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Pham J, Benefield RJ, Baker N, Lindblom S, Canfield N, Gomez CA, Fisher M. In vitro activity of omadacycline against clinical isolates of Nocardia. Antimicrob Agents Chemother 2024; 68:e0168623. [PMID: 38534103 PMCID: PMC11064614 DOI: 10.1128/aac.01686-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
Nocardiosis typically requires a prolonged treatment duration of ≥6 months and initial combination therapy with 2-3 antibiotics. First-line regimens for nocardiosis are associated with considerable toxicity; therefore, alternative therapies are needed. Omadacycline is an aminomethylcycline with broad antimicrobial activity whose in vitro activity against Nocardia species has not been formally assessed. The in vitro potency of omadacycline was evaluated against 300 Nocardia clinical isolates by broth microdilution. The most common Nocardia species tested were N. cyriacigeorgica (21%), N. nova (20%), and N. farcinica (12%). The most common specimens were respiratory (178 isolates, 59%) and wound (57 isolates, 19%). Omadacycline minimum inhibitory concentrations (MICs) across all Nocardia species ranged from 0.06 µg/mL to 8 µg/mL, with an MIC50 of 2 µg/mL and MIC90 of 4 µg/mL. The lowest MICs were found among N. paucivorans (MIC50 = 0.25 µg/mL, MIC90 = 0.25 µg/mL), N. asiatica (MIC50 = 0.25 µg/mL, MIC90 = 1 µg/mL), N. abscessus complex (MIC50 = 0.5 µg/mL, MIC90 = 1 µg/mL), N. beijingensis (MIC50 = 0.5 µg/mL, MIC90 = 2 µg/mL), and N. otitidiscaviarum (MIC50 = 1 µg/mL, MIC90 = 2 µg/mL). The highest MICs were found among N. farcinica (MIC50 = 4 µg/mL, MIC90 = 8 µg/mL). In vitro potency differed by species among Nocardia clinical isolates. Further studies are warranted to evaluate the potential clinical utility of omadacycline for nocardiosis.
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Affiliation(s)
- Jonathan Pham
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Russell J. Benefield
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Natali Baker
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, USA
| | - Shane Lindblom
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, USA
| | - Nicholas Canfield
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, USA
| | - Carlos A. Gomez
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mark Fisher
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, USA
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Besteiro B, Coutinho D, Fragoso J, Figueiredo C, Nunes S, Azevedo C, Teixeira T, Selaru A, Abreu G, Malheiro L. Nocardiosis: a single-center experience and literature review. Braz J Infect Dis 2023; 27:102806. [PMID: 37802128 PMCID: PMC10582834 DOI: 10.1016/j.bjid.2023.102806] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION Nocardiosis is a rare bacterial infection caused by Nocardia spp. However, an increasing incidence has been described whereby data about epidemiology and prognosis are essential. METHODS A retrospective descriptive study was conducted among patients with positive Nocardia spp. culture, from January 2019 to January 2023, at a Terciary Hospital in Portugal. RESULTS Nocardiosis was considered in 18 cases with a median age of 63.8-years-old. At least one immunosuppressive cause was identified in 70% of patients. Five patients had Disseminated Nocardiosis (DN). The lung was the most common site of clinical disease (77.8%) and Nocardia was most commonly identified in respiratory tract samples. The most frequently isolated species were Nocardia nova/africana (n = 7) followed by Nocardia cyriacigeorgica (n = 3) and Nocardia pseudobrasiliensis (n = 3). The majority of the patients (94.4%) received antibiotic therapy, of whom as many as 55.6% were treated with monotherapy. The most frequently prescribed antibiotic was trimethoprim-sulfamethoxazole. Selected antimicrobial agents were generally effective, with linezolid and cotrimoxazole (100% Susceptibility [S]) and amikacin (94% S) having the most activity against Nocardia species. The median (IQR) duration of treatment was 24.2 (1‒51.4) weeks for DN; The overall one-year case fatality was 33.3% (n = 6) and was higher in the DN (66.7%). No recurrence was observed. CONCLUSION Nocardiosis is an emerging infectious disease with a poor prognosis, particularly in DN. This review offers essential epidemiological insights and underscores the importance of gaining a better understanding of the microbiology of nocardiosis. Such knowledge can lead to the optimization of antimicrobial therapy and, when necessary, guide appropriate surgical interventions to prevent unfavorable outcomes.
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Affiliation(s)
- Bruno Besteiro
- Centro Hospitalar e Universitário de São João, Internal Medicine Department, Oporto, Portugal; Oporto University, Faculty of Medicine, Centro Hospitalar e Universitário de São João, Oporto, Portugal; Centro Académico Clínico de São João, Oporto, Portugal.
| | - Daniel Coutinho
- Centro Hospitalar de Vila Nova de Gaia Espinho, Infectious Diseases Department, Vila Nova de Gaia, Portugal
| | - Joana Fragoso
- Centro Hospitalar de Vila Nova de Gaia Espinho, Infectious Diseases Department, Vila Nova de Gaia, Portugal
| | - Cristóvão Figueiredo
- Centro Hospitalar de Vila Nova de Gaia Espinho, Infectious Diseases Department, Vila Nova de Gaia, Portugal
| | - Sofia Nunes
- Centro Hospitalar de Vila Nova de Gaia Espinho, Infectious Diseases Department, Vila Nova de Gaia, Portugal
| | - Carlos Azevedo
- Centro Hospitalar de Vila Nova de Gaia Espinho, Infectious Diseases Department, Vila Nova de Gaia, Portugal
| | - Tiago Teixeira
- Centro Hospitalar de Vila Nova de Gaia Espinho, Infectious Diseases Department, Vila Nova de Gaia, Portugal
| | - Aurélia Selaru
- Centro Hospitalar de Vila Nova de Gaia Espinho, Microbiology Department, Vila Nova de Gaia, Portugal
| | - Gabriela Abreu
- Centro Hospitalar de Vila Nova de Gaia Espinho, Microbiology Department, Vila Nova de Gaia, Portugal
| | - Luís Malheiro
- Oporto University, Faculty of Medicine, Centro Hospitalar e Universitário de São João, Oporto, Portugal; Centro Académico Clínico de São João, Oporto, Portugal; Centro Hospitalar de Vila Nova de Gaia Espinho, Infectious Diseases Department, Vila Nova de Gaia, Portugal
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Anwar S, Acharya S, Thapa K, Adhikari N, Mobarakai N. Brain Abscesses by Nocardia: An Interesting Case. Cureus 2023; 15:e38911. [PMID: 37313078 PMCID: PMC10259744 DOI: 10.7759/cureus.38911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/15/2023] Open
Abstract
The successful management of disseminated Nocardia infection is not well described in medical literature. Immunocompetent individuals presenting with complicated and widespread Nocardia infection is an uncommon phenomenon. We describe an interesting case of a large Nocardia abscess in the brain in an immunocompetent patient that was aspirated. The patient clinically improved and was discharged home on a prolonged course of intravenous antibiotics and close outpatient follow-up. He successfully finished the antibiotic therapy for one year, and repeat imaging studies suggested the resolution of the abscess. With this case, we also intend to do a brief literature analysis about the management of brain abscess caused by Nocardia species.
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Affiliation(s)
- Shamsuddin Anwar
- Infectious Diseases, Tufts Medical Center, Boston, USA
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
| | - Sudeep Acharya
- Pulmonary and Critical Care, Staten Island University Hospital, Staten Island, USA
| | - Kumar Thapa
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
| | - Nawaraj Adhikari
- Internal Medicine, Staten Island University Hospital, Staten Island, USA
| | - Neville Mobarakai
- Infectious Diseases, Staten Island University Hospital, Staten Island, USA
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Immunoprotective Analysis of the NFA49590 Protein from Nocardia farcinica IFM 10152 Demonstrates Its Potential as a Vaccine Candidate. Pathogens 2022; 11:pathogens11121488. [PMID: 36558822 PMCID: PMC9782307 DOI: 10.3390/pathogens11121488] [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: 10/17/2022] [Revised: 11/26/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022] Open
Abstract
Nocardia is emerging as a serious and easily neglected pathogen in clinical practice with multidrug resistance that extends the treatment period for months or even years. This has led to the investigation of a vaccine approach to prevent Nocardia infections. However, studies on the protective proteins of Nocardia have not yet been carried out. In the present work, over 500 proteins in the supernatant of N. farcinica IFM10152 were identified by LC−MS/MS. In silico analysis of these proteins with a high content (score > 2000) predicted that NFA49590 was one of the conserved proteins in N. farcinica strains with potential antigenicity. After the rNFA49590 protein was cloned and expressed in E. coli (DE3) and purified using a Ni-NTA column, its good antigenicity was confirmed with sera from mice immunized with different Nocardia species by Western blot. Then we confirmed its ability to activate innate immunity by examining the phosphorylation status of ERK1/2, JNK, p38, and p65 and the cytokine levels of IL-6, TNF-α, and IL-10. Finally, we evaluated its immunoprotective effect in BALB/c mice, and we found that mice immunized with rNFA49590 protein exhibited high antibody titers, enhanced bacterial clearance ability, and generated robust protective effects from the N. farcinica challenge. These results offer strong support for the use of NFA49590 protein as a vaccine candidate and open the possibilities for the exploration of a large array of immunoprotective proteins.
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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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Lao CK, Tseng MC, Chiu CH, Chen NY, Chen CH, Chung WH, Liu TP, Lu JJ, Lai HC, Yang LY, Lee CH, Wu TS. Clinical manifestations and antimicrobial susceptibility of Nocardia species at a tertiary hospital in Taiwan, 2011-2020. J Formos Med Assoc 2022; 121:2109-2122. [PMID: 35811270 DOI: 10.1016/j.jfma.2022.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 06/21/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The study aimed to assess the clinical characteristics of patients with nocardiosis, to evaluate the in vitro susceptibility of antimicrobial agents against Nocardia species, and to explore changes in antimicrobial susceptibilities in this era of multidrug resistance. METHODS Nocardia isolates were identified to the species level using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rRNA, hsp65, and secA1 gene sequencing, and minimum inhibitory concentrations (MICs) of 15 antimicrobial agents were assessed with the broth microdilution method. RESULTS Eighty-nine isolates from 68 patients were identified to species level. The most common species were Nocardia brasiliensis (n = 28, 31.5%), followed by N. farcinica (n = 24, 27%) and N. cyriacigeorgica (n = 16, 18%). Skin and soft tissue were the most common sites of nocardiosis. In multivariate analysis, cutaneous infection (OR, 0.052; p = 0.009), immunosuppressant use (OR, 16.006; p = 0.013) and Charlson combidity index (OR, 1.522; p = 0.029) were significant predictors for death. In total, 98.9% isolates were susceptible to trimethoprim-sulfamethoxazole and linezolid. Further, the MIC range and resistance rate of all Nocardia species to ceftriaxone, imipenem, and amoxicillin-clavulanic acid were found to generally increase over time. CONCLUSIONS Considering that trimethoprim-sulfamethoxazole is effective against most Nocardia species, it is the antibiotic of choice in Taiwan. Besides, amikacin, tigecycline, and linezolid showed high activity against Nocardia species and are thus good alternatives or additional therapies to treat nocardiosis, depending on patient's underlying conditions and site of infection.
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Affiliation(s)
- Chong Kei Lao
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan
| | - Mei-Chueh Tseng
- Department of Medical Research and Development, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan
| | - Cheng-Hsun Chiu
- School of Medicine, Chang Gung University, 259, Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan; Infection Control Committee, Chang Gung Memorial Hospital, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan
| | - Nan-Yu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan; School of Medicine, Chang Gung University, 259, Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan
| | - Chih-Hung Chen
- School of Medicine, Chang Gung University, 259, Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Department of Thoracic Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan
| | - Wen-Hung Chung
- School of Medicine, Chang Gung University, 259, Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Department of Dermatology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan
| | - Tsui-Ping Liu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan
| | - Jang-Jih Lu
- School of Medicine, Chang Gung University, 259, Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Department of Laboratory Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan
| | - Hsin-Chih Lai
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, 259, Wenhua 1st Road, Gueishan District, Taoyuan 33302, Taiwan
| | - Lan-Yan Yang
- Biostatistics Unit of Clinical Trial Center, Chang Gung Memorial Hospital, 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Chia-Hui Lee
- Biostatistics Unit of Clinical Trial Center, Chang Gung Memorial Hospital, 5, Fuxing Street, Guishan District, Taoyuan City 33305, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan; School of Medicine, Chang Gung University, 259, Wenhua 1st Road, Guishan District, Taoyuan 33302, Taiwan; Infection Control Committee, Chang Gung Memorial Hospital, 5, Fuxing Street, Guishan District, Taoyuan 33305, Taiwan.
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Chomei Y, Nishimura S, Iwata K. Long-term use of tedizolid for pulmonary nocardiosis. J Infect Chemother 2022; 28:1172-1176. [PMID: 35450784 DOI: 10.1016/j.jiac.2022.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/20/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
Abstract
Nocardiosis usually occurs in immunocompromised patients and causes infections in various organs, including the lungs, skin, and organs of the central nervous system. Herein, we report the case of a patient with minimal change nephrotic syndrome who had been on immunosuppressive drugs and developed pulmonary nocardiosis due to Nocardia nova complex and Pneumocystis pneumonia. For pulmonary nocardiosis, trimethoprim-sulfamethoxazole, linezolid, and clarithromycin were initiated sequentially, but were subsequently discontinued due to side effects; the treatment was completed with tedizolid. Tedizolid was used safely for 200 out of 286 days of antibiotic treatment, and clinical improvement was observed. Tedizolid is a bacteriostatic oxazolidine antibiotic that inhibits bacterial protein synthesis, the same mechanism as its predecessor, linezolid. Tedizolid is thought to cause less frequent myelosuppression than linezolid, at least for short-term use. In the future, tedizolid may be a promising alternative to linezolid in cases of nocardiosis that usually require long-term treatment.
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Affiliation(s)
- Yuri Chomei
- Division of Infectious Diseases, Kobe University Hospital, Japan.
| | - Sho Nishimura
- Division of Infectious Diseases, Kobe University Hospital, Japan
| | - Kentaro Iwata
- Division of Infectious Diseases, Kobe University Hospital, Japan
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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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Margalit I, Lebeaux D, Tishler O, Goldberg E, Bishara J, Yahav D, Coussement J. How do I manage nocardiosis? Clin Microbiol Infect 2021; 27:550-558. [PMID: 33418019 DOI: 10.1016/j.cmi.2020.12.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nocardiosis is a rare infection that is often difficult to treat and may be life-threatening. There is no consensus on its management. OBJECTIVES Our aim was to provide the current evidence for the diagnosis and management of individuals with nocardiosis, and to propose a management approach for this uncommon infection. SOURCES We systematically searched the medical literature on nocardiosis for studies published between 2010 and 2020 and describing ten or more individuals. CONTENT Nocardiosis, a primarily opportunistic infection which may occur in immunocompetent persons, most commonly involves the lungs and frequently disseminates to other sites including the central nervous system. The reference standard for Nocardia species identification is molecular biology, and the preferred method for antibiotic susceptibility testing (AST) is broth microdilution. Monotherapy seems appropriate for patients with primary skin nocardiosis or non-severe pulmonary disease; we reserve a multidrug regimen for more severe infections. Species identification and AST results are often missing at initiation of antibiotics. Trimethoprim-sulfamethoxazole is the preferred agent for initial therapy, because Nocardia is very often susceptible to this agent, and because it has been the keystone of nocardiosis treatment for years. Linezolid, to which Nocardia is almost always susceptible, may be an alternative. When combination therapy is required, the repertoire of companion drugs includes third-generation cephalosporins, amikacin and imipenem. Therapeutic modifications should take into account clinical response to initial therapy and AST results. Treatment duration of 6 months is appropriate for most situations, but longer durations are preferred for disseminated nocardiosis and shorter durations are reasonable in low-risk situations. Secondary prophylaxis may be considered in selected individuals with permanent immunosuppression. IMPLICATIONS We hereby provide the clinician with an easy-to-use algorithm for the management of individuals with nocardiosis. We also illuminate gaps in evidence and suggest future research directions.
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Affiliation(s)
- Ili Margalit
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - David Lebeaux
- Université de Paris, Paris, France; Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Ori Tishler
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Elad Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Julien Coussement
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
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Primary Cutaneous Nocardiosis in an Adolescent with Crohn Disease. Case Rep Pediatr 2020; 2020:1532875. [PMID: 33224544 PMCID: PMC7673915 DOI: 10.1155/2020/1532875] [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: 03/11/2020] [Accepted: 11/03/2020] [Indexed: 11/18/2022] Open
Abstract
Nocardia is an aerobic, Gram-positive, partially acid-fast bacterium that often manifests as pulmonary infection since the primary route of entry is via the respiratory tract. As an opportunistic organism, Nocardia primarily affects immunocompromised individuals. Infection with Nocardia is uncommon. Primary cutaneous nocardiosis which is caused by percutaneous inoculation is even more rare. Here, we report a case of primary cutaneous nocardiosis in an adolescent with Crohn disease receiving treatment with adalimumab and azathioprine. Early identification and treatment are important to prevent disease progression and to avoid severe complications. Diagnosis is made principally by culture. Given that culture results may take up to two weeks to return, primary cutaneous nocardiosis should be maintained in the differential for any superficial cutaneous infection that arises in individuals undergoing treatment with immunosuppressive agents.
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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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12
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Yagishita M, Tsuboi H, Tabuchi D, Sugita T, Nishiyama T, Okamoto S, Terasaki T, Shimizu M, Honda F, Ohyama A, Kurata I, Abe S, Takahashi H, Osada A, Hagiwara S, Kondo Y, Matsumoto I, Sumida T. Clinical features and prognosis of nocardiosis in patients with connective tissue diseases. Mod Rheumatol 2020; 31:636-642. [PMID: 32930047 DOI: 10.1080/14397595.2020.1823070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To investigate the clinical features and prognosis of nocardiosis complicated by connective tissue diseases (CTDs). METHODS We examined patients with CTDs who were diagnosed with nocardiosis from October 2004 to 2019. We retrospectively investigated patient characteristics and therapeutic outcomes. We then performed a comparison between survivors and non-survivors. RESULTS Fourteen patients were examined. Underlying CTDs were systemic lupus erythematosus (28.6%), vasculitis syndrome (28.6%), rheumatoid arthritis (21.4%), adult Still disease (14.3%) and dermatomyositis (7.1%). Infected organs were lung (85.7%), brain (42.9%), skin/cutaneous lesions (28.6%) and muscle (7.1%). Disseminated infections were seen in nine patients (64.3%). At the onset of nocardiosis, all patients were given prednisolone (23.2 ± 11.9 mg/day). Only two patients (14.3%) were given TMP-SMX for prophylaxis of pneumocystis pneumonia. Relapse occurred in one patient (7.1%) and four patients (28.6%) died from nocardiosis for a cumulative survival rate at 52 weeks of 76.9%. In a comparison of survivors (71.4%) and non-survivors (28.6%), cutaneous lesions were significantly more frequent in the latter (10 vs 75%, p = .04) with an odds ratio of 27.0 (95% CI: 1.7-453.4). CONCLUSION Cutaneous lesions as a result of dissemination might be a risk factor for nocardiosis mortality in patients with CTDs.
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Affiliation(s)
- Mizuki Yagishita
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroto Tsuboi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Daiki Tabuchi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshiki Sugita
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Taihei Nishiyama
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shota Okamoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Toshihiko Terasaki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masaru Shimizu
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Fumika Honda
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ayako Ohyama
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Izumi Kurata
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Saori Abe
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroyuki Takahashi
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Atsumu Osada
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shinya Hagiwara
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yuya Kondo
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Isao Matsumoto
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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13
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Margalit I, Goldberg E, Ben Ari Y, Ben-Zvi H, Shostak Y, Krause I, Muhsen K. Clinical correlates of nocardiosis. Sci Rep 2020; 10:14272. [PMID: 32868850 PMCID: PMC7459281 DOI: 10.1038/s41598-020-71214-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 08/13/2020] [Indexed: 02/07/2023] Open
Abstract
Nocardia is an opportunistic pathogen that most frequently affects the lungs. Evidence is limited regarding the risk factors for nocardiosis. The current study assessed clinical correlates of nocardiosis. A retrospective study was conducted based on medical records of consecutive adult patients (N = 60) with nocardiosis hospitalized during 2007–2018 at a tertiary hospital in central Israel. A matched comparison group of 120 patients was randomly selected among hospitalized patients with community-acquired pneumonia. Multivariable conditional logistic regression models were fitted. Immunosuppressive pharmacotherapy was positively associated with nocardiosis (matched odds ratio [OR] 4.40, 95% confidence interval [CI] 2.25–8.62, p < 0.001), particularly corticosteroid therapy (matched OR 4.69, 95% CI 2.45–8.99, p < 0.001). Systemic corticosteroid therapy was strongly associated with pulmonary nocardiosis (matched OR 5.90, 95% CI 2.75–12.66, p < 0.001). The positive association between solid organ transplantation and nocardiosis was attenuated following adjustment for systemic corticosteroids in a multivariable model. The association between corticosteroid therapy and nocardiosis appeared stronger in patients with chronic pulmonary disease (OR 5.74, 95% CI 2.75–12.66, p < 0.001) than in the pooled analysis of all nocardiosis cases. In conclusion, corticosteroid therapy was strongly correlated with nocardiosis, particularly among individuals with chronic pulmonary disease and in pulmonary nocardiosis.
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Affiliation(s)
- Ili Margalit
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Elad Goldberg
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Yaara Ben Ari
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Haim Ben-Zvi
- Microbiology Laboratory, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Yael Shostak
- Pulmonary Institute and Department of Internal Medicine D, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Ilan Krause
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, School of Public Health, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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14
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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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15
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Abstract
Nocardiosis is a neglected tropical disease. It has varied geographical presence and a spectrum of clinical presentations. This review aims to focus on the epidemiology of nocardial infections with a systematic approach to their diagnosis and treatment. Nocardiacauses chronic infections and ailments, and may remain cryptic but progressive in its course. Unless suspected, diagnosis can be easily missed resulting in increased morbidity and mortality. Thorough knowledge of local epidemiology, demography, clinical course and presentation, diagnostic modalities, and antibiotic susceptibility patterns of the prevalent Nocardia species is essential to curb spread of this infection. This is a systematic review in which internet search has been done for citation indices (Embase, PubMed, Ovid, and other individual journals) till March 2020 utilizing the following key words "Nocardia," "taxonomy," "prevalence," "clinical features," "diagnosis," "treatment," and "susceptibility." We selected a total of 87 review articles, case series, and case reports all in English language.
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16
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Nocardia colonization in contrast to nocardiosis: a comparison of patients' clinical characteristics. Eur J Clin Microbiol Infect Dis 2019; 39:759-763. [PMID: 31863237 DOI: 10.1007/s10096-019-03796-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/09/2019] [Indexed: 12/26/2022]
Abstract
Information on Nocardia colonization of the lower respiratory tract is scarce. The current study is aimed at comparing clinical characteristics between individuals with Nocardia colonization and those with nocardiosis. All patients with Nocardia isolation between 2007 and 2018 at a tertiary hospital in Israel were included. Nocardia isolation was based on biochemical tests together with phenotypic susceptibility and resistance patterns until 2011 and on matrix-assisted laser desorption/ionization time-of-flight mass spectrometer from 2012. We defined nocardiosis as a clinically evident infection related to the isolation of the bacteria, which required antibiotic therapy. We defined colonization as Nocardia isolation with no clinical evidence of disease. The medical charts of all included individuals were independently reviewed by an infectious disease specialist to ensure adequate classification. Logistic regression models were fitted to compare clinical characteristics between the groups. Fifteen (20%) of the 75 Nocardia isolations met the criteria for colonization. Of those, 13 (87%) had background illnesses. Having a chronic pulmonary disease was associated with increased likelihood of Nocardia colonization, in contrast to nocardiosis (adjusted odds ratio [OR] 4.06, 95% confidence interval [CI] 1.06-15.48, p = 0.040), while an inverse association was found with corticosteroid therapy (adjusted OR 0.21, 95% CI 0.06-0.74, p = 0.015). Nocardia colonization of the lower respiratory tract accounts for a substantial proportion of all Nocardia isolations. Individuals colonized with Nocardia typically have chronic pulmonary disease and are less frequently treated with corticosteroid than patients with nocardiosis.
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17
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Kurosawa S, Sekiya N, Doki N, Yaguchi T, Kishida Y, Nagata A, Yamada Y, Konishi T, Kaito S, Yoshifuji K, Shirane S, Uchida T, Inamoto K, Toya T, Igarashi A, Najima Y, Muto H, Kobayashi T, Kakihana K, Sakamaki H, Ohashi K. The emergence of rare nocardiosis following allogeneic hematopoietic stem cell transplantation in the era of molecular taxonomy. Int J Infect Dis 2019; 89:154-162. [PMID: 31605809 DOI: 10.1016/j.ijid.2019.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The purpose of this study was to describe the clinical features of nocardiosis after allogeneic hematopoietic stem cell transplantation (allo-HSCT), focusing on new Nocardia species. METHODS We retrospectively reviewed data from patients with nocardiosis after allo-HSCT treated at our hospital and documented cases in the medical literature. RESULTS Fifty-seven cases were identified from our institution and the literature review. Although 51 patients (89.5%) responded to initial treatment, 28 (49.1%) patients were switched over to other treatment regimens due to the recurrence of nocardiosis or adverse events of antimicrobials. Nocardiosis-attributed mortality occurred in ten patients (17.5%). Antimicrobial susceptibilities varied among intra- and inter-species except linezolid (LZD). In the present study, five species were newly discovered after 2000, including N. cyriacigeorgica, N. veterana, N. abscessus, N. aobensis, and N. mexicana. All isolates of N. cyriacigeorgica, N. veterana, N. abscessus, and N. aobensis were sensitive to trimethoprim/sulfamethoxazole, amikacin (AMK), imipenem (IPM), and LZD; however, N. mexicana was resistant to AMK and IPM. CONCLUSION Newly identified Nocardia species have various antimicrobial susceptibility patterns. Long-term maintenance therapy could be challenging due to the adverse events of antimicrobials, especially in the allo-HSCT setting. Prudent evaluation is crucial for selecting a second-line or further treatment options.
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Affiliation(s)
- Shuhei Kurosawa
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Noritaka Sekiya
- Department of Infection Prevention and Control, Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan.
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | | | - Yuya Kishida
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Akihito Nagata
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Yuta Yamada
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Tatsuya Konishi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Satoshi Kaito
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kota Yoshifuji
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Shuichi Shirane
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Tomoyuki Uchida
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kyoko Inamoto
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Takashi Toya
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Aiko Igarashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Hideharu Muto
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Takeshi Kobayashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kazuhiko Kakihana
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
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18
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Xu S, Hou X, Sun L, Zhang J, Ji X, Wang X, Li H, Li Z. An immunoproteomic approach to identify antigenic proteins in Nocardia farcinica IFM 10152. Microb Pathog 2019; 137:103705. [PMID: 31487535 DOI: 10.1016/j.micpath.2019.103705] [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: 06/02/2019] [Revised: 08/22/2019] [Accepted: 09/01/2019] [Indexed: 02/07/2023]
Abstract
Nocardia farcinica is the etiological agent of nocardiosis, leading to serious pulmonary or systemic infections. To uncover virulence factors and early diagnostic markers, secreted proteins of N. farcinica IFM 10152 were analyzed using an immunoproteome-based approach. A total of 5 proteins were identified by matrix-assisted laser desorption (MALDI-TOF-MS). Bioinformatic analyses showed that the identified proteins were involved in defense against the host innate immune system and required for pathogenesis. All proteins were expressed in E. coli and antigenicity was analyzed with Western blot. To our knowledge, these proteins with antigenicity were identified for the first time in N. farcinica and they may help elucidate the pathogenesis underlying Nocardia and provide potential future diagnostic markers.
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Affiliation(s)
- Shuai Xu
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xuexin Hou
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lina Sun
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jingshan Zhang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xingzhao Ji
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xuebing Wang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Heqiao Li
- CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China
| | - Zhenjun Li
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
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19
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Morado-Aramburo O, Delgado-Ávila BG, Calderón-Campas SA, Badel-Ramos LM. Lung nodules and retinal lesions in an immunocompromised patient. Enferm Infecc Microbiol Clin 2019; 38:132-134. [PMID: 31447170 DOI: 10.1016/j.eimc.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Oscar Morado-Aramburo
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Brenda G Delgado-Ávila
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Sergio A Calderón-Campas
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico
| | - Laura M Badel-Ramos
- Infectious Diseases Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico.
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20
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Ott SR, Meier N, Kolditz M, Bauer TT, Rohde G, Presterl E, Schürmann D, Lepper PM, Ringshausen FC, Flick H, Leib SL, Pletz MW. Pulmonary nocardiosis in Western Europe—Clinical evaluation of 43 patients and population-based estimates of hospitalization rates. Int J Infect Dis 2019; 81:140-148. [DOI: 10.1016/j.ijid.2018.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 11/26/2022] Open
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21
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Tashiro H, Takahashi K, Kusaba K, Tanaka M, Komiya K, Nakamura T, Aoki Y, Kimura S, Sueoka-Aragane N. Relationship between the duration of trimethoprim/sulfamethoxazole treatment and the clinical outcome of pulmonary nocardiosis. Respir Investig 2018; 56:166-172. [PMID: 29548655 DOI: 10.1016/j.resinv.2017.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 10/24/2017] [Accepted: 11/10/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND Despite treatment, pulmonary nocardiosis, which is a rare opportunistic disease caused by Nocardia species, has poor clinical outcomes including recurrence and death. Currently, the treatment regimen and duration for pulmonary nocardiosis are not fully understood. The present study aimed to clarify the factors related to the clinical outcome of pulmonary nocardiosis. METHODS The medical records of 24 patients with pulmonary nocardiosis were retrospectively reviewed. The patients were divided into two groups based on the outcomes within 2 years: patients with controlled disease (n = 14) and patients who developed recurrence or died (n = 10). RESULTS Nocardia was identified by 16S ribosomal RNA sequencing in 17 patients (70.8%) and by conventional biochemical test in five patients (20.8%). The patients' characteristics, clinical findings, radiological features, and treatment history were not different between the two groups. Compared with patients who developed recurrence or died, those with controlled disease had significantly longer total duration of treatment with antibiotics, especially trimethoprim/sulfamethoxazole (67.5 ± 111.6 days vs. 9.0 ± 6.5 days; p = 0.01). Pancytopenia was the most frequent adverse effect of trimethoprim/sulfamethoxazole. CONCLUSIONS Longer duration of trimethoprim/sulfamethoxazole treatment was significantly associated with better outcomes of pulmonary nocardiosis. In such cases, antibiotics, especially trimethoprim/sulfamethoxazole, should be administered for more than 3 months.
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Affiliation(s)
- Hiroki Tashiro
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
| | - Koichiro Takahashi
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
| | - Koji Kusaba
- Department of Laboratory Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
| | - Masahide Tanaka
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
| | - Kazutoshi Komiya
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
| | - Tomomi Nakamura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
| | - Yosuke Aoki
- Department of International Medicine, Division of Infection Disease, Faculty of Medicine, Saga University Hospital, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
| | - Shinya Kimura
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
| | - Naoko Sueoka-Aragane
- Division of Hematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Prefecture 849-8501, Japan.
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Anzalone CL, Cohen PR, Tarrand JJ, Diwan AH, Prieto VG. Nocardia yamanashiensis in an immunocompromised patient presenting as an indurated nodule on the dorsal hand. TUMORI JOURNAL 2018; 99:e156-8. [DOI: 10.1177/030089161309900424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Nocardia are ubiquitous, aerobic, gram-positive actinomycetes. Nocardiosis typically occurs in immunocompromised patients, although immunocompetent individuals can also be affected. Purpose The purpose of this case study is to review the clinical characteristics and treatments of a unique form of cutaneous nocardiosis. Materials and Methods We retrospectively reviewed the medical literature using PubMed, searching the terms cutaneous, host, immunocompromised, Nocardia, primary, yamanashiensis. Patient reports and previous reviews of the subject were critically assessed and the salient features are presented. Results Cutaneous nocardiosis typically presents as pustular nodules and the lesions may progress to become abscesses, cellulitis, granulomas or keloid-like tumors. N. brasiliensis is the predominant species involved in primary cutaneous nocardiosis; other common Nocardia species involved in human disease are N. farcinica, N. abscessus, N. cyriacigeorgica, and N. nova. Only two individuals (including the patient presented here) with primary cutaneous infection by N. yamanashiensis have been described in the literature; a third clinical isolate was recovered from a lung biopsy. Conclusion Nocardia yamanashiensis is a rare clinical form of primary cutaneous nocardiosis. 16S ribosomal gene sequencing, as well as Gram stain and modified Fite acid-fast stain, play a vital role in identifying this clinical variant.
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Affiliation(s)
- C Lane Anzalone
- Medical School, University of Texas Medical School at Houston, Houston, TX
| | - Philip R Cohen
- Department of Dermatology, University of Texas Medical School at Houston, Houston, TX
- University of Texas Health Science Center, University of Texas, Houston, TX
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jeffrey J Tarrand
- Department of Microbiology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Abdul H Diwan
- Department of Pathology, Baylor College of Medicine, Houston, TX, USA
| | - Victor G Prieto
- Department of Dermatology, University of Texas MD Anderson Cancer Center, Houston, TX
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, TX
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Abstract
The skin is colonized by a diverse collection of microorganisms which, for the most part, peacefully coexist with their hosts. Skin and soft tissue infections (SSTIs) encompass a variety of conditions; in immunocompromised hosts, SSTIs can be caused by diverse microorganisms-most commonly bacteria, but also fungi, viruses, mycobacteria, and protozoa. The diagnosis of SSTIs is difficult because they may commonly masquerade as other clinical syndromes or can be a manifestation of systemic disease. In immunocompromised hosts, SSTI poses a major diagnostic challenge, and clinical dermatological assessment should be initially performed; to better identify the pathogen and to lead to appropriate treatment, etiology should include cultures of lesions and blood, biopsy with histology, specific microbiological analysis with special stains, molecular techniques, and antigen-detection methodologies. Here, we reviewed the epidemiology, pathophysiology, clinical presentation, and diagnostic techniques, including molecular biological techniques, used for SSTIs, with a focus on the immunocompromised host, such as patients with cellular immunodeficiency, HIV, and diabetic foot infection.
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Lebeaux D, Freund R, van Delden C, Guillot H, Marbus SD, Matignon M, Van Wijngaerden E, Douvry B, De Greef J, Vuotto F, Tricot L, Fernández-Ruiz M, Dantal J, Hirzel C, Jais JP, Rodriguez-Nava V, Jacobs F, Lortholary O, Coussement J. Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study. Clin Infect Dis 2017; 64:1396-1405. [PMID: 28329348 PMCID: PMC10941331 DOI: 10.1093/cid/cix124] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 02/02/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Solid organ transplant (SOT) recipients are at risk of nocardiosis, a rare opportunistic bacterial infection, but prognosis and outcome of these patients are poorly defined. Our objectives were to identify factors associated with 1-year mortality after nocardiosis and describe the outcome of patients receiving short-course antibiotics (≤120 days). METHODS We analyzed data from a multicenter European case-control study that included 117 SOT recipients with nocardiosis diagnosed between 2000 and 2014. Factors associated with 1-year all-cause mortality were identified using multivariable conditional logistic regression. RESULTS One-year mortality was 10-fold higher in patients with nocardiosis (16.2%, 19/117) than in control transplant recipients (1.3%, 3/233, P < .001). A history of tumor (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.8), invasive fungal infection (OR, 1.3; 95% CI, 1.1-1.5), and donor age (OR, 1.0046; 95% CI, 1.0007-1.0083) were independently associated with 1-year mortality. Acute rejection in the year before nocardiosis was associated with improved survival (OR, 0.85; 95% CI, 0.73-0.98). Seventeen patients received short-course antibiotics (median duration 56 [24-120] days) with a 1-year success rate (cured and surviving) of 88% and a 5.9% risk of relapse (median follow-up 49 [6-136] months). CONCLUSIONS One-year mortality was 10-fold higher in SOT patients with nocardiosis than in those without. Four factors, largely reflecting general medical condition rather than severity and/or management of nocardiosis, were independently associated with 1-year mortality. Patients who received short-course antibiotic treatment had good outcomes, suggesting that this may be a strategy for further study.
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Affiliation(s)
- David Lebeaux
- Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine
| | - Romain Freund
- Université Paris Descartes, INSERM UMRS 1138 Team 22, and
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Biostatistics Unit, Paris, France
| | - Christian van Delden
- Transplant Infectious Diseases Unit, Hôpitaux Universitaires de Genève, Geneva, and
- Swiss Transplant Cohort Study, Basel, Switzerland
| | - Hélène Guillot
- Sorbonne Universités, UPMC Université Paris 06, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Service des Maladies Infectieuses et Tropicales, France
| | - Sierk D Marbus
- Department of Infectious Diseases, Leiden University Medical Center, The Netherlands
| | - Marie Matignon
- Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor-Albert Chenevier, Nephrology and Transplantation Department, Centre d'Investigation Clinique-BioThérapies 504 and Institut National de la Santé et de la Recherche Médicale U955 and Paris Est University, Créteil, France
| | | | - Benoit Douvry
- Service de Pneumologie et de Transplantation Pulmonaire, Hôpital Foch, Suresnes, France
| | - Julien De Greef
- Department of Internal Medicine and Infectious Diseases, Saint-Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Fanny Vuotto
- Infectious Diseases Unit, Huriez Hospital, CHRU Lille, and
| | - Leïla Tricot
- Service de Néphrologie-Transplantation Rénale, Hôpital Foch, Suresnes, France
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Jacques Dantal
- Institut de Transplantation, d'Urologie et de Néphrologie, CHU Nantes, France
| | - Cédric Hirzel
- Swiss Transplant Cohort Study, Basel, Switzerland
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Jean-Philippe Jais
- Université Paris Descartes, INSERM UMRS 1138 Team 22, and
- Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Biostatistics Unit, Paris, France
| | - Veronica Rodriguez-Nava
- Research Group on Bacterial Opportunistic Pathogens and Environment UMR5557 Écologie Microbienne, French Observatory of Nocardiosis, Université de Lyon 1, CNRS, VetAgro Sup, France; and
| | - Frédérique Jacobs
- Division of Infectious Diseases, CUB-Erasme, Université Libre de Bruxelles, Belgium
| | - Olivier Lortholary
- Université Paris Descartes, Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine
| | - Julien Coussement
- Division of Infectious Diseases, CUB-Erasme, Université Libre de Bruxelles, Belgium
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Haussaire D, Fournier PE, Djiguiba K, Moal V, Legris T, Purgus R, Bismuth J, Elharrar X, Reynaud-Gaubert M, Vacher-Coponat H. Nocardiosis in the south of France over a 10-years period, 2004-2014. Int J Infect Dis 2017; 57:13-20. [PMID: 28088585 DOI: 10.1016/j.ijid.2017.01.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 12/29/2016] [Accepted: 01/05/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Nocardiosis is a rare disease with polymorphic presentations. The epidemiology and clinical presentation could change with the increasing number of immunocompromised patients. METHODS The medical records and microbiological data of patients affected by nocardiosis and treated at the university hospitals of Marseille between 2004 and 2014 were analyzed retrospectively. RESULTS The cases of 34 patients infected by Nocardia spp during this period were analyzed. The main underlying conditions were transplantation (n=15), malignancy (n=9), cystic fibrosis (n=4), and immune disease (n=3); no immunodeficiency condition was observed for three patients. No case of AIDS was observed. At diagnosis, 61.8% had received steroids for over 3 months. Four clinical presentations were identified, depending on the underlying condition: the disseminated form (50.0%) and the visceral isolated form (26.5%) in severely immunocompromised patients, the bronchial form (14.7%) in patients with chronic lung disease, and the cutaneous isolated form (8.8%) in immunocompetent patients. Nocardia farcinica was the main species identified (26.5%). Trimethoprim-sulfamethoxazole was prescribed in 68.0% of patients, and 38.0% underwent surgery. Mortality was 11.7%, and the patients who died had disseminated or visceral nocardiosis. CONCLUSIONS The clinical presentation and outcome of nocardiosis depend on the patient's initial immune status and underlying pulmonary condition. Severe forms were all iatrogenic, occurring after treatments altering the immune system.
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Affiliation(s)
- Delphine Haussaire
- Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France.
| | - Pierre-Edouard Fournier
- Department of Infectious Diseases, AP-HM, Aix-Marseille University, Hôpital de la Timone, Marseille, France
| | - Karamoko Djiguiba
- Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France
| | - Valerie Moal
- Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France
| | - Tristan Legris
- Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France
| | - Rajsingh Purgus
- Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France
| | - Jeremy Bismuth
- Department of Pneumology and Lung Transplantation, AP-HM, Aix-Marseille University, Hôpital Nord, Marseille, France
| | - Xavier Elharrar
- Department of Multidisciplinary Oncology and Therapeutic Innovations, Aix Marseille University, Hôpital Nord, Marseille, France
| | - Martine Reynaud-Gaubert
- Department of Pneumology and Lung Transplantation, AP-HM, Aix-Marseille University, Hôpital Nord, Marseille, France
| | - Henri Vacher-Coponat
- Department of Nephrology, AP-HM, Aix-Marseille University, Hôpital de la Conception, 147,boulevard Baille, 13385 Marseille cedex 5, France.
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Cohen J. Vasculitis and Other Immunologically Mediated Diseases. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Disseminated Nocardiosis in an Immunocompetent Individual Infected with Nocardia brasiliensis, an Opportunistic Agent. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2016. [DOI: 10.5812/archcid.37738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Kim YK, Sung H, Jung J, Yu SN, Lee JY, Kim SH, Choi SH, Kim YS, Woo JH, Lee SO, Chong YP. Impact of immune status on the clinical characteristics and treatment outcomes of nocardiosis. Diagn Microbiol Infect Dis 2016; 85:482-7. [DOI: 10.1016/j.diagmicrobio.2016.05.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 05/04/2016] [Accepted: 05/07/2016] [Indexed: 01/29/2023]
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Castellana G, Grimaldi A, Castellana M, Farina C, Castellana G. Pulmonary nocardiosis in Chronic Obstructive Pulmonary Disease: A new clinical challenge. Respir Med Case Rep 2016; 18:14-21. [PMID: 27144111 PMCID: PMC4840429 DOI: 10.1016/j.rmcr.2016.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 03/09/2016] [Accepted: 03/10/2016] [Indexed: 01/28/2023] Open
Abstract
Pulmonary nocardiosis (PN) is a rare but severe disease caused by Nocardia spp. Despite the traditional description as opportunistic infection, case reports and case series of pulmonary nocardiosis have recently been reported in immunocompetent patients too, in particular among people with chronic pulmonary diseases such as advanced Chronic Obstructive Pulmonary Disease (COPD). PN is characterized by non-specific symptoms and radiological findings; bacteriological culture can be difficult. For the reasons above, diagnosis of PN is challenging, sometimes resulting in a misdiagnosis of tuberculosis. We report an interesting case of PN in a 75-year-old male with COPD. He complained a 3-months history of fatigue, evening rise in body temperature, night sweats, unexplained weight loss of 5 kg, worsening dyspnea, cough and mucopurulent sputum. The chest X-ray showed multiple nodules with cavitations bilaterally in the apical and subclavian regions. Nocardia cyriacigeorgica with 100% identity was identified in three sputum samples. Since the patient has never undergone a systemic and/or inhaled steroid therapy, and has no respiratory failure and comorbidities entailing immunodepression, it is conceivable that, in this immunocompetent patient, the COPD could represent an isolated risk factor for PN. Risk factors, clinical presentations, radiographic findings, differential diagnosis and review of the literature of PN cases in COPD, pointing out the similarities and differences, are also described.
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Affiliation(s)
- Giorgio Castellana
- Institute of Respiratory Disease, Aldo Moro University of Bari, Piazza Giulio Cesare 11, Bari, Italy
| | - Anna Grimaldi
- Clinical Laboratory Medicine, P.O. “Di Venere-Triggiano”, ASL Bari, Viale A. Moro, Triggiano, Bari, Italy
| | - Marco Castellana
- Aldo Moro University of Bari, Piazza Giulio Cesare 11, Bari, Italy
| | - Claudio Farina
- Microbiology Institute, AO “Papa Giovanni XXIII”, Piazza OMS 1, Bergamo, Italy
| | - Giuseppe Castellana
- District Health Center, ASL Bari, Via Edmondo De Amicis 36, Conversano, Bari, Italy
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Dagan A, Keller N, Vilozni D, Ramon-Saraf R, Bar BE, Sarouk I, Ashkenazi M, Lavie M, Efrati O. Nocardia Colonization: A Risk Factor for Lung Deterioration in Cystic Fibrosis Patients? Med Sci Monit 2015; 21:1889-94. [PMID: 26125407 PMCID: PMC4498443 DOI: 10.12659/msm.893643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Cystic fibrosis (CF) patients are predisposed to infection and colonization with different microbes. Some cause deterioration of lung functions, while others are colonizers without clear pathogenic effects. Our aim was to understand the effects of Nocardia species in sputum cultures on the course of lung disease in CF patients. Material/Methods A retrospective study analyzing the impact of positive Nocardia spp. in sputum of 19 CF patients over a period of 10 years, comparing them with similar status patients without Nocardia growth. Pulmonary function tests (PFTs) are used as indicators of lung disease severity and decline rate in functions per year is calculated. Results No significant difference in PFTs of CF patients with positive Nocardia in sputum was found in different sub-groups according to number of episodes of growth, background variables, or treatment plans. The yearly decline in PFTs was similar to that recognized in CF patients. The control group patients showed similar background data. However, a small difference was found in the rate of decline of their PFTs, which implies a possibly slower rate of progression of lung disease. Conclusions The prognosis of lung disease in CF patients colonized with Nocardia does not seem to differ based on the persistence of growth on cultures, different treatment plans or risk factors. Apparently, Nocardia does not cause a deterioration of lung functions with time. However, it may show a trend to faster decline in PFTs compared to similar status CF patients without isolation of this microorganism in their sputum.
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Affiliation(s)
- Adi Dagan
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Nathan Keller
- Microbiology Laboratories, Edmond and Lili Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ariel University, Ramat-Gan, Israel
| | - Daphna Vilozni
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Reut Ramon-Saraf
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Bat-El Bar
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Ifat Sarouk
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Moshe Ashkenazi
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Moran Lavie
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
| | - Ori Efrati
- Pediatric Pulmonary Unit and the National Center for Cystic Fibrosis, Sackler Medical School, Tel Aviv University, Ramat-Gan, Israel
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Abreu C, Rocha-Pereira N, Sarmento A, Magro F. Nocardia infections among immunomodulated inflammatory bowel disease patients: A review. World J Gastroenterol 2015; 21:6491-6498. [PMID: 26074688 PMCID: PMC4458760 DOI: 10.3748/wjg.v21.i21.6491] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 03/31/2015] [Indexed: 02/06/2023] Open
Abstract
Human nocardiosis, caused by Nocardia spp., an ubiquitous soil-borne bacteria, is a rare granulomatous disease close related to immune dysfunctions. Clinically can occur as an acute life-threatening disease, with lung, brain and skin being commonly affected. The infection was classically diagnosed in HIV infected persons, organ transplanted recipients and long term corticosteroid treated patients. Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario. Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings. We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals. Eleven cases of nocardiosis associated with anti-tumor necrosis factor (TNF) prescription (9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease (IBD), 4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients, lung disease in 4 patients, hepatic in one and disseminated disease in 3 patients. From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine. In conclusion, nocardiosis requires high levels of clinical suspicion and experience of laboratory staff, in order to establish a timely diagnosis and by doing so avoid worst outcomes. Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential. The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated.
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Ricci JA, Weil AA, Eberlin KR. Necrotizing Cutaneous Nocardiosis of the Hand: A Case Report and Review of the Literature. J Hand Microsurg 2015; 7:224-7. [PMID: 26078549 PMCID: PMC4461627 DOI: 10.1007/s12593-015-0173-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022] Open
Affiliation(s)
- Joseph A. Ricci
- />Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WAC 435, Boston, MA 02114 USA
| | - Ana A. Weil
- />Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA USA
| | - Kyle R. Eberlin
- />Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, WAC 435, Boston, MA 02114 USA
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Kachuei R, Emami M, Mirnejad R, Khoobdel M. Diversity and frequency of Nocardia spp. in the soil of Isfahan province, Iran. Asian Pac J Trop Biomed 2015; 2:474-8. [PMID: 23569953 DOI: 10.1016/s2221-1691(12)60079-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/05/2011] [Accepted: 12/03/2011] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To isolate and identify Nocardia spp. from soil in different regions of Isfahan province in the center of Iran. METHODS This study was conducted in 32 districts (16 cities and 16 villages) in Isfahan province during two years. A total of 800 soil samples from these regions were studied by using kanamycin. The isolated Nocardia species were examined by gram and acid-fast staining and were identified biochemically and morphologically. The frequency and distribution of Nocardia spp. were determined in relation to different factors such as soil pH and temperate climate. RESULTS From 153 (19.1%) Nocardia isolates identified, Nocardia asteroids (N. asteroids) complex (45.5%) and Nocardia brasiliensis (N. brasiliensis) (24.7%) were the most frequently isolated species, followed by Nocardia otitidiscaviarum (2.2%), Nocardiopsis dassonvillei, Actinomadura actinomadura (each 1.7%) and Nocardia transvalensis (1.1%) and also unknown spp. (23.0%). In this study, most species (54.4%) of Nocardia, especially N. asteroides complex were isolated from soils with pH: 7.01-8, whereas in pH: 8.01-9 more N. brasiliensis was isolated. The most Nocardia spp. was detected from regions with semi-nomadic and temperate climate (41.1%). CONCLUSIONS N. asteroids complex is more prevalent in Isfahan province and soil can be a potential source of nocardiosis infections. It is to be considering that climate and soil pH are involved in the frequency and diversity of aerobic Actinomycetes.
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Affiliation(s)
- R Kachuei
- Molecular Biology Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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de Clerck F, Van Ryckeghem F, Depuydt P, Benoit D, Druwé P, Hugel A, Claeys G, Cools P, Decruyenaere J. Dual disseminated infection with Nocardia farcinica and Mucor in a patient with systemic lupus erythematosus: a case report. J Med Case Rep 2014; 8:376. [PMID: 25410282 PMCID: PMC4244119 DOI: 10.1186/1752-1947-8-376] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 09/23/2014] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Infections remain a major cause of morbidity and mortality in immunocompromised patients and require early diagnosis and treatment. However, correct diagnosis and treatment are often delayed by a multitude of factors. We report what we believe to be the first case of a combined disseminated infection with Nocardia and Mucor in a patient with systemic lupus erythematosus. CASE PRESENTATION A 74-year-old Caucasian woman with systemic lupus erythematosus presented with recurrent pneumonia. Despite empirical treatment with antibiotics, her condition gradually deteriorated. Microbiological sampling by thoracoscopy revealed the presence of Nocardia. Despite the institution of therapy for disseminated nocardiosis, she died of multi-organ failure. A post-mortem investigation confirmed nocardiosis, but showed concomitant disseminated mucormycosis infection as well. CONCLUSION Members of the bacterial genus Nocardia and the fungal genus Mucor are ubiquitous in the environment, have the ability to spread to virtually any organ, and are remarkably resistant to appropriate therapy. Both pathogens can mimic other pathologies both on clinical and radiological investigations. Invasive sampling procedures are often needed to prove their presence. Establishing a timely, correct diagnosis and a specific treatment is essential for patient survival.
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Affiliation(s)
- Frederik de Clerck
- Department of Gastroenterology and Hepatology, University Hospital, De Pintelaan 185, 9000 Ghent, Belgium.
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Nocardiosis at a University Medical Center in the American Southwest. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0000000000000139] [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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Li J, Cao J, Wu Y, Wan N, Pan L, Chen Y. A case of an immunocompetent young man obtaining community-acquired disseminated Nocardia brasiliensis. Heart Lung 2014; 43:164-7. [PMID: 24594251 DOI: 10.1016/j.hrtlng.2013.12.002] [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: 09/04/2013] [Revised: 12/17/2013] [Accepted: 12/20/2013] [Indexed: 11/28/2022]
Abstract
Nocardiosis is a rare but severe pyogenic or granulomatous disease and caused by Nocardia that mainly infects immunocompromised patients. We report here a case of an immunocompetent 24-year-old male student with community-acquired pneumonia with asymptomatic disseminated cerebral abscess by Brasiliensis nocardiosis. The patient was fully recovered after receiving optimized antimicrobial therapy without relapse. This case suggests the health professionals such as the physicians of pulmonary, infection, neurology department and et al should always think about unusual cause of community acquired pneumonia, even in immunocompetent patients and when having pulmonary nocardiosis we should do a radiological neurological work up, even with the absence of neurological finding or symptom.
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Affiliation(s)
- Jinna Li
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Jie Cao
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin 300052, China.
| | - Yueqing Wu
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Nansheng Wan
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Li Pan
- Respiratory Department, Fourth Center Hospital, Tianjin 300142, China
| | - Yuanbao Chen
- Respiratory Department, Tianjin Medical University General Hospital, Tianjin 300052, China
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Chen J, Zhou H, Xu P, Zhang P, Ma S, Zhou J. Clinical and radiographic characteristics of pulmonary nocardiosis: clues to earlier diagnosis. PLoS One 2014; 9:e90724. [PMID: 24594890 PMCID: PMC3940923 DOI: 10.1371/journal.pone.0090724] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 02/03/2014] [Indexed: 01/20/2023] Open
Abstract
Background and objectives Pulmonary nocardiosis (PN) is a rare but life-threatening disease that is caused by Nocardia spp. The aim of this study was to characterize the common risk factors, clinical features, imaging findings, treatment and outcomes of PN, which are useful for an early diagnosis and patient management. Methods From January 2009 to June 2013, a retrospective study was performed on all PN cases that were diagnosed at our hospital. Results The study included 17 patients who were diagnosed with PN. Of these patients, 4 developed concomitant disseminated disease. A male predominance was observed among the patients with PN (76.47%). The most common risk factors were corticosteroid therapy (64.71%), diabetes mellitus (29.41) and chronic lung disease (23.53%). Cough and fever were the most common symptoms (94% and 71%, respectively). One or more nodules or masses (82.35%) and consolidations (58.82%) were the most frequent radiologic abnormalities, and cavitation mostly occurred within two weeks. The median time to diagnosis was 25 days. Overall, the mortality rate was 18.75% for PN, and death was most frequent among patients who received immunosuppressive drugs. For the patients with central nervous system involvement, the mortality rate was 50%. Conclusion PN remains a rare opportunistic infection that mainly affects immunocompromised patients. A high clinical index of suspicion is necessary for an early diagnosis and timely treatment in immunocompromised patients who present with new nodules or masses evolving into cavitation in a short amount of time.
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Affiliation(s)
- Junjun Chen
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Hua Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Panfeng Xu
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Pei Zhang
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Shanni Ma
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
| | - Jianying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of China
- * E-mail:
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Baio PVP, Ramos JN, dos Santos LS, Soriano MF, Ladeira EM, Souza MC, Camello TCF, Ribeiro MG, Hirata Junior R, Vieira VV, Mattos-Guaraldi AL. Molecular identification of nocardia isolates from clinical samples and an overview of human nocardiosis in Brazil. PLoS Negl Trop Dis 2013; 7:e2573. [PMID: 24340116 PMCID: PMC3854972 DOI: 10.1371/journal.pntd.0002573] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 10/21/2013] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nocardia sp. causes a variety of clinical presentations. The incidence of nocardiosis varies geographically according to several factors, such as the prevalence of HIV infections, transplants, neoplastic and rheumatic diseases, as well as climate, socio-economic conditions and laboratory procedures for Nocardia detection and identification. In Brazil the paucity of clinical reports of Nocardia infections suggests that this genus may be underestimated as a cause of human diseases and/or either neglected or misidentified in laboratory specimens. Accurate identification of Nocardia species has become increasingly important for clinical and epidemiological investigations. In this study, seven clinical Nocardia isolates were identified by multilocus sequence analysis (MLSA) and their antimicrobial susceptibility was also determined. Most Nocardia isolates were associated to pulmonary disease. METHODOLOGY/PRINCIPAL FINDINGS The majority of Brazilian human isolates in cases reported in literature were identified as Nocardia sp. Molecular characterization was used for species identification of Nocardia nova, Nocardia cyriacigeorgica, Nocardia asiatica and Nocardia exalbida/gamkensis. Data indicated that molecular analysis provided a different Nocardia speciation than the initial biochemical identification for most Brazilian isolates. All Nocardia isolates showed susceptibility to trimethoprim-sulfamethoxazole, the antimicrobial of choice in the treatment nocardiosis. N. nova isolated from different clinical specimens from one patient showed identical antimicrobial susceptibility patterns and two distinct clones. CONCLUSIONS/SIGNIFICANCE Although Brazil is the world's fifth-largest country in terms of land mass and population, pulmonary, extrapulmonary and systemic forms of nocardiosis were reported in only 6 of the 26 Brazilian states from 1970 to 2013. A least 33.8% of these 46 cases of nocardiosis proved fatal. Interestingly, coinfection by two clones may occur in patients presenting nocardiosis. Nocardia infection may be more common throughout the Brazilian territory and in other developing tropical countries than is currently recognized and MLSA should be used more extensively as an effective method for Nocardia identification.
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Affiliation(s)
- Paulo Victor Pereira Baio
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde (INCQS), Instituto Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
- Ministério da Defesa, Laboratório Químico Farmacêutico do Exército, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Juliana Nunes Ramos
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde (INCQS), Instituto Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Louisy Sanches dos Santos
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Morgana Fonseca Soriano
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Elisa Martins Ladeira
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde (INCQS), Instituto Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mônica Cristina Souza
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thereza Cristina Ferreira Camello
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade do Estado do Rio de Janeiro – UERJ, Hospital Universitário Pedro Ernesto, Laboratório de Bacteriologia, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcio Garcia Ribeiro
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina Veterinária e Zootecnia, Botucatu, São Paulo, Brazil
| | - Raphael Hirata Junior
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Verônica Viana Vieira
- Fundação Oswaldo Cruz, Instituto Nacional de Controle de Qualidade em Saúde (INCQS), Instituto Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ana Luíza Mattos-Guaraldi
- Universidade do Estado do Rio de Janeiro – UERJ, Faculdade de Ciências Médicas, Departamento de Microbiologia, Imunologia e Patologia, Laboratório de Difteria e Corinebactérias de Importância Clínica-LDCIC, Centro Colaborador para Difteria da CGLAB/SVS/MS, Rio de Janeiro, Rio de Janeiro, Brazil
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Nocardiosis in transplant recipients. Eur J Clin Microbiol Infect Dis 2013; 33:689-702. [PMID: 24272063 DOI: 10.1007/s10096-013-2015-5] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/31/2013] [Indexed: 01/11/2023]
Abstract
Nocardiosis is a rare opportunistic infection caused by Nocardia spp., an aerobic actinomycete, that mainly affects patients with cell-mediated immunity defects, such as transplant recipients. Despite recent progress regarding Nocardia identification and changes in taxonomic assignment, many challenges remain for the diagnosis or management of nocardiosis. This opportunistic infection affects 0.04 to 3.5 % of patients with solid organ or hematopoietic stem cell transplantation, depending on the organ transplanted, cytomegalovirus (CMV) infection, corticosteroids dose and calcineurin inhibitors level. Nocardiosis diagnosis relies on appropriate clinical, radiological and microbiological workup that includes the sampling of an accessible involved site and molecular microbiology tools. In parallel, extensive clinical and radiological evaluations are mandatory, including brain imaging, even in the absence of neurological signs. In transplanted patients, differential diagnosis is challenging, with co-infections reported in 20 to 64 % of cases. As the antibiotic susceptibility pattern varies among species, the antimicrobial regimen before species identification should rely on the association of antibiotics active on all species of Nocardia. Bactericidal antibiotics are required in cases of severe or disseminated disease. Furthermore, in transplant recipients, combination therapy is difficult to manage because of cumulative toxicity and interactions with immunosuppressive agents. Because of a high recurrence rate, antibiotic therapy should be prescribed for 6 to 12 months.
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Clinical characteristics of Nocardia infection in patients with rheumatic diseases. Clin Dev Immunol 2013; 2013:818654. [PMID: 24171035 PMCID: PMC3792524 DOI: 10.1155/2013/818654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/26/2013] [Indexed: 12/29/2022]
Abstract
Although Nocardiosis has considerable recurrence and mortality rates, characteristics and risk factors of Nocardia infection have not been assessed in patients with rheumatic diseases. Here, we examined the characteristics and risk factors of Nocardia infection in rheumatic disease patients in our hospital. Ten rheumatic disease patients who developed Nocardia infection were identified by retrospectively reviewing the medical records. Possible predisposing factors for Nocardia infection were high-dose glucocorticoid treatment, concomitant use of immunosuppressants, preexisting pulmonary diseases, and diabetes mellitus. All patients had pulmonary Nocardiosis, and six of them had disseminated Nocardiosis when their pulmonary lesions were identified.
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Cattaneo C, Antoniazzi F, Caira M, Castagnola C, Delia M, Tumbarello M, Rossi G, Pagano L. Nocardia spp infections among hematological patients: results of a retrospective multicenter study. Int J Infect Dis 2013; 17:e610-4. [DOI: 10.1016/j.ijid.2013.01.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 12/22/2012] [Accepted: 01/12/2013] [Indexed: 11/30/2022] Open
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Abstract
We report a case of nocardiosis in a patient with several risk factors for this rare infection. Radiologically, the patient's multiple lung abscesses were misinterpreted as pulmonary metastases. Diagnosis was finally reached by the growth of Nocardia asteroides in two different blood culture sets. Nocardia bacteraemia is a rare clinical event. Despite initiation of an effective antibiotic therapy, the patient died. Autopsy revealed disseminated nocardial abscesses in the lungs, the kidneys and the brain.
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