1
|
Yan C, Liu TT, Gao LT. Chronic inflammatory demyelinating polyneuropathy with pulmonary nocardiosis: A case report. Medicine (Baltimore) 2024; 103:e38544. [PMID: 38875438 PMCID: PMC11175944 DOI: 10.1097/md.0000000000038544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
RATIONALE Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated motor sensory peripheral neuropathy that is rare in clinical practice. This treatment method aims to suppress potential immunopathology. Nocardiosis is a rare, destructive, opportunistic disease. We report a case of failed treatment of CIDP combined with pulmonary nocardiosis, and for the first time, we link these 2 diseases together. PATIENT CONCERNS A 65-year-old man developed symmetrical limb weakness. Four months later, he was diagnosed with CIDP and started receiving glucocorticoid (GC) treatment. The disease progressed slowly and was treated with mycophenolate mofetil (MMF) in combination. He did not follow the doctor requirements for monthly follow-up visits, and the preventive medication for sulfamethoxazole/trimethoprim was not strictly implemented. Two months after the combination therapy, the patient developed fever, coughing and sputum production, as well as fatigue and poor appetite. Based on imaging and etiological results, he was diagnosed with pulmonary nocardiosis. DIAGNOSES Chronic inflammatory demyelinating polyneuropathy, pulmonary nocardiosis. INTERVENTIONS After treatment with antibiotics, the patient lung infection temporarily improved. However, the patient CIDP condition progressed, limb weakness worsened, respiratory muscle involvement occurred, and intravenous immunoglobulin (IVIG) was administered. However, there was no significant improvement in the condition, and the patient died. OUTCOMES In this report, we present a case of a patient with CIDP and pulmonary nocardiosis. It is worth noting that in order to avoid the progression and recurrence of CIDP, we did not stop using related therapeutic drugs during the treatment process, the patient had repeatedly refused to use IVIG. Despite this, the patient condition worsened when lung inflammation improved, leading to persistent respiratory failure and ultimately death. Treatment contradictions, medication issues, and patient compliance issues reflected in this case are worth considering. LESSONS For patients with CIDP receiving immunosuppressive therapy, attention should be paid to the occurrence and severity of Nocardia infection. Therefore, early detection and treatment are necessary. We need to pay attention to the compliance of patients with prophylactic use of antibiotics, strengthen the follow-up, and urge them to return to their appointments on time.
Collapse
Affiliation(s)
- Cheng Yan
- Department of Clinical Pharmacy, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Ting-Ting Liu
- Department of Clinical Pharmacy, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Li-Tao Gao
- Department of Neurology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| |
Collapse
|
2
|
O'Brien A, Hart J, Higgins A, Arthur I, Lee GH, Leung M, Kennedy K, Bradbury S, Foster S, Warren S, Korman TM, Abbott IJ, Heney C, Bletchley C, Warner M, Wells N, Wilson D, Varadhan H, Stevens R, Lahra M, Newton P, Maley M, van Hal S, Ingram PR. Nocardia species distribution and antimicrobial susceptibility within Australia. Intern Med J 2024; 54:613-619. [PMID: 37929813 DOI: 10.1111/imj.16234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Nocardia is a ubiquitous saprophyte capable of causing human disease. Disease is primarily respiratory or cutaneous, usually acquired via inhalation or inoculation. Under the influence of environmental and host factors, Nocardia incidence and species distribution demonstrate geographical variation. AIMS To examine for differences in Nocardia incidence within Western Australia (WA) and analyse species distribution in the context of prior published studies. To analyse antibiogram data from a nationwide passive antimicrobial resistance surveillance program. METHODS Retrospective extraction of laboratory data for Western Australian Nocardia isolates over a 21-year period. Analysis of Nocardia antimicrobial susceptibility testing data submitted to the Australian Passive Antimicrobial Resistance Surveillance (APAS) program between 2005 and 2022. RESULTS Nine hundred sixty WA isolates were identified, giving an annual incidence of 3.03 per 100 000 population with apparent latitudinal variation. The four most common species identified within WA and amongst APAS isolates were N. nova, N. cyriacigeorgica, N. brasiliensis and N. farcinica. APAS data demonstrated that all species exhibited high rates of susceptibility to linezolid (100%) and trimethoprim-sulfamethoxazole (98%). Amikacin (>90% susceptibility for all species except N. transvalensis) was the next most active parenteral agent, superior to both carbapenems and third-generation cephalosporins. Susceptibility to oral antimicrobials (other than linezolid) demonstrated significant interspecies variation. CONCLUSIONS We demonstrate geographical variation in the distribution of Nocardia incidence. Four species predominate in the Australian setting, and nationwide data confirm a high in vitro susceptibility to trimethoprim-sulphamethoxazole and linezolid, justifying their ongoing role as part of first-line empiric therapy.
Collapse
Affiliation(s)
- Aine O'Brien
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Julie Hart
- Department of Infectious Diseases, Sir Charles Gardiner Hospital, Perth, Western Australia, Australia
| | - Ammie Higgins
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Ian Arthur
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Gar-Hing Lee
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Michael Leung
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Karina Kennedy
- ACT Health, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Susan Bradbury
- ACT Health, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Sarah Foster
- Launceston General Hospital, Tasmanian Health Service (THS), Hobart, Tasmania, Australia
| | - Sanchia Warren
- Royal Hobart Hospital, Department of Microbiology and Infectious Diseases, Hobart, Tasmania, Australia
| | - Tony M Korman
- Monash Health, Monash Infectious Diseases, Melbourne, Victoria, Australia
| | | | - Claire Heney
- Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | - Morgyn Warner
- Infectious Diseases and Microbiology Department, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Nicholas Wells
- South Australia Pathology, Adelaide, South Australia, Australia
| | - Desley Wilson
- South Australia Pathology, Adelaide, South Australia, Australia
| | - Hemalatha Varadhan
- Hunter New England, NSW Health Pathology, Newcastle, New South Wales, Australia
| | - Robert Stevens
- South Eastern Sydney, NSW Health Pathology, Sydney, New South Wales, Australia
- School of Biomedical Sciences, University of New South Wales, Sydney, New South Wales, Australia
| | - Monica Lahra
- NSW Health Pathology, Newcastle, New South Wales, Australia
| | - Peter Newton
- Illawarra-Shoalhaven, NSW Health Pathology, Wollongong, New South Wales, Australia
| | - Michael Maley
- South Western Sydney, NSW Health Pathology, Sydney, New South Wales, Australia
- Microbiology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Sebastian van Hal
- NSW Health Pathology, Newcastle, New South Wales, Australia
- Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Paul R Ingram
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia
| |
Collapse
|
3
|
Kim S, Shi HJ, Jeon CH, Kim SB, Yi J, Kim AR, Kim KH, Lim S. Clinical Characteristics of Nocardiosis: a Multicenter Retrospective Study in Korea. Infect Chemother 2023; 55:431-440. [PMID: 37674336 PMCID: PMC10771949 DOI: 10.3947/ic.2023.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/21/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Nocardiosis is a rare, but potentially life-threatening condition. It is difficult to diagnose, and bacterial culture identification can be time consuming. We investigated the characteristics of nocardiosis and the suitability of the treatment approach in Korea. MATERIALS AND METHODS This retrospective study was conducted at 5 medical institutions between 2011 and 2021. We reviewed the medical records of patients with microbiologically confirmed nocardiosis. Appropriate antibiotic selection was defined as follows: (1) selecting antibiotics according to the species, (2) if the species of Nocardia was unknown, trimethoprim-sulfamethoxazole-based therapy or linezolid-based therapy was administered, and (3) selection of antibiotics using the antibiotic susceptibility test. The appropriate treatment periods for antibiotics were defined as treatment maintained from 3 to 12 months, depending on involvement of the organs. Descriptive analysis and Fisher exact test were used. Statistical significance was set at P-values of <0.05. RESULTS Thirty patients were enrolled. Of these patients, 18 (60.0%) were male. The median age was 70.5 years. Among the diagnosed patients, 12 (40.0%) had an immunocompromised status. Eight (30.0%) patients received optimal treatment for the appropriate treatment period. Appropriate dosing duration was observed in 3 of the 12 (25.0%) immunocompromised patients. There was no significant difference between the presence or absence of immunosuppression and the adequacy of treatment for nocardiosis (P = 1.000). Skin and soft tissue (14 patients) were most frequently involved in this study. Nocardia species (spp.) were isolated from culture at a median of 6.0 days. There were 7 cases with N. farcinica (23.3%). CONCLUSION We found that 60.0% of the patients with nocardiosis did not have an immunocompromised status. Further, 26.7% of the total patients received adequate treatment for nocardiosis. The reasons for suboptimal management of nocardiosis in Korea are presumed to be diagnostic difficulties, lack of awareness about nocardiosis, and difficulties in selecting antibiotics for Nocardia spp. among clinicians. The lack of antibiotic susceptibility tests for Nocardia spp. could be the source of these problems. Nocardiosis should be suspected in cases of recurrent infections with skin and soft tissue, musculoskeletal, or respiratory system involvement with or without an immunocompromised status. Clinical microbiological support is required for the diagnosis and selection of antibiotics in Korea. High clinical index of suspicion and clinical microbiological support are required for the accurate diagnosis of nocardiosis in Korea.
Collapse
Affiliation(s)
- Seulki Kim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hye Jin Shi
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Cheon-Hoo Jeon
- Division of Infectious Diseases, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, Korea
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - A Reum Kim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Kye-Hyung Kim
- Medical Research Institute, Pusan National University Hospital, Busan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
| | - Seungjin Lim
- Division of Infectious Diseases, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea.
| |
Collapse
|
4
|
Sun H, Xie X, Wang Y, Wang J, Deng T. Clinical screening of Nocardia in sputum smears based on neural networks. Front Cell Infect Microbiol 2023; 13:1270289. [PMID: 38094748 PMCID: PMC10716215 DOI: 10.3389/fcimb.2023.1270289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Objective Nocardia is clinically rare but highly pathogenic in clinical practice. Due to the lack of Nocardia screening methods, Nocardia is often missed in diagnosis, leading to worsening the condition. Therefore, this paper proposes a Nocardia screening method based on neural networks, aiming at quick Nocardia detection in sputum specimens with low costs and thereby reducing the missed diagnosis rate. Methods Firstly, sputum specimens were collected from patients who were infected with Nocardia, and a part of the specimens were mixed with new sputum specimens from patients without Nocardia infection to enhance the data diversity. Secondly, the specimens were converted into smears with Gram staining. Images were captured under a microscope and subsequently annotated by experts, creating two datasets. Thirdly, each dataset was divided into three subsets: the training set, the validation set and the test set. The training and validation sets were used for training networks, while the test set was used for evaluating the effeteness of the trained networks. Finally, a neural network model was trained on this dataset, with an image of Gram-stained sputum smear as input, this model determines the presence and locations of Nocardia instances within the image. Results After training, the detection network was evaluated on two datasets, resulting in classification accuracies of 97.3% and 98.3%, respectively. This network can identify Nocardia instances in about 24 milliseconds per image on a personal computer. The detection metrics of mAP50 on both datasets were 0.780 and 0.841, respectively. Conclusion The Nocardia screening method can accurately and efficiently determine whether Nocardia exists in the images of Gram-stained sputum smears. Additionally, it can precisely locate the Nocardia instances, assisting doctors in confirming the presence of Nocardia.
Collapse
Affiliation(s)
- Hong Sun
- Department of Laboratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xuanmeng Xie
- Effect, Jianying, Intelligent Creation Lab, Bytedance Inc., Hangzhou, China
| | - Yaqi Wang
- College of Media Engineering, Communication University of Zhejiang, Hangzhou, China
| | - Juan Wang
- Department of Laboratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Tongyang Deng
- Department of Laboratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Zhang J, Zhu Y, Sun Y, Han X, Mao Y. Pathogenic Nocardia amamiensis infection: A rare case report and literature review. Heliyon 2023; 9:e17183. [PMID: 37449159 PMCID: PMC10336398 DOI: 10.1016/j.heliyon.2023.e17183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
Background To date, only six cases of Nocardia amamiensis infection have been reported, including two ocular cases, three pulmonary cases, and one disseminated case. However, no Nocardia amamiensis pulmonary infection cases have been reported in immunocompetent patients without structural pulmonary disease. This study describes a rare case and provides a detailed review of all previous cases. Methods A pulmonary infection caused by Nocardia amamiensis in a 64-year-old man with low-grade fever, night sweats, and weight loss was reported. All previously reported cases of Nocardia amamiensis infection were searched and reviewed. Results The pathogen was identified as Nocardia amamiensis using bronchoalveolar lavage fluid (BALF) mNGS, and the current case was successfully treated with trimethoprim-sulfamethoxazole (ST) monotherapy. mNGS and 16S rRNA PCR are standard tests to identify Nocardia.Conclusion: mNGS has high diagnostic performance for Nocardia amamiensis. Further studies are needed to clarify the clinical characteristics and explore more effective treatment protocols for this rare pathogen.
Collapse
Affiliation(s)
- Jing Zhang
- Department of Respiratory Medicine, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yingwei Zhu
- Department of Respiratory Medicine, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Yuxia Sun
- Department of Respiratory Medicine, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| | - Xuewei Han
- China Aviation Industry Corporation Luoyang Institute of Electro-Optical Devices, Luoyang, China
| | - Yimin Mao
- Department of Respiratory Medicine, The First Affiliated Hospital, and College of Clinical Medicine of Henan University of Science and Technology, Luoyang, China
| |
Collapse
|
7
|
McKinney WP, Smith MR, Roberts SA, Morris AJ. Species distribution and susceptibility of Nocardia isolates in New Zealand 2002-2021. Pathology 2023:S0031-3025(23)00122-8. [PMID: 37277236 DOI: 10.1016/j.pathol.2023.03.008] [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: 10/21/2022] [Revised: 02/16/2023] [Accepted: 03/13/2023] [Indexed: 06/07/2023]
Abstract
The aim was to record the distribution and susceptibility of Nocardia species in New Zealand. Local and referred isolates were identified by an evolving approach over the study period including conventional phenotypic methods, susceptibility profiles, matrix-assisted laser desorption ionisation-time of flight mass spectrometry (MALDI-TOF) and molecular sequencing. Isolates previously identified as a Nocardia sp. or part of the N. asteroides complex were reidentified by MALDI-TOF and/or molecular methods. Antimicrobial susceptibility to eight antibiotics was performed by standard microbroth dilution. The site of isolation, susceptibility profiles and species distribution were analysed. A total of 383 isolates were tested: N. brasiliensis 23 (6%), N. cyriacigeorgica 42 (11%), N. farcinica 41 (11%), N. nova complex 226 (59%), and 51 (13%) other species/complexes. The respiratory tract was the most common site of infection (244, 64%), with skin and soft tissue the second most common site (104, 27%). All 23 N. brasiliensis isolates were from skin and soft tissue specimens. Almost all isolates (≥98%) were susceptible to amikacin, linezolid and trimethoprim-sulfamethoxazole; 35% and 77% were resistant to clarithromycin and quinolones, respectively. The expected susceptibility profiles of the four common species and complex were observed for most agent-organism parings. Multi-drug resistance was uncommon (3.4%). The spectrum of Nocardia species in New Zealand is similar to overseas reports and our most common group is the N. nova complex. While amikacin, linezolid and trimethoprim-sulfamethoxazole remain good empiric treatment choices, other agents should have their activity confirmed before use.
Collapse
Affiliation(s)
- Wendy P McKinney
- Clinical Microbiology Laboratory, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Marian R Smith
- Clinical Microbiology Laboratory, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Sally A Roberts
- Clinical Microbiology Laboratory, LabPLUS, Auckland City Hospital, Auckland, New Zealand
| | - Arthur J Morris
- Clinical Microbiology Laboratory, LabPLUS, Auckland City Hospital, Auckland, New Zealand.
| |
Collapse
|
8
|
Wang S, Wang P, Liu J, Yang C, Li T, Yang J, Gu L, Wei M. Molecular detection of Nocardia: development and application of a real-time PCR assay in sputum and bronchoalveolar lavage fluid samples. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04619-4. [PMID: 37156981 DOI: 10.1007/s10096-023-04619-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
The diagnosis of pulmonary nocardiosis remains challenging. Rapid detection of Nocardia is of primary importance for early diagnosis and precise treatment of nocardiosis. In this study, our objective was to develop and validate a new TaqMan real-time PCR (qPCR) assay for rapidly detecting Nocardia spp. in respiratory samples. Based on published sequence data, primers in a conserved region of the 16S rRNA gene and a probe within that region that was specific for Nocardia were designed. The distinction effect of the qPCR assay was assessed between Nocardia and other respiratory-associated bacteria. Furthermore, the specificity and sensitivity of the assay were evaluated in respiratory clinical samples (n = 205), compared to the results of 16S rRNA gene amplicon sequencing and clinical diagnosis. The qPCR assay exhibited high specificity, sensitivity, repeatability, and reproducibility. The limit of detection of standard plasmid DNA was 3 × 102 copies/mL. Additionally, the qPCR assay was applied to the direct detection of 205 clinical respiratory samples. The specificity and sensitivity of the qPCR were all 100% compared to 16S rRNA gene amplicon sequencing, as well as 98.4% and 100% compared to clinical diagnosis respectively. The qPCR yielded results within 3 h of sample processing, compared to several days for culture, significantly reducing turnaround time. The results suggest that the new qPCR assay developed in this study provides reliable and rapid detection of Nocardia spp. in the respiratory tracts and is expected to reduce the time required for diagnosing and treating nocardiosis.
Collapse
Affiliation(s)
- Shuai Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Wang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jun Liu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chunxia Yang
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Tianmeng Li
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jingxian Yang
- Department of Clinical Laboratory, Aerospace Center Hospital, Beijing, China
| | - Li Gu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| | - Ming Wei
- Department of Infectious Diseases and Clinical Microbiology, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
9
|
The Computed Tomography Findings and Follow-up Course of Pulmonary Nocardiosis. J Comput Assist Tomogr 2023; 47:418-423. [PMID: 36877779 DOI: 10.1097/rct.0000000000001439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE Our study aimed to elucidate the computed tomography (CT) features and follow-up course of pulmonary nocardiosis patients to improve the understanding and diagnostic accuracy of this disease. METHODS The chest CT findings and clinical data of patients diagnosed with pulmonary nocardiosis by culture or histopathological examination in our hospital between 2010 and 2019 were retrospectively analyzed. RESULTS A total of 34 cases of pulmonary nocardiosis were included in our study. Thirteen patients were on long-term immunosuppressant therapy, among whom 6 had disseminated nocardiosis. Among the immunocompetent patients, 16 had chronic lung diseases or a history of trauma. Multiple or solitary nodules represented the most common CT feature (n = 32, 94.12%), followed by ground-glass opacities (n = 26, 76.47%), patchy consolidations (n = 25, 73.53%), cavitations (n = 18, 52.94%), and masses (n = 11, 32.35%). There were 20 cases (61.76%) with mediastinal and hilar lymphadenopathy, 18 (52.94%) with pleural thickening, 15 (44.12%) with bronchiectasis, and 13 (38.24%) with pleural effusion. Significantly higher rates of cavitations were observed among immunosuppressed patients (85% vs 29%, P = 0.005). At follow-up, 28 patients (82.35%) clinically improved with treatment, while 5 (14.71%) had disease progression, and 1 (2.94%) died. CONCLUSIONS Chronic structural lung diseases and long-term immunosuppressant use were found as risk factors for pulmonary nocardiosis. While the CT manifestations were highly heterogeneous, clinical suspicion should be raised upon findings of coexisting nodules, patchy consolidations, and cavitations, particularly in the presence of extrapulmonary infections such as those of the brain and subcutaneous tissues. A significant incidence of cavitations may be observed among immunosuppressed patients.
Collapse
|
10
|
Sim BZ, Aaron L, Coulter C, Parkes-Smith J, Badrick T, May K, Armstrong M, Hendry S, Sundac L, Dang L, Ho J, Hanson J, Smith S, Choong K, Henderson AH, Bursle E. A multi-centre retrospective study of Nocardia speciation and antimicrobial susceptibility in Queensland, Australia. Eur J Clin Microbiol Infect Dis 2023; 42:339-345. [PMID: 36720769 DOI: 10.1007/s10096-022-04542-0] [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: 09/20/2022] [Accepted: 12/15/2022] [Indexed: 02/02/2023]
Abstract
The study aims to characterise the species identification and antimicrobial susceptibility testing (AST) results of Nocardial isolates from adult patients across major public hospitals in Queensland, Australia, over a 15-year period. A multi-centre retrospective observational study of Nocardia sp. isolates was conducted from 7 major public hospitals in Queensland, Australia, over a 15-year period. Clinical samples from patients aged ≥ 18 years that isolated Nocardia sp. were included. Demographic and clinical data were collected, along with species identification and AST results. Overall, 484 Nocardia sp. were isolated. Most patients were male (297, 61%) with a mean (IQR) age of 60 (51-75) and a median (IQR) Charlson Comorbidity Index of 4 (2-6). Of these, 239 (49%) patients were immunosuppressed. Organisms were most frequently isolated from sputum (174, 36%), and superficial swabs (102, 21%). Patients presented with pulmonary infections (165, 35%) and superficial skin and soft tissue infections (87, 18%) most commonly. One hundred (21%) isolates were deemed pulmonary colonisation and were not treated. Of the speciated organisms, N. nova complex was the most common (93, 19%), followed by N. farcinica complex (79, 16%). Organisms were reliably susceptible to linezolid (240/245, 98%), amikacin (455/470, 97%), and trimethoprim/sulfamethoxazole (459/476, 96%), but less so to imipenem (243/472, 51%) and ceftriaxone (261/448, 58%). This is the largest Australian description of Nocardia sp. to date. Given antimicrobials are often commenced prior to AST results and sometimes even speciation, characterisation of local species and antibiogram data is important to guide empiric choices and local guidelines.
Collapse
Affiliation(s)
- B Z Sim
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia. .,Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia. .,University of Queensland, St. Lucia, QLD, 4072, Australia.
| | - L Aaron
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - C Coulter
- Queensland Mycobacterium Reference Laboratory, Herston Road, Herston, QLD, 4029, Australia
| | - J Parkes-Smith
- The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
| | - T Badrick
- Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia
| | - K May
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - M Armstrong
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - S Hendry
- Townsville University Hospital, 100 Angus Smith Drive, Douglas, QLD, 4814, Australia
| | - L Sundac
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - L Dang
- Royal Brisbane and Women's Hospital, Butterfield Street, Herston, QLD, 4029, Australia
| | - J Ho
- Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia
| | - J Hanson
- Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia.,Kirby Institute, High Street, Kensington, NSW, 2052, Australia
| | - S Smith
- Cairns Hospital, 165 The Esplanade, Cairns, QLD, 4870, Australia
| | - K Choong
- Sunshine Coast University Hospital, 6 Doherty Street, Birtinya, QLD, 4575, Australia
| | - A H Henderson
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia
| | - E Bursle
- Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, QLD, 4102, Australia.,University of Queensland, St. Lucia, QLD, 4072, Australia
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Yeoh K, Globan M, Naimo P, Williamson DA, Lea K, Bond K. Identification and antimicrobial susceptibility of referred Nocardia isolates in Victoria, Australia 2009-2019. J Med Microbiol 2022; 71. [PMID: 35976092 DOI: 10.1099/jmm.0.001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Nocardia is an opportunistic pathogen that can cause significant morbidity and mortality, particularly in the immunocompromised host. Antimicrobial susceptibility profiles vary across Nocardia spp. and vary within Australia as well as worldwide. Knowledge of local susceptibility patterns is important in informing appropriate empiric antimicrobial therapy.Gap Statement. This is the largest study to date in Australia that correlates antimicrobial susceptibility profiles with molecular identification of Nocardia species. It is the first study that examines isolates from multiple institutions across the state of Victoria, Australia.Aim. To investigate the species distribution and antibiotic susceptibility of Nocardia spp. isolates referred to the Mycobacterial Reference Laboratory (MRL) in Victoria, Australia from 2009 to 2019.Methodology. We conducted a retrospective review of Nocardia spp. isolates which were identified using molecular sequencing. Antimicrobial susceptibility testing was performed using standardized broth microdilution method with Sensititre RAPMYCO1 plates. Species distribution and antibiotic susceptibility profiles were analysed.Results. In total, 414 Nocardia isolates were identified to 27 species levels, the majority originating from the respiratory tract (n=336, 81.2 %). N. nova (n=147, 35.5 %) was the most frequently isolated, followed by N. cyriacigeorgica (n=75, 18.1 %). Species distribution varied by isolate source, with N. farcinica and N. paucivorans found more commonly from sterile sites. Linezolid and amikacin had the highest proportion of susceptible isolates (100 and 99% respectively), while low susceptibility rates were detected for ceftriaxone (59 %) and imipenem (41 %). Susceptibility to trimethoprim sulfamethoxazole varied by species (0-100 %).Conclusion. This is the largest study to date in Australia of Nocardia species distribution and antimicrobial susceptibility patterns. N. farcinica and N. paucivorans were more likely to be isolated from sterile sites, while N. brasiliensis and N. otitidiscvarium were more likely to be isolated from skin and soft tissue. First line therapeutic antimicrobial recommendations by local guidelines were not necessarily reflective of the in vitro susceptibility of Nocardia isolates in this study, with high susceptibility detected for linezolid and amikacin, but poor susceptibility demonstrated for ceftriaxone and imipenem. Profiles for trimethoprim-sulfamethoxazole varied across different Nocardia species, warranting ongoing susceptibility testing for targeted clinical use.
Collapse
Affiliation(s)
- Kim Yeoh
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
| | - Maria Globan
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
| | - Phillip Naimo
- Department of General Medicine, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, 3050, Victoria, Australia
| | - Deborah A Williamson
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
| | - Kerrie Lea
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
| | - Katherine Bond
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
| |
Collapse
|
13
|
Sana M, Mahmood Butt F, Hasan MIU, Amir A. A Rare Case of Chest Wall Abscess by Nocardia in a Patient With Sarcoidosis. Cureus 2022; 14:e26769. [PMID: 35967147 PMCID: PMC9366025 DOI: 10.7759/cureus.26769] [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] [Accepted: 07/10/2022] [Indexed: 11/26/2022] Open
Abstract
Nocardia is a rare gram-positive pathogen reported to cause infections in immunocompromised individuals. It usually involves the lungs but may also lead to abscess formation; cases of disseminated nocardiosis have also been reported. We are presenting a case of an Asian male who had sarcoidosis with pulmonary and skin involvement. The patient was on long-term immunosuppressive therapy with corticosteroids with good control of the disease. He developed a fever, weight loss, and right-sided chest pain. CT of the chest showed new nodular infiltrates. Worsening of sarcoidosis was suspected; the corticosteroid dose was increased and methotrexate was started. There was no favorable response to the increase in immunosuppressive therapy. Weight loss was followed by worsening shortness of breath and fluctuant swelling in the right lateral half of the chest. Bronchoalveolar lavage was done to rule out tuberculosis but it did not show any organism’s growth. Ultrasound-guided needle aspiration from the abscess was done that showed growth of Nocardia species. Therapeutic dose co-trimoxazole (trimethoprim-sulphamethoxazole) was started as first-line therapy after confirming the organism’s drug susceptibility pattern along with needle aspiration of the collection on the chest wall. Immunosuppressive agents were stopped. There was a good response to treatment with resolution of symptoms within two months. However, complete radiological recovery took 10 months. Co-trimoxazole (trimethoprim-sulphamethoxazole) therapy continued for two months after radiological recovery. Physicians, therefore, should keep Nocardia as an important differential diagnosis while treating the immunosuppressed population.
Collapse
|
14
|
Pender M, Mehta N, Hamilton BD, Swaminathan S. Nocardia beijingensis isolated from an adrenal abscess in a diabetic host. Open Forum Infect Dis 2022; 9:ofac328. [PMID: 35899284 PMCID: PMC9310264 DOI: 10.1093/ofid/ofac328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
We describe the case of a 57-year-old man with poorly controlled type 2 diabetes mellitus who presented with 30 days of left-sided abdominal pain. He was found to have a left adrenal abscess and underwent adrenalectomy. Intraoperative cultures grew Nocardia beijingensis, which is an uncommonly identified Nocardia species rarely affecting immunocompetent patients. We review the published literature on cases of N. beijingensis among immunocompetent patients. This is the first report summarizing the diagnosis and management of N. beijingensis isolated from an adrenal abscess.
Collapse
Affiliation(s)
- Melissa Pender
- Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine , Salt Lake City, UT , USA
| | - Ninad Mehta
- Department of Pathology, University of Utah School of Medicine , Salt Lake City, Utah , USA
- Department of Pathology and Laboratory Medicine, University of Saskatchewan , Saskatoon, SK , Canada
| | - Blake D Hamilton
- Division of Urology, Department of Surgery, University of Utah School of Medicine , Salt Lake 17 City, Utah , USA
| | - Sankar Swaminathan
- Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine , Salt Lake City, UT , USA
- Department of Medicine, George E. Wahlen Veterans Affairs Medical Center , Salt Lake City, UT , USA
| |
Collapse
|
15
|
Strashny A, Alford J, Rappole C, Santo L. The National Hospital Care Survey Is a Unique Source of Data on Rare Diseases. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:S1098-3015(22)01959-3. [PMID: 35654662 PMCID: PMC9708926 DOI: 10.1016/j.jval.2022.04.1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aims to demonstrate the usefulness of the National Hospital Care Survey (NHCS) for studying rare diseases. METHODS NHCS contains data on millions of hospital patients from participating US hospitals, including diagnoses coded using 10th revision of International Classification of Diseases, Clinical Modification, making it likely that some of the patients have a diagnosed rare disease. The data for 2016 are unweighted and are not nationally representative. The Orphanet Nomenclature Pack lists 877 10th revision of the International Classification of Diseases codes that correspond to 536 rare diseases. Using Orphanet Nomenclature Pack, we identified NHCS patients with diagnosed rare diseases. We demonstrate the usefulness of NHCS for studying rare diseases by reporting, for each rare disease, the number of patients in NHCS with the disease, the average number of hospital encounters per patient, the average length of hospital stay, and the percent of patients who died either in-hospital or within 90 days after discharge. RESULTS In just 1 year of NHCS, we identified hundreds of rare diseases with ≥30 patients each (313 rare diseases in the inpatient setting and 273 in the emergency department setting). Although 10th revision of the International Classification of Diseases, Clinical Modification codes identify a small percent of known rare diseases, 12.9% of inpatient patients and 3.4% of emergency department patients had a diagnosed rare disease. CONCLUSIONS NHCS is a rich source of administrative and electronic health record data on hospital patients with rare diseases, providing unique variables and observations on many patients. Although the percent of patients with each rare disease is low, a large percent of hospital patients has a rare disease.
Collapse
Affiliation(s)
- Alex Strashny
- National Center for Health Statistics, Hyattsville, MD, USA.
| | | | | | - Loredana Santo
- National Center for Health Statistics, Hyattsville, MD, USA
| |
Collapse
|
16
|
Nonimaging Diagnostic Tests for Pneumonia. Radiol Clin North Am 2022; 60:521-534. [DOI: 10.1016/j.rcl.2022.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
17
|
Yadav P, Kumar D, Meena DS, Bohra GK, Jain V, Garg P, Dutt N, Abhishek KS, Agarwal A, Garg MK. Clinical Features, Radiological Findings, and Treatment Outcomes in Patients with Pulmonary Nocardiosis: A Retrospective Analysis. Cureus 2021; 13:e17250. [PMID: 34540476 PMCID: PMC8445149 DOI: 10.7759/cureus.17250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Lack of specific clinical features makes the diagnosis of pulmonary nocardiosis difficult. A high index of suspicion is required for diagnosis especially in cohorts with pre-existing risk factors. This study aimed to study the clinical and radiological characteristics and outcomes in patients with pulmonary nocardiosis. Methods This was a retrospective observational study. Data of confirmed cases with pulmonary nocardiosis were collected from a digital patient management system. Results A total of eight cases of pulmonary nocardiosis were included. The mean age of patients was 50 ± 14.3 years with a female preponderance (62.5%). The most common co-morbidity was chronic lung disease (37.5%). The common clinical feature of pulmonary nocardiosis was cough with expectoration (50%) and the mean duration of symptoms was 18 days. The common radiological (CT thorax) findings were consolidation, bronchiectasis, mediastinal lymphadenopathy, and nodularity (50% each). One patient had an extension of pulmonary disease in the chest wall. Microbiological detection of Nocardia spp. was done in sputum samples (50%) and in bronchoalveolar lavage (BAL) samples (50%). Culture was positive in two BAL samples. Intravenous empirical antibiotics in combination with oral trimethoprim-sulfamethoxazole double standard (15 mg/kg trimethoprim) were started at the time of diagnosis. Ceftriaxone and amikacin were commonly used antimicrobials. Conclusion Nocardia spp. commonly causes disease in patients with pre-existing chronic disease. A high index of suspicion is required in patients with subacute to chronic respiratory symptoms, raised inflammatory markers, and the absence of common respiratory pathogens in evaluation.
Collapse
Affiliation(s)
- Prakrati Yadav
- Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Deepak Kumar
- Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | | | - Gopal K Bohra
- Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Vidhi Jain
- Microbiology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Pawan Garg
- Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Naveen Dutt
- Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| | - Kumar S Abhishek
- Microbiology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Ashwini Agarwal
- Microbiology, All India Institute of Medical Sciences, Jodhpur, IND
| | - Mahendra K Garg
- Medicine, All India Institute of Medical Sciences, Jodhpur, IND
| |
Collapse
|
18
|
Derungs T, Leo F, Loddenkemper C, Schneider T. Treatment of disseminated nocardiosis: a host-pathogen approach with adjuvant interferon gamma. THE LANCET. INFECTIOUS DISEASES 2021; 21:e334-e340. [PMID: 34425068 DOI: 10.1016/s1473-3099(20)30920-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 12/19/2022]
Abstract
Disseminated nocardiosis is a rare, life-threatening disease. Particularly at risk are immunocompromised patients, highlighting the crucial role of host factors. Conventional intensive antibiotic treatment has improved survival rates, but the overall prognosis of patients with disseminated nocardiosis remains unsatisfactory. In this Grand Round, we present a case of severe nocardiosis that did not respond to standard therapy. The patient's condition deteriorated when antibiotic therapy was given alone and improved substantially only after coadministration of interferon gamma. We review the literature relevant to adjuvant interferon gamma therapy of nocardiosis and discuss its potential harms and benefits. Overall, we consider such treatment as beneficial and low risk if the patient is followed-up closely. We conclude that clinicians should consider this regimen in refractory cases of severe Nocardia infection.
Collapse
Affiliation(s)
- Thomas Derungs
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
| | - Fabian Leo
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany; Department of Respiratory Medicine, Evangelische Lungenklinik, Berlin, Germany
| | | | - Thomas Schneider
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany
| |
Collapse
|
19
|
Lee EK, Kim J, Park DH, Lee CK, Kim SB, Sohn JW, Yoon YK. Disseminated nocardiosis caused by Nocardia farcinica in a patient with colon cancer: A case report and literature review. Medicine (Baltimore) 2021; 100:e26682. [PMID: 34398037 PMCID: PMC8294930 DOI: 10.1097/md.0000000000026682] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/07/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Nocardiosis is an uncommon and potentially life-threatening infection that usually affects immunocompromised hosts. No clinical guidelines have been established for managing this rare disease, and the optimal treatment modality remains unclear. Nocardia farcinica, a relatively infrequent pathogen of nocardiosis, causes a clinically aggressive infection. In addition to our patient data, our search of the literature for patients who presented with empyema caused by N. farcinica will provide fundamental information for optimal treatment modalities. PATIENT CONCERNS A 64-year-old man was diagnosed with empyema, 4 days following surgery for sigmoid colon cancer. Brain lesions were evaluated only after N. farcinica was isolated and identified as the causative pathogen through repeated culture tests. DIAGNOSES N. farcinica was isolated from the pleural effusion and confirmed as the pathogen through 16S rRNA sequencing. INTERVENTIONS The patient was successfully treated with tube thoracotomy, neurosurgical evacuation, and a combination of trimethoprim/sulfamethoxazole plus imipenem. Long-term antibiotic therapy was required to prevent recurrence. OUTCOMES Pyothorax showed a good clinical response to antimicrobial therapy and drainage of pleural effusion, whereas brain abscess did not respond to medical therapy and required surgery. The patient eventually recovered and continued chemotherapy as treatment for sigmoid colon cancer. LESSONS Although extremely rare, this report demonstrates the importance of considering Nocardia infection as the differential diagnosis in immunocompromised patients who present with empyema. In particular, because of the N. farcinica infection's tendency to spread and the resistance of the organism to antibiotics, aggressive evaluation of metastatic lesions and standardized support from microbiological laboratories are important. Surgery may be required in some patients with brain abscesses to improve the chance of survival.
Collapse
Affiliation(s)
- Eung Kyum Lee
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Jin Kim
- Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Dong-Hyuk Park
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Chang Kyu Lee
- Department of Laboratory Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, The Republic of Korea
| |
Collapse
|
20
|
Li J, Shen H, Yu T, Tao XY, Hu YM, Wang HC, Zou MX. Isolation and Characterization of Nocardia Species from Pulmonary Nocardiosis in a tertiary hospital in China. Jpn J Infect Dis 2021; 75:31-35. [PMID: 34053953 DOI: 10.7883/yoken.jjid.2020.1096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to investigate the clinical features, distribution and antimicrobial susceptibility of Nocardia species isolated from pulmonary nocardiosis cases in tertiary hospital in China. The species were collected from January 1, 2018 to May 31, 2019 and identified using MALDI-TOF MS or PCR. Antimicrobial susceptibility testing was performed using the broth microdilution method. Within the 44 Nocardia species, N. farcinica was the most frequently identified species (n = 36), followed by N. nova (n = 5), N. otitidiscaviarum (n = 1), N. cyriacigeorgica (n = 1), and N. transvalensis (n = 1). The top three predisposing factors of pulmonary nocardiosis were chronic obstructive pulmonary disease (45.5%), hypertension (34.1%), and tuberculosis (31.8%). All 44 Nocardia strains were susceptible to amikacin, trimethoprim / sulfamethoxazole, and linezolid. The resistance rates of Nocardia to amoxicillin-clavulanic acid, ciprofloxacin, clarithromycin, ceftriaxone, tobramycin, and imipenem were 4.5%, 9.1%, 79.5%, 72.7%, 63.6%, and 38.6%, respectively. Two Nocardia strains had decreased sensitivity to trimethoprim / sulfamethoxazole. In conclusion, N. farcinica was the most frequently isolated Nocardia species in the First Hospital of Changsha. All isolated clinical Nocardia strains showed susceptible to amikacin, trimethoprim / sulfamethoxazole, and linezolid, suggesting that these drugs can be primary therapeutic choices for treating Nocardia infections.
Collapse
Affiliation(s)
- Jun Li
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, China
| | - Hui Shen
- Department of Clinical Laboratory, the First Hospital of Changsha, China
| | - Ting Yu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, China
| | - Xiao-Yan Tao
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, China
| | - Yong-Mei Hu
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, China
| | - Hai-Chen Wang
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, China
| | - Ming-Xiang Zou
- Department of Clinical Laboratory, Xiangya Hospital, Central South University, China
| |
Collapse
|
21
|
Idiopathic thrombocytopenic purpura with brain abscess caused by Nocardia farcinica diagnosed using metagenomics next-generation sequencing of the cerebrospinal fluid: a case report. BMC Infect Dis 2021; 21:380. [PMID: 33892637 PMCID: PMC8066483 DOI: 10.1186/s12879-021-06071-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/14/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Brain abscesses caused by Nocardia farcinica are rare, and mostly occur in immunocompromised individuals. Rapid and accurate diagnosis of nocardiosis is challenging. Due to the inadequate performance of conventional diagnostic methods for Nocardia infection, metagenomics next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) has the potential to improve the diagnosis intracranial nocardiosis. CASE PRESENTATION We report a case of 50-year-old man with brain abscess caused by Nocardia farcinica. The patient had a idiopathic thrombocytopenic purpura complication that required long-term methylprednisolone administration. His chest image showed multiple lesions, which had been misdiagnosed as lung cancer, and his head image showed multiple intracranial metastases. No pathogen was detected in routine examinations including blood culture, sputum culture and traditional culture methods of cerebrospinal fluid. In order to accurately identify the pathogen, mNGS was used to detect Nocardia in CSF. Although the patient's condition improved after using sensitive antibiotics, he transferred to the local hospital for treatment because of many complicated diseases and family financial limitations. CONCLUSION This case highlights the value of mNGS in the diagnosis of Nocardia brain abscess, and emphasizes the inadequate sensitivity of conventional diagnostic methods for Nocardia infection. Using mNGS can facilitate early and accurate detection of Norcadia-associated of meningitis in immunocompromised patients, thereby reducing unnecessary use of antibiotics and reducing mortality of the disease.
Collapse
|
22
|
Li Y, Tang T, Xiao J, Wang J, Li B, Ma L, Xie S, Nie D. Clinical analysis of 11 cases of nocardiosis. Open Med (Wars) 2021; 16:610-617. [PMID: 33869782 PMCID: PMC8034244 DOI: 10.1515/med-2020-0196] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 02/05/2021] [Accepted: 02/24/2021] [Indexed: 11/15/2022] Open
Abstract
Nocardiosis is a rare, life-threatening, opportunistic, and suppurative infection. Its clinical manifestation lacks specificity, which makes early diagnosis difficult. A retrospective analysis of the clinical records of 11 patients with nocardiosis admitted to our hospital from January 2013 to November 2018 was conducted. All patients had at least one underlying disorder, such as an autoimmune disease (6/11), a blood malignancy (2/11), avascular necrosis of the femoral head (1/11), bronchiectasis (1/11), or pneumonia (1/11). The first-line treatment was trimethoprim-sulfamethoxazole (TMP-SMX); one or two additional antibiotics were given according to the drug-sensitive test. The median time from onset to treatment was 3 weeks (ranging from 1 to 9 weeks). The median duration of treatment after diagnosis was 20.5 weeks (ranging from 7 to 47 weeks). Eight patients were discharged and survived, and three patients died. This indicates that early use of TMP-SMX combined with sensitive antibiotics could improve the condition of patients and improve the cure rate (8/11). Clinically, it is necessary to consider the possibility of nocardiosis in patients with long-term use of immunosuppressants and poor response to treatment of common bacterial infections. Early diagnosis, timely treatment, and combination drug therapy are keys to improving the outcomes of patients with nocardiosis.
Collapse
Affiliation(s)
- Yiqing Li
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Sun Yat-Sen University, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong 510120, People's Republic of China
| | - Ting Tang
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Sun Yat-Sen University, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong 510120, People's Republic of China
| | - Jie Xiao
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Sun Yat-Sen University, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong 510120, People's Republic of China
| | - Jieyu Wang
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Sun Yat-Sen University, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong 510120, People's Republic of China
| | - Boqi Li
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Sun Yat-Sen University, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong 510120, People's Republic of China
| | - Liping Ma
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Sun Yat-Sen University, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong 510120, People's Republic of China
| | - Shuangfeng Xie
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Sun Yat-Sen University, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong 510120, People's Republic of China
| | - Danian Nie
- Department of Hematology, Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetic and Gene Regulation, Sun Yat-Sen University, Sun Yat-Sen Memorial Hospital, Guangzhou, Guangdong 510120, People's Republic of China
| |
Collapse
|
23
|
Abstract
PURPOSE OF REVIEW Nocardia is a ubiquitous pathogen associated with life-threatening opportunistic infections. Organ transplant recipients are uniquely predisposed to Nocardia infections due to their iatrogenic cell-mediated immune deficit necessary to maintain allograft function. This review aims to address recent updates in the epidemiology, clinical presentation, diagnostics, treatment, and outcomes of Nocardia infections in solid-organ transplant recipients. RECENT FINDINGS The incidence of Nocardia infection depends on multiple patient and environmental factors. Among transplant recipients, lung recipients are most commonly affected. Species identification and antimicrobial susceptibility testing are critical for optimizing therapy as substantial variation occurs among and within Nocardia spp. This has been increasingly accomplished through advances in molecular methods leading to improved accuracy and wider accessibility to testing. There are emerging data applying novel therapeutics and short course therapy that may offer alternative management approaches for transplant associated nocardiosis to minimize drug toxicity and intolerance. SUMMARY Further prospective, multicenter studies are needed to better characterize the epidemiology of Nocardia in transplant recipients, as well as evaluate the impact of diagnostic advancements and new treatment strategies.
Collapse
|
24
|
Harris DM, Dumitrascu AG, Chirila RM, Omer M, Stancampiano FF, Hata DJ, Meza Villegas DM, Heckman MG, Cochuyt JJ, Alvarez S. Invasive Nocardiosis in Transplant and Nontransplant Patients: 20-Year Experience in a Tertiary Care Center. Mayo Clin Proc Innov Qual Outcomes 2021; 5:298-307. [PMID: 33997629 PMCID: PMC8105525 DOI: 10.1016/j.mayocpiqo.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To present the clinical characteristics and outcome of transplant and nontransplant patients with invasive nocardiosis. Patients and Methods We conducted a retrospective chart review of 110 patients 18 years and older diagnosed with culture-proven invasive nocardiosis (defined as the presence of clinical signs and/or radiographic abnormalities) between August 1, 1998, and November 30, 2018. Information on demographic, clinical, radiographic, and microbiological characteristics as well as mortality was collected. Results One hundred ten individuals with invasive nocardiosis were identified, of whom 54 (49%) were transplant and 56 nontransplant (51%) patients. Most transplant patients were kidney and lung recipients. The overall mean age was 64.9 years, and transplant patients had a higher prevalence of diabetes and chronic kidney disease. A substantial proportion of nontransplant patients were receiving corticosteroids (39%), immunosuppressive medications (16%), and chemotherapy (9%) and had chronic obstructive pulmonary disease (20%), rheumatologic conditions (18%), and malignant neoplasia (18%). A higher proportion of transplant patients (28%) than nontransplant patients (4%) received trimethoprim-sulfamethoxazole prophylaxis. In both groups, the lung was the most common site of infection. Seventy percent of all Nocardia species isolated were present in almost equal proportion: N brasiliensis (16%), N farcinica (16%), N nova (15%), N cyriacigeorgia (13%), and N asteroides (11%). More than 90% of isolates were susceptible to trimethoprim-sulfamethoxazole, linezolid, and amikacin. There was no significant difference in mortality between the 2 groups at 1, 6, and 12 months after the initial diagnosis. Conclusion The frequency of invasive Nocardia infection was similar in transplant and nontransplant patients and mortality at 1, 6, and 12 months was similar in both groups. Trimethoprim-sulfamethoxazole prophylaxis failed to prevent Nocardia infection.
Collapse
Affiliation(s)
- Dana M Harris
- Division of Community Internal Medicine, Mayo Clinic, FL
| | | | - Razvan M Chirila
- Division of International and Executive Medicine, Mayo Clinic, FL
| | | | | | - D Jane Hata
- Division of Laboratory Medicine and Pathology, Mayo Clinic, FL
| | | | | | - Jordan J Cochuyt
- Division of Biomedical Statistics and Informatics, Mayo Clinic, FL
| | | |
Collapse
|
25
|
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.
Collapse
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
| | | |
Collapse
|
26
|
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: 73] [Impact Index Per Article: 24.3] [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.
Collapse
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
| |
Collapse
|
27
|
Han Y, Huang Z, Zhang H, He L, Sun L, Liu Y, Liu F, Xiao L. Nocardiosis in glomerular disease patients with immunosuppressive therapy. BMC Nephrol 2020; 21:516. [PMID: 33243202 PMCID: PMC7690096 DOI: 10.1186/s12882-020-02179-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 11/19/2020] [Indexed: 01/14/2023] Open
Abstract
Background Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. Methods We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. Results It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. Conclusions It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.
Collapse
Affiliation(s)
- Yuzhang Han
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zineng Huang
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Huifang Zhang
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Liyu He
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Sun
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yu Liu
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fuyou Liu
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Li Xiao
- Department of Nephrology, 2nd Xiangya Hospital, Central South University, Changsha, Hunan, China.
| |
Collapse
|
28
|
Goodlet KJ, Tokman S, Nasar A, Cherrier L, Walia R, Nailor MD. Nocardia prophylaxis, treatment, and outcomes of infection in lung transplant recipients: A matched case-control study. Transpl Infect Dis 2020; 23:e13478. [PMID: 32989873 DOI: 10.1111/tid.13478] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 09/20/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND Lung transplant recipients are at heightened risk for nocardiosis compared to other solid organ transplant recipients, with incidence rates as high as 9% and up to 30% associated mortality. No controlled studies assessing risk factors for nocardiosis in this high-risk population have been reported. METHODS Patients undergoing lung transplantation at a single center between 2012 and 2018 and diagnosed with nocardiosis post-transplant were matched 1:2 to uninfected control subjects on the basis of age, transplant date, and sex. RESULTS The incidence of nocardiosis in this lung transplant population was 3.4% (20/586), occurring a median of 9.4 months (range 4.4-55.2) post-transplant. In multivariable analysis, consistent use of trimethoprim/sulfamethoxazole (TMP/SMX) in the 12 weeks prior to diagnosis was independently associated with protection against nocardiosis (OR 0.038; 95% CI 0.01-0.29; P = .002). Augmented immunosuppression in the 6 months prior to diagnosis was independently associated with the development of nocardiosis (OR 9.94; 95% CI 1.62- 61.00; P = .013). Six case patients (30%) had disseminated disease; all-cause 6-month mortality was 25%. The most common species was Nocardia farcinica (7/17 isolates), which was associated with dissemination and mortality. The most active antibiotics were TMP/SMX (100%), linezolid (100%), and amikacin (76%). Imipenem was only active against 4/17 isolates (24% susceptibility), with two isolates becoming non-susceptible later in therapy. CONCLUSIONS Trimethoprim/sulfamethoxazole prophylaxis was shown to be protective against nocardiosis in lung transplant recipients, while augmented immunosuppression conferred increased risk. Institutional epidemiologic data are needed to best guide empiric therapy for Nocardia, as historical in vitro data may not predict local susceptibilities.
Collapse
Affiliation(s)
- Kellie J Goodlet
- Department of Pharmacy Practice, College of Pharmacy, Midwestern University, Glendale, AZ, USA
| | - Sofya Tokman
- Division of Transplant Pulmonology, Norton Thoracic Institute, Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Aasya Nasar
- Division of Transplant Pulmonology, Norton Thoracic Institute, Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.,Department of Pharmacy Services, Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Lauren Cherrier
- Division of Transplant Pulmonology, Norton Thoracic Institute, Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA.,Department of Pharmacy Services, Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Rajat Walia
- Division of Transplant Pulmonology, Norton Thoracic Institute, Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Michael D Nailor
- Department of Pharmacy Services, Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| |
Collapse
|
29
|
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.
Collapse
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
| |
Collapse
|
30
|
Männle D, McKinnie SMK, Mantri SS, Steinke K, Lu Z, Moore BS, Ziemert N, Kaysser L. Comparative Genomics and Metabolomics in the Genus Nocardia. mSystems 2020; 5:e00125-20. [PMID: 32487740 PMCID: PMC7413640 DOI: 10.1128/msystems.00125-20] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/13/2020] [Indexed: 01/22/2023] Open
Abstract
Using automated genome analysis tools, it is often unclear to what degree genetic variability in homologous biosynthetic pathways relates to structural variation. This hampers strain prioritization and compound identification and can lead to overinterpretation of chemical diversity. Here, we assessed the metabolic potential of Nocardia, an underinvestigated actinobacterial genus that is known to comprise opportunistic human pathogens. Our analysis revealed a plethora of putative biosynthetic gene clusters of various classes, including polyketide, nonribosomal peptide, and terpenoid pathways. Furthermore, we used the highly conserved biosynthetic pathway for nocobactin-like siderophores to investigate how gene cluster differences correlate to structural differences in the produced compounds. Sequence similarity networks generated by BiG-SCAPE (Biosynthetic Gene Similarity Clustering and Prospecting Engine) showed the presence of several distinct gene cluster families. Metabolic profiling of selected Nocardia strains using liquid chromatography-mass spectrometry (LC-MS) metabolomics data, nuclear magnetic resonance (NMR) spectroscopy, and GNPS (Global Natural Product Social molecular networking) revealed that nocobactin-like biosynthetic gene cluster (BGC) families above a BiG-SCAPE threshold of 70% can be assigned to distinct structural types of nocobactin-like siderophores.IMPORTANCE Our work emphasizes that Nocardia represent a prolific source for natural products rivaling better-characterized genera such as Streptomyces or Amycolatopsis Furthermore, we showed that large-scale analysis of biosynthetic gene clusters using similarity networks with high stringency allows the distinction and prediction of natural product structural variations. This will facilitate future genomics-driven drug discovery campaigns.
Collapse
Affiliation(s)
- Daniel Männle
- Pharmaceutical Biology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Centre for Infection Research (DZIF), Tübingen, Germany
- Interfaculty Institute for Microbiology and Infection Medicine Tübingen (IMIT), Microbiology and Biotechnology, University of Tübingen, Tübingen, Germany
| | - Shaun M K McKinnie
- Department of Chemistry and Biochemistry, University of California, Santa Cruz, California, USA
| | - Shrikant S Mantri
- German Centre for Infection Research (DZIF), Tübingen, Germany
- Interfaculty Institute for Microbiology and Infection Medicine Tübingen (IMIT), Microbiology and Biotechnology, University of Tübingen, Tübingen, Germany
| | - Katharina Steinke
- German Centre for Infection Research (DZIF), Tübingen, Germany
- Interfaculty Institute for Microbiology and Infection Medicine Tübingen (IMIT), Microbiology and Biotechnology, University of Tübingen, Tübingen, Germany
| | - Zeyin Lu
- Pharmaceutical Biology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Centre for Infection Research (DZIF), Tübingen, Germany
| | - Bradley S Moore
- Scripps Institution of Oceanography, University of California, San Diego, California, USA
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, California, USA
| | - Nadine Ziemert
- German Centre for Infection Research (DZIF), Tübingen, Germany
- Interfaculty Institute for Microbiology and Infection Medicine Tübingen (IMIT), Microbiology and Biotechnology, University of Tübingen, Tübingen, Germany
| | - Leonard Kaysser
- Pharmaceutical Biology, Eberhard Karls University Tübingen, Tübingen, Germany
- German Centre for Infection Research (DZIF), Tübingen, Germany
| |
Collapse
|
31
|
Davidson N, Grigg MJ, Mcguinness SL, Baird RJ, Anstey NM. Safety and Outcomes of Linezolid Use for Nocardiosis. Open Forum Infect Dis 2020; 7:ofaa090. [PMID: 32258209 PMCID: PMC7112726 DOI: 10.1093/ofid/ofaa090] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/13/2020] [Indexed: 11/12/2022] Open
Abstract
Background Tropical Australia has a high incidence of nocardiosis, with high rates of intrinsic antimicrobial resistance. Linezolid, the only antimicrobial to which all local Nocardia species are susceptible, has been recommended in empirical combination treatment regimens for moderate-severe Nocardia infections at Royal Darwin Hospital (RDH) since 2014. We report the safety and efficacy of linezolid use for nocardiosis in this setting. Methods We identified cases through a retrospective review of all RDH Nocardia isolates from December 2014 to August 2018 and included 5 linezolid-treated cases from a previous cohort. Laboratory, demographic, and clinical data were included in the primary analysis of safety and treatment outcomes. Results Between 2014 and 2018, Nocardia was isolated from 35 individuals; 28 (80%) had clinically significant infection and 23 (82%) received treatment. All isolates were linezolid-susceptible. Safety and efficacy were assessed for 20 patients receiving linezolid-containing regimens and 8 receiving nonlinezolid regimens. Median linezolid induction therapy duration was 28 days. Common adverse effects in those receiving linezolid were thrombocytopenia (45%) and anemia (40%). Adverse events prompted discontinuation of trimethoprim-sulfamethoxazole more often than linezolid (40% vs 20%). Linezolid therapeutic drug monitoring was used in 1 patient, with successful dose reduction and outcome. There was no difference in 30-day survival between those treated with linezolid (90%) vs no linezolid (87%). One Nocardia-attributed death occurred during linezolid therapy. Conclusions Linezolid is safe and efficacious in empirical treatment for moderate to severe nocardiosis in a monitored hospital setting, with 100% drug susceptibility and no difference in adverse events or outcomes compared with nonlinezolid regimens.
Collapse
Affiliation(s)
- Natalie Davidson
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia
| | | | | | - Robert J Baird
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia.,Department Microbiology, Royal Darwin Hospital, Darwin, NT, Australia
| | - Nicholas M Anstey
- Department of Infectious Diseases, Royal Darwin Hospital, Darwin, NT, Australia.,Menzies School of Health Research, Darwin, NT, Australia
| |
Collapse
|
32
|
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.
Collapse
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
| |
Collapse
|
33
|
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.
Collapse
|
34
|
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.
Collapse
|
35
|
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.
Collapse
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
| |
Collapse
|