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Nocardia veterana infections: case report and systematic review. New Microbes New Infect 2020; 39:100833. [PMID: 33456780 PMCID: PMC7797559 DOI: 10.1016/j.nmni.2020.100833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Members of the genus Nocardia are filamentous, Gram-positive, aerobic bacteria and exist ubiquitously in most environments. In 2001, the species Nocardia veterana was first isolated, and it predominantly causes pulmonary infections in immunocompromised hosts. We present the first report of a soft-tissue abscess caused by N. veterana in a 59-year-old woman being treated for chronic cutaneous graft-versus-host disease. After failing to improve with empirical treatment, two incision and drainage procedures were required. She subsequently completed a 1-year course of oral antibiotic therapy consisting of trimethoprim-sulfamethoxazole then azithromycin. No relapse occurred over the next 5 years of follow up. To better characterize N. veterana infections, we performed a systematic literature review and summarized all previously reported cases. Overall, the rising prevalence of immunocompromising conditions warrants increased vigilance for infections caused by atypical or opportunistic pathogens. Systematic review of Nocardia veterana infections. First report of N. veterana soft tissue abscess. N. veterana typically causes pulmonary infections in immunocompromised hosts.
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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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Hemmersbach-Miller M, Catania J, Saullo JL. Updates on Nocardia Skin and Soft Tissue Infections in Solid Organ Transplantation. Curr Infect Dis Rep 2019; 21:27. [PMID: 31227922 DOI: 10.1007/s11908-019-0684-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Due to their immunocompromised status, solid organ transplant (SOT) recipients are at risk for Nocardia infections. These infections often necessitate early invasive diagnostics alongside prolonged, often combination antimicrobial therapy. This review summarizes the importance of this pathogen in skin and soft tissue infections (SSTIs) in SOT recipients inclusive of recently reported cases in the literature and an update on the epidemiology, diagnostics, and management. RECENT FINDINGS Six studies with 13 isolated SSTIs due to Nocardia have been published in the last 5 years in SOT recipients. The most common underlying type of transplant was kidney and time from transplantation to infection varied from 6 months to 16 years. Misdiagnosis was frequent. Available identified species included N. brasiliensis (2), N. farcinica (2), N. flavorosea (1), N. abscessus (1), N. anaemiae (1), N. asteroides (1), N. nova (1), and N. vinacea (1). Treatment choice and duration varied widely, and trimethoprim-sulfamethoxazole was utilized most often with no documented infection relapse. Nocardia SSTIs can occur both in isolation and as a component of a disseminated infection. Overall, isolated Nocardia SSTIs are uncommon in SOT recipients and are often initially misdiagnosed. They present multiple challenges to the clinician including evaluation for potential co-pathogens and/or non-infectious processes and ruling out the presence of disseminated infection. While trimethoprim-sulfamethoxazole remains the agent of choice for management of most isolated SSTIs, therapy must be tailored to the individual patient based on species-specific susceptibility patterns and formal susceptibility testing, site(s) of infection, and patient tolerability.
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Affiliation(s)
- Marion Hemmersbach-Miller
- Infectious Diseases Division, Duke University Medical Center, Durham, NC, USA.
- Duke Clinical Research Institute, Durham, NC, USA.
| | - Jelena Catania
- Infectious Disease Section, Orlando Veterans Affairs Medical Center, Orlando, FL, USA
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, USA
| | - Jennifer L Saullo
- Infectious Diseases Division, Duke University Medical Center, Durham, NC, USA
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Yaemsiri S, Sykes JE. Successful Treatment of Disseminated Nocardiosis Caused by Nocardia veterana in a Dog. J Vet Intern Med 2017; 32:418-422. [PMID: 29105868 PMCID: PMC5787162 DOI: 10.1111/jvim.14855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/16/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022] Open
Abstract
A 5‐year‐old male castrated Lhasa Apso cross was evaluated for a 1‐month history of inappetence, lethargy, gagging, and progressive right thoracic limb lameness. Synovial fluid analysis revealed nonseptic suppurative inflammation, and a diagnosis of immune‐mediated polyarthritis (IMPA) was made. After 3 months of treatment with prednisone and later cyclosporine, the dog developed multiple firm cutaneous and subcutaneous masses and a focal mass within the jejunum. Cultures of blood, urine, skin lesions, and the jejunal mass identified Nocardia veterana by matrix‐absorption laser desorption ionization‐time‐of‐flight mass spectrometry (MALDI‐TOF MS) and allowed for earlier identification of the organism compared to more traditional secA1 gene sequencing. Immunosuppressive drug treatment was discontinued, and the dog was treated for 3 months by administration of trimethoprim‐sulfamethoxazole (TMS). No recurrence of clinical signs was reported 1 year later. This case report highlights the clinical utility of MALDI‐TOF MS, particularly for the rapid identification of slow‐growing, fastidious organisms.
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Affiliation(s)
- S Yaemsiri
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA
| | - J E Sykes
- Department of Medicine & Epidemiology, University of California-Davis, Davis, CA
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Uhde AK, Kilwinski J, Peters M, Verspohl J, Feßler AT, Schwarz S, Wohlsein P. Fatal nocardiosis in a dog caused by multiresistant Nocardia veterana. Vet Microbiol 2016; 183:78-84. [PMID: 26790938 DOI: 10.1016/j.vetmic.2015.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 11/26/2015] [Accepted: 12/03/2015] [Indexed: 10/22/2022]
Abstract
Among pathogenic Nocardia species in humans and animals, infections caused by Nocardia (N.) veterana have rarely been described and so far, all non-human cases are linked to bovine mastitis in Brazil. The aim of this study was to identify the causative microorganism involved in the death of a three-month-old dog suffering from dyspnea and neurological deficits ante mortem. Pathomorphological investigation revealed (pyo-)granulomatous lesions in various organs. Bacteriological examination was performed and the respective bacteria were subjected to matrix-assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS), 16S rDNA sequencing, and antimicrobial susceptibility testing by broth microdilution. Gram-staining and colony morphology suggested the presence of an actinomycete which was identified as N. veterana by MALDI-TOF MS. This identification was confirmed by 16S rDNA sequence analysis. Distemper-associated immunosuppression may have played a role in the pathogenesis of systemic nocardiosis in this dog. Retrospective analysis of the antimicrobial susceptibility status showed that the N. veterana isolate was multiresistant and displayed high minimal inhibitory concentrations to all antimicrobial agents used for the dog's therapy. To the best of our knowledge, this is the first report of a systemic nocardiosis caused by N. veterana in a dog with a concurrent canine distemper virus infection.
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Affiliation(s)
- Ann-Kathrin Uhde
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Jochen Kilwinski
- Chemisches und Veterinäruntersuchungsamt Westfalen, Arnsberg, Germany
| | - Martin Peters
- Chemisches und Veterinäruntersuchungsamt Westfalen, Arnsberg, Germany
| | - Jutta Verspohl
- Department of Microbiology, University of Veterinary Medicine Hannover, Hannover, Germany
| | - Andrea T Feßler
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Neustadt-Mariensee, Germany
| | - Stefan Schwarz
- Institute of Farm Animal Genetics, Friedrich-Loeffler-Institut (FLI), Neustadt-Mariensee, Germany.
| | - Peter Wohlsein
- Department of Pathology, University of Veterinary Medicine Hannover, Hannover, Germany.
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Poisnel E, Roseau JB, Landais C, Rodriguez-Nava V, Bussy E, Gaillard T. Nocardia veterana: disseminated infection with urinary tract infection. Braz J Infect Dis 2015; 19:216-9. [PMID: 25636185 PMCID: PMC9425234 DOI: 10.1016/j.bjid.2014.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/14/2014] [Accepted: 11/12/2014] [Indexed: 11/18/2022] Open
Abstract
Nocardia spp. are a group of aerobic actinomycetes widely distributed in soil, and associated with severe opportunistic infections, essentially pulmonary infections. We report the first case of disseminated infection associated with urinary tract infection caused by Nocardia veterana. The diagnosis was difficult; despite the presence of pulmonary nodules, the lung biopsies remained negative while only one aerobic blood culture and the urine culture were positive for N. veterana, identified after a 16S rDNA gene sequence analysis. Few cases of clinical importance due to N. veterana have been published since its characterization. The bacteriological diagnosis of nocardiosis can be difficult to establish because of the delayed growth and the specific techniques that are required. This case illustrates the necessity of performing specific investigations in immunocompromised patients who present with infectious disease because the severity of this infection requires early diagnosis and quick initiation of appropriate antibiotic therapy.
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Affiliation(s)
- Elodie Poisnel
- Department of Medicine, Hospital Sainte Anne, Toulon, France
| | | | - Cécile Landais
- Department of Medicine, Hospital Sainte Anne, Toulon, France
| | - Veronica Rodriguez-Nava
- Center for Microbial Ecology, Nocardiosis French Observatory, School of Pharmacy, University Claude Bernard Lyon 1, Lyon, France
| | - Emmanuel Bussy
- Department of Nuclear Medicine, Hospital Sainte Anne, Toulon, France
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