-center retrospective review and a systematic review of the literature. Int J Infect Dis 2020; 92:197-207. [PMID: 31978577 DOI: 10.1016/j.ijid.2020.01.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Nocardia bacteremia is a rare but severe disease associated with high mortality. This systematic review is the largest and most comprehensive review performed over the past 20 years. METHODS A single-center retrospective review of Nocardia bacteremia was performed using hospital microbiology records from January 1, 2010 to December 31, 2017. A systematic literature review was also performed to identify cases of Nocardia bacteremia described in the NCBI PubMed database in English between January 1, 1999 and December 31, 2018. RESULTS Four new cases of Nocardia bacteremia are described. The systematic review identified 134 cases with sufficient information available for analysis. Of the total 138 cases, the median age was 58 years (interquartile range (IQR) 44-69 years) and 70% were male. Eighty-one percent were immunocompromised (corticosteroid use (49%), hematological malignancy (20%), solid organ transplant (20%), solid organ malignancy (19%), and hematopoietic stem cell transplantation (15%)) and 29% had endovascular devices. Pulmonary infection was the most common concurrent site of clinical disease (67%). The median incubation time to the detection of Nocardia bacteremia was 4 days (IQR 3-6 days). Blood cultures were the only positive microbiological specimen in 38% of cases. The median total duration of treatment was 75 days (IQR 25-182 days). Thirty-day all-cause mortality was 28% and overall all-cause mortality was 40%. CONCLUSIONS Nocardia bacteremia is most frequently identified in immunocompromised patients and those with intravascular devices. Although rare, it represents a serious infection with high associated overall mortality.
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Affiliation(s)
- Eloise Williams
- Microbiology Unit, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia; Department of Infectious Diseases, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia.
| | - Adam W Jenney
- Microbiology Unit, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia; Department of Infectious Diseases, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia; Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Denis W Spelman
- Microbiology Unit, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia; Department of Infectious Diseases, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia; Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
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Abu Sitta E, Hollingshead C, Luttmann K, Elsaghir H. Gardener with primary lymphocutaneous nocardiosis. BMJ Case Rep 2019; 12:12/12/e233586. [PMID: 31843784 DOI: 10.1136/bcr-2019-233586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Emad Abu Sitta
- Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA
| | | | - Kelly Luttmann
- Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Hend Elsaghir
- Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA
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Kancherla R, Ramanathan RP, Appalaraju B, Rajagopala S. Pulmonary Nocardiosis Presenting as Exacerbation of Chronic Pulmonary Disease. Indian J Crit Care Med 2019; 23:467-474. [PMID: 31749556 PMCID: PMC6842839 DOI: 10.5005/jp-journals-10071-23270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Pulmonary nocardiosis (PN) occurs in chronic pulmonary disease (CPD) in the absence of traditional risk factors. Clinical features that differentiate bacterial exacerbations (AE-CPDb) from PN-related exacerbations (AE-CPDPN) are not well described. OBJECTIVES To describe a series of AE-CPDPN without traditional risk factors and compare clinical features, radiology and outcomes with age, gender and CLD-type matched AE-CPDb. MATERIALS AND METHODS Single-center retrospective review and case-control study. RESULTS AE-CPDPN had longer duration of symptoms and more leukocytosis at hospitalization. AE-CPDb patients were sicker with more chronic respiratory failure (OR 33.3, p = 0.01), cardiac disease and pulmonary hypertension (OR 6.2, p = 0.008) at diagnosis. More patients with AE-CPDb were discharged on domiciliary oxygen (OR 5.27, p = 0.01). On logistic regression, AE-CPDPN was independently associated with mechanical ventilation (OR 22.3, p = 0.01), length of hospital stay (median difference, 4 days, p = 0.016) but not to hospital mortality. 22.7% of AE-CPDPN died. Respiratory failure requiring oxygen, NIPPV or mechanical ventilation was associated with mortality in AE-CPDPN. CONCLUSION PN is a rare cause of AE-CPD and can be suspected by longer symptom duration, more leukocytosis, consolidation and cavitation. AE-CPDPN is associated with longer hospital stay and mechanical ventilation. Respiratory failure is associated with mortality in AE-CPDPN. KEY MESSAGES Pulmonary nocardiosis can present in advanced chronic lung disease as an exacerbation in the absence of traditional risk factors like immunosuppression.Bronchiectasis, followed by chronic obstructive pulmonary disease are the most common chronic lung disease risk factors.Pulmonary nocardiosis is a rare cause of acute exacerbation of chronic pulmonary disease (CPD).Compared to exacerbations of CPD due to bacterial infections, nocardiosis-related exacerbations (CPDPN) were independently related to need for mechanical ventilation and length of hospital stay.Respiratory failure requiring oxygen, noninvasive ventilation and mechanical ventilation are associated with mortality in AE-CPDPN. HOW TO CITE THIS ARTICLE Kancherla R, Ramanathan RM PL, Appalaraju B, Srinivas R. Pulmonary Nocardiosis Presenting as Exacerbation of Chronic Pulmonary Disease. Indian J Crit Care Med 2019;23(10):467-474.
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Affiliation(s)
- Roopa Kancherla
- Department of Pulmonology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
| | | | - Bobbe Appalaraju
- Department of Microbiology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
| | - Srinivas Rajagopala
- Department of Pulmonology, PSG Institute of Medical Sciences and Research, Peelamedu, Coimbatore, Tamil Nadu, India
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Mahboob M, Hassan S, Attia AA, Rahman E, Khan MS, Bokhari SR. Treatment of cardiac nocardiosis in a post-renal transplant patient of systemic nocardiosis. J Cardiovasc Thorac Res 2019; 11:161-163. [PMID: 31384412 PMCID: PMC6669421 DOI: 10.15171/jcvtr.2019.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 05/03/2019] [Indexed: 11/20/2022] Open
Abstract
In general, nocardia infects immunosuppressed patients, however, sometimes it can also infect immunocompetent individuals. Nocardia infection can disseminate to any organ system of the body but the pulmonary system is the most commonly involved system. In some rare cases, the heart can also be involved and the resulting cardiac mycetoma can be treated successfully with antimicrobials without the need of surgery, unlike fungal cardiac mycetomas wherein surgery may be required in addition to antimicrobial therapy. We present an interesting case of post-renal transplant cardiac nocardiosis, which was treated successfully with a course of antibiotics.
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Bowman C, Davies H, Wilmore S. Disseminated nocardiosis in a liver transplant patient. Br J Hosp Med (Lond) 2019; 78:720-721. [PMID: 29240499 DOI: 10.12968/hmed.2017.78.12.720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Conor Bowman
- Infectious Diseases Registrar, Infectious Diseases Department, Royal Free Hospital, London NW3 2QG
| | - Hannah Davies
- Paediatric Specialist Trainee, Paediatric Accident and Emergency Department, Guys and St Thomas Hospital, London
| | - Stephanie Wilmore
- Infectious Diseases Registrar, Infectious Diseases Department, Royal Free Hospital, London
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43
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Gupta S, Gulia S, Kannan RA, Rodrigues C, Dhareshwar J, Vora A. Nocardial endocarditis in native aortic valve with nocardial sepsis in a case of breast cancer. BMJ Case Rep 2019; 12:12/7/e229370. [PMID: 31300597 DOI: 10.1136/bcr-2019-229370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Central venous catheter-associated bacteraemia caused by Nocardia species is very rare; the diagnosis of nocardiosis in patients with cancer is challenging because its clinical presentation is varied, sometimes mimicking metastases, and the high index of clinical suspicion is required for prompt institution of therapy. Herein, we report a case of nocardial sepsis with native aortic valve endocarditis in a patient with breast cancer in whom multidisciplinary team involvement and prompt initiation of therapy have led to successful outcome.
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Affiliation(s)
- Sudeep Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Seema Gulia
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Ram Abhinav Kannan
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Camilla Rodrigues
- Department of Microbiology, Hinduja Hospital, Mumbai, Maharashtra, India
| | - Jayesh Dhareshwar
- Department of Cardiothoracic Surgery, Jupiter Hospital, Mumbai, Maharashtra, India
| | - Amit Vora
- Glenmark Cardiac Centre, Mumbai, Maharashtra, India
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Restrepo A, Clark NM. Nocardia infections in solid organ transplantation: Guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation. Clin Transplant 2019; 33:e13509. [PMID: 30817024 DOI: 10.1111/ctr.13509] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 02/12/2019] [Indexed: 12/29/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of Nocardia infections after solid organ transplantation (SOT). Nocardia infections have increased in the last two decades, likely due to improved detection and identification methods and an expanding immunocompromised population. The risk of developing nocardiosis after transplantation varies with the type of organ transplanted and the immunosuppression regimen used. Nocardia infection most commonly involves the lung. Disseminated infection can occur, with spread to the bloodstream, skin, or central nervous system. Early recognition of the infection and initial appropriate treatment is important to achieve good outcomes. Species identification and antimicrobial susceptibility testing are strongly recommended, as inter- and intraspecies susceptibility patterns can vary. Sulfonamide is the first-line treatment of Nocardia infections, and combination therapy with at least two antimicrobial agents should be used initially for disseminated or severe nocardiosis. Trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis may be helpful in preventing Nocardia infection after SOT.
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Affiliation(s)
- Alejandro Restrepo
- Division of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Nina M Clark
- Division of Infectious Diseases, Department of Medicine, Loyola University Stritch School of Medicine, Maywood, Illinois
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Yamate R, Matono T, Yaguchi T, Fujii Y, Goto Y, Tobino K, Imura H, Nagano S. Disseminated nocardiosis with Nocardia brasiliensis bacteremia in a patient with rheumatoid arthritis using tocilizumab. J Infect Chemother 2019; 25:552-555. [PMID: 30852105 DOI: 10.1016/j.jiac.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/08/2019] [Accepted: 02/13/2019] [Indexed: 02/07/2023]
Abstract
Here, we present a case of disseminated nocardiosis, involving pneumonia, percutaneous abscess, and bacteremia, in a 67-year-old Japanese woman. She had also been treated for rheumatoid arthritis with prednisolone, methotrexate, and tocilizumab (interleukin-6 receptor inhibitor). Based on the 16S rRNA sequence analysis and a blast search, we identified the isolate as Nocardia brasiliensis. We discontinued methotrexate and tocilizumab on admission, and administered intravenous antimicrobial combination therapy for 6 weeks, followed by oral trimethoprim-sulfamethoxazole for 12 months, in total. Nocardia bacteremia is rare, often difficult to diagnose, and substantially fatal. However, due to our prompt diagnosis within one day of the onset of symptoms, and administration of appropriate treatment based on antimicrobial susceptibilities, this patient succeeded in surviving the infection. Not only microbiologists but also clinicians should be aware of the characteristic bacterial form of Gram/Kinyoun staining for early recognition of nocardiosis.
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Affiliation(s)
| | | | - Takashi Yaguchi
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | | | - Yuki Goto
- Respiratory Medicine, Iizuka Hospital, Iizuka, Japan
| | | | - Hiroshi Imura
- Department of General Internal Medicine, Iizuka, Japan
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Nocardia brasiliensis Preseptal Cellulitis in an Immunocompetent Patient. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Freiberg JA, Saharia KK, Morales MK. An unusual case of Nocardia cyriacigeorgica presenting with spinal abscesses in a renal transplant recipient and a review of the literature. Transpl Infect Dis 2018; 21:e13025. [PMID: 30414295 DOI: 10.1111/tid.13025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/05/2018] [Accepted: 10/28/2018] [Indexed: 01/28/2023]
Abstract
Nocardia species represent a well-recognized yet uncommon cause of opportunistic infections in humans. It most frequently presents as a pulmonary infection with or without central nervous system involvement. It is a very rare cause of spinal abscesses, with only 26 cases reported in the literature. Here we report a 49-year-old man with a history of renal transplantation who presented with low back pain and was diagnosed with epidural and paraspinal abscesses due to Nocardia cyriacigeorgica that was successfully treated with antimicrobial therapy alone. In addition to the case reported here, we also conducted a systematic review of the existing literature regarding spinal abscesses due to Nocardia species and examined the success of the various treatments utilized.
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Affiliation(s)
| | - Kapil K Saharia
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland
| | - Megan K Morales
- Institute of Human Virology and Division of Infectious Diseases, University of Maryland School of Medicine, Baltimore, Maryland
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48
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Baek JO, Kim JS, Lee SK, Jeong JH, Lee MJ, Seo IH. Two cases of primary cutaneous nocardiosis caused by intralesional injection. Dermatol Ther 2018; 32:e12775. [PMID: 30365211 DOI: 10.1111/dth.12775] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 10/14/2018] [Accepted: 10/18/2018] [Indexed: 11/26/2022]
Abstract
Nocardiosis is a rare localized or systemic suppurative disease caused by the actinomycete Nocardia species. The respiratory tract is the most common site of infection, but primary cutaneous nocardiosis can also be induced by direct inoculation. Nocardiosis is usually reported in immunocompromised patients, such as those with human immunodeficiency virus (HIV) infection, chronic obstructive pulmonary disease, autoimmune diseases, cancer, or in those who have had organ transplantation or corticosteroid administration. However, it can also affect individuals with no serious underlying condition. We reported two cases of primary cutaneous nocardiosis in immunocompetent patients after intralesional injection of steroid.
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Affiliation(s)
- Jin O Baek
- Department of Dermatology and Laboratory Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Jeong S Kim
- Department of Dermatology and Laboratory Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Seul K Lee
- Department of Dermatology and Laboratory Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Ji H Jeong
- Department of Dermatology and Laboratory Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Myung J Lee
- Department of Internal Medicine, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, South Korea
| | - Il H Seo
- Department of Dermatology and Laboratory Medicine, Gachon University Gil Medical Center, Incheon, South Korea
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49
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Wu J, Wu Y, Zhu Z. Pulmonary infection caused by Nocardia cyriacigeorgica in a patient with allergic bronchopulmonary aspergillosis: A case report. Medicine (Baltimore) 2018; 97:e13023. [PMID: 30412142 PMCID: PMC6221653 DOI: 10.1097/md.0000000000013023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
RATIONALE Nocardia species is known as conditional pathogenic bacteria. Among Nocardia species, pulmonary infection caused by Nocardia cyriacigeorgica associated with Aspergillus fumigatus complex lung disease is rarely reported. PATIENT CONCERNS A 55-year-old female with a history of productive cough with recurrent expectoration for 20 years presented with increasing cough for 12 months. The patient presented complaining of respiratory symptoms including increasing cough with yellow phlegm, poor appetite, and generalized fatigue for a week prior to admission. DIAGNOSES Nocardia cyriacigeorgica pneumonia was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing. INTERVENTIONS Combined treatments (trimethoprim-sulfamethoxazole and meropenem) were administered after identification of N cyriacigeorgica. OUTCOMES The respiratory symptoms of the patient had improved both clinically and radiologically after 4 weeks of antibacterial therapy. LESSONS Early precise diagnosis and prompt combined therapy are of vital importance in severe Nocardia pulmonary infection.
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50
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Baldassarri RJ, Kumar D, Baldassarri S, Cai G. Diagnosis of Infectious Diseases in the Lower Respiratory Tract: A Cytopathologist's Perspective. Arch Pathol Lab Med 2018; 143:683-694. [PMID: 30203986 DOI: 10.5858/arpa.2017-0573-ra] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Respiratory cytology continues to play an important role in the diagnosis of lower respiratory tract infections. Prompt, accurate diagnosis of causative organisms is of paramount importance, particularly in immunosuppressed patients. In addition, a rapidly expanding arsenal of ancillary testing is now available, aiding tremendously in organism identification. OBJECTIVE.— To provide an updated review on the cytomorphologic features of common organisms in lower respiratory tract infection. Relevant ancillary tests, differential diagnoses, and potential pitfalls of organism identification will also be discussed. DATA SOURCES.— Data for this review were gathered from PubMed searches of infectious diseases of the lower respiratory tract, especially related to the diagnoses. CONCLUSIONS.— The lower respiratory tract is subject to infection by a wide variety of infectious agents. Pathologists should be familiar with common organisms, including their general clinical characteristics, cytomorphologic features, differential diagnoses, and ancillary methods of detection. Above all, correlation with microbiologic and clinical information is necessary to make a confident diagnosis of infection.
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Affiliation(s)
- Rebecca J Baldassarri
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
| | - Deepika Kumar
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
| | - Stephen Baldassarri
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
| | - Guoping Cai
- From the Departments of Pathology (Drs R. J. Baldassarri, Kumar, and Cai) and Internal Medicine (Dr S. Baldassarri), Yale School of Medicine, New Haven, Connecticut
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