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Del Ricco VF, Occhineri S, Leonildi A, Falcone M, Lupetti A, Rindi L. A rare case of primary cutaneous Nocardia vinacea in an immunocompetent patient: A case report and a review of the literature. Diagn Microbiol Infect Dis 2024; 109:116307. [PMID: 38733753 DOI: 10.1016/j.diagmicrobio.2024.116307] [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: 02/19/2024] [Revised: 03/26/2024] [Accepted: 04/16/2024] [Indexed: 05/13/2024]
Abstract
The nocardiae are a complex group of bacteria belonging to the aerobic saprophytes actinomycetes. Although nocardiosis typically occurs in immunocompromised patients, infection may occasionally develop in immunocompetent patients as well. Here we describe a rare case of primary cutaneous nocardiosis due to Nocardia vinacea in an immunocompetent 79-year-old patient. Since cutaneous nocardiosis presents variably and mimics other cutaneous infections, acid-fast and Gram stainings on clinical samples are significant to obtain a rapid and presumptive diagnosis.
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Affiliation(s)
| | - Sara Occhineri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonella Lupetti
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Laura Rindi
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
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2
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Zhang L, Zhou M, Wang Z, Zhu H, Lin J, Lu M, Ge Y, Xu Y, Li T, Liu Z. Comparison of Clinical Characteristics and Treatment Outcome Between Localized and Disseminated Nocardiosis in a Tertiary Hospital in China. Infect Drug Resist 2024; 17:2379-2387. [PMID: 38894887 PMCID: PMC11185256 DOI: 10.2147/idr.s458124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024] Open
Abstract
Background In China, due to the large population, infections caused by Nocardia may not be as rare. Unfortunately, there is still inadequate knowledge of the clinical impact caused by Nocardia. This study aimed to compare the clinical characteristics and treatment of localized and disseminated nocardiosis. Methods The clinical and microbiological data of patients diagnosed with nocardiosis in a tertiary hospital in Beijing from July 2011 to July 2021 were collected and retrospectively analyzed. Results Among the 54 nocardiosis cases, 34 cases were in the localized infection group, while 20 cases in the disseminated infection group. The proportion of patients with chronic structural lung disease was higher in the localized group (P=0.010). In contrast, patients with disseminated infections were more prone to receive long-term glucocorticoids and/or immunosuppressants (P=0.027). Pulmonary nodules were prominent features of imaging changes in patients with disseminated infections (P=0.027) whereas bronchial dilatation was more common in patients with localized infections (P=0.025). In addition, the disseminated group had longer average hospitalization days relative to the localized group (P=0.016), but there was no significant difference in mortality between them (P=0.942). Conclusion There were differences in the clinical profiles between patients with localized and disseminated nocardiosis in terms of clinical presentation, infection site, radiological features, treatment, and prognosis. These findings may provide references for the management and treatment of patients with nocardiosis.
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Affiliation(s)
- Li Zhang
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Menglan Zhou
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Ziran Wang
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Hongqiong Zhu
- Department of Infectious Disease, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, People’s Republic of China
| | - Jing Lin
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
- Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Minya Lu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Ying Ge
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Yingchun Xu
- Department of Clinical Laboratory, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
- Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Peking Union Medical College Hospital, Beijing, People’s Republic of China
| | - Taisheng Li
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
| | - Zhengyin Liu
- Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, People’s Republic of China
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Huang L, Xu J, Jia K, Wu Y, Yuan W, Liao Z, Cheng B, Luo Q, Tian G, Lu H. Butylparaben induced zebrafish (Danio rerio) kidney injury by down-regulating the PI3K-AKT pathway. JOURNAL OF HAZARDOUS MATERIALS 2024; 470:134129. [PMID: 38565019 DOI: 10.1016/j.jhazmat.2024.134129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 02/24/2024] [Accepted: 03/24/2024] [Indexed: 04/04/2024]
Abstract
Butylparaben, a common endocrine disruptor in the environment, is known to be toxic to the reproductive system, heart, and intestines, but its nephrotoxicity has rarely been reported. In order to study the nephrotoxicity and mechanism of butylparaben, we examined the acute and chronic effects on human embryonic kidney cells (HEK293T) and zebrafish. Additionally, we assessed the potential remedial effects of salidroside against butylparaben-induced nephrotoxicity. Our in vitro findings demonstrated oxidative stress and cytotoxicity to HEK293T cells caused by butylparaben. In the zebrafish model, the concentration of butylparaben exposure ranged from 0.5 to 15 μM. An assortment of experimental techniques was employed, including the assessment of kidney tissue morphology using Hematoxylin-Eosin staining, kidney function analysis via fluorescent dextran injection, and gene expression studies related to kidney injury, development, and function. Additionally, butylparaben caused lipid peroxidation in the kidney, thereby damaging glomeruli and renal tubules, which resulted from the downregulation of the PI3K-AKT signaling pathway. Furthermore, salidroside ameliorated butylparaben-induced nephrotoxicity through the PI3K-AKT signaling pathway. This study reveals the seldom-reported kidney toxicity of butylparaben and the protective effect of salidroside against toxicological reactions related to nephrotoxicity. It offers valuable insights into the risks to kidney health posed by environmental toxins.
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Affiliation(s)
- Lirong Huang
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000, Jiangxi, China
| | - Jiaxin Xu
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000, Jiangxi, China
| | - Kun Jia
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000, Jiangxi, China
| | - Yulin Wu
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000, Jiangxi, China
| | - Wei Yuan
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000, Jiangxi, China
| | - Zhipeng Liao
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000, Jiangxi, China
| | - Bo Cheng
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000, Jiangxi, China
| | - Qiang Luo
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000, Jiangxi, China
| | - Guiyou Tian
- Ganzhou Key Laboratory for Drug Screening and Discovery, School of Geography and Environmental Engineering, Gannan Normal University, Ganzhou 341000, Jiangxi, China
| | - Huiqiang Lu
- Center for Clinical Medicine Research, First Affiliated Hospital of Gannan Medical University, Ganzhou 341000, Jiangxi Province, China.
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Pham J, Benefield RJ, Baker N, Lindblom S, Canfield N, Gomez CA, Fisher M. In vitro activity of omadacycline against clinical isolates of Nocardia. Antimicrob Agents Chemother 2024; 68:e0168623. [PMID: 38534103 PMCID: PMC11064614 DOI: 10.1128/aac.01686-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
Nocardiosis typically requires a prolonged treatment duration of ≥6 months and initial combination therapy with 2-3 antibiotics. First-line regimens for nocardiosis are associated with considerable toxicity; therefore, alternative therapies are needed. Omadacycline is an aminomethylcycline with broad antimicrobial activity whose in vitro activity against Nocardia species has not been formally assessed. The in vitro potency of omadacycline was evaluated against 300 Nocardia clinical isolates by broth microdilution. The most common Nocardia species tested were N. cyriacigeorgica (21%), N. nova (20%), and N. farcinica (12%). The most common specimens were respiratory (178 isolates, 59%) and wound (57 isolates, 19%). Omadacycline minimum inhibitory concentrations (MICs) across all Nocardia species ranged from 0.06 µg/mL to 8 µg/mL, with an MIC50 of 2 µg/mL and MIC90 of 4 µg/mL. The lowest MICs were found among N. paucivorans (MIC50 = 0.25 µg/mL, MIC90 = 0.25 µg/mL), N. asiatica (MIC50 = 0.25 µg/mL, MIC90 = 1 µg/mL), N. abscessus complex (MIC50 = 0.5 µg/mL, MIC90 = 1 µg/mL), N. beijingensis (MIC50 = 0.5 µg/mL, MIC90 = 2 µg/mL), and N. otitidiscaviarum (MIC50 = 1 µg/mL, MIC90 = 2 µg/mL). The highest MICs were found among N. farcinica (MIC50 = 4 µg/mL, MIC90 = 8 µg/mL). In vitro potency differed by species among Nocardia clinical isolates. Further studies are warranted to evaluate the potential clinical utility of omadacycline for nocardiosis.
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Affiliation(s)
- Jonathan Pham
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Russell J. Benefield
- Department of Pharmacy, University of Utah Health, Salt Lake City, Utah, USA
- Department of Pharmacotherapy, University of Utah College of Pharmacy, Salt Lake City, Utah, USA
| | - Natali Baker
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, USA
| | - Shane Lindblom
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, USA
| | - Nicholas Canfield
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, USA
| | - Carlos A. Gomez
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mark Fisher
- Department of Pathology, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Associated Regional and University Pathologists (ARUP) Laboratories, Salt Lake City, Utah, USA
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Song RJ, Zhang GL. A Rare Case Report of Disseminated Nocardia Farcinica Granulomatous Hepatitis and Clinical Management Experience. Infect Drug Resist 2024; 17:1523-1528. [PMID: 38645888 PMCID: PMC11032677 DOI: 10.2147/idr.s461494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/11/2024] [Indexed: 04/23/2024] Open
Abstract
Background Nocardiosis is primarily an opportunistic infection affecting immunocompromised individuals, with a predilection for the lungs, brain, or skin in those with compromised immune function. Granulomatous hepatitis caused by Nocardia is a rare clinical manifestation. This study aims to provide a systematic overview of the clinical features of Nocardiosis caused by Nocardia farcinica, enhancing our understanding of this disease. Methods We report a case of a 75-year-old male with no underlying diseases presenting with a history of "recurrent fever for more than 4 months", along with fatigue, poor appetite, and pleural and abdominal effusion. Despite treatment at multiple hospitals, the patient showed little improvement. Chest CT revealed chronic inflammation, small nodules, bilateral pleural effusion, and pleural thickening. Abdominal CT indicated multiple low-density lesions in the liver, multiple small calcifications, and abdominal effusion. Results Liver biopsy suggested inflammatory changes, with focal granuloma formation. Metagenomic next-generation sequencing (mNGS) of liver tissue indicated Nocardia farcinica, leading to the final diagnosis of disseminated Nocardia farcinica granulomatous hepatitis. Conclusion Nocardia infection is a rare disease primarily observed in immunocompromised patients but can also occur in those with normal immune function. The clinical and radiological features lack specificity; however, the utilization of mNGS technology enables rapid identification of the pathogenic microorganism. Nocardia farcinica is generally susceptible to sulfonamide drugs and amikacin, offering viable treatment options.
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Affiliation(s)
- Rui Juan Song
- Department of Infectious Diseases, Anhui Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Hefei, People’s Republic of China
| | - Guang Lin Zhang
- Department of Infectious Diseases, Anhui Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Hefei, People’s Republic of China
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Yetmar ZA, Khodadadi RB, Chesdachai S, McHugh JW, Challener DW, Wengenack NL, Bosch W, Seville MT, Beam E. Epidemiology, Timing, and Secondary Prophylaxis of Recurrent Nocardiosis. Open Forum Infect Dis 2024; 11:ofae122. [PMID: 38560606 PMCID: PMC10977627 DOI: 10.1093/ofid/ofae122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Background Nocardia tends to cause infection in immunocompromised patients or those with chronic pulmonary disease. Nocardia is known to recur, prompting the practice of secondary prophylaxis in patients perceived at high risk. However, few data exist regarding the epidemiology of recurrent nocardiosis or the effectiveness of secondary prophylaxis. Methods We performed a multicenter, retrospective cohort study of adults diagnosed with nocardiosis from November 2011 to April 2022, including patients who completed primary treatment and had at least 30 days of posttreatment follow-up. Propensity score matching was used to analyze the effect of secondary prophylaxis on Nocardia recurrence. Results Fifteen of 303 (5.0%) patients developed recurrent nocardiosis after primary treatment. Most recurrences were diagnosed either within 60 days (N = 6/15, 40.0%) or between 2 to 3 years (N = 4/15, 26.7%). Patients with primary disseminated infection tended to recur within 1 year, whereas later recurrences were often nondisseminated pulmonary infection. Seventy-eight (25.7%) patients were prescribed secondary prophylaxis, mostly trimethoprim-sulfamethoxazole (N = 67/78). After propensity-matching, secondary prophylaxis was not associated with reduced risk of recurrence (hazard ratio, 0.96; 95% confidence interval, .24-3.83), including in multiple subgroups. Eight (53.3%) patients with recurrent nocardiosis required hospitalization and no patients died from recurrent infection. Conclusions Recurrent nocardiosis tends to occur either within months because of the same Nocardia species or after several years with a new species. Although we did not find evidence for the effectiveness of secondary prophylaxis, the confidence intervals were wide. However, outcomes of recurrent nocardiosis are generally favorable and may not justify long-term antibiotic prophylaxis for this indication alone.
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Affiliation(s)
- Zachary A Yetmar
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Infectious Disease, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ryan B Khodadadi
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Supavit Chesdachai
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jack W McHugh
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas W Challener
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nancy L Wengenack
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Elena Beam
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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7
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Lee HN, Do KH, Kim EY, Choe J, Sung H, Choi SH, Kim HJ. Comparative Analysis of CT Findings and Clinical Outcomes in Adult Patients With Disseminated and Localized Pulmonary Nocardiosis. J Korean Med Sci 2024; 39:e107. [PMID: 38529577 DOI: 10.3346/jkms.2024.39.e107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/01/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Pulmonary nocardiosis is a rare opportunistic infection with occasional systemic dissemination. This study aimed to investigate the computed tomography (CT) findings and prognosis of pulmonary nocardiosis associated with dissemination. METHODS We conducted a retrospective analysis of patients diagnosed with pulmonary nocardiosis between March 2001 and September 2023. We reviewed the chest CT findings and categorized them based on the dominant CT findings as consolidation, nodules and/or masses, consolidation with multiple nodules, and nodular bronchiectasis. We compared chest CT findings between localized and disseminated pulmonary nocardiosis and identified significant prognostic factors associated with 12-month mortality using multivariate Cox regression analysis. RESULTS Pulmonary nocardiosis was diagnosed in 75 patients, of whom 14 (18.7%) had dissemination, including involvement of the brain in 9 (64.3%) cases, soft tissue in 3 (21.4%) cases and positive blood cultures in 3 (21.4%) cases. Disseminated pulmonary nocardiosis showed a higher frequency of cavitation (64.3% vs. 32.8%, P = 0.029) and pleural effusion (64.3% vs. 29.5%, P = 0.014) compared to localized infection. The 12-month mortality rate was 25.3%. The presence of dissemination was not a significant prognostic factor (hazard ratio [HR], 0.80; confidence interval [CI], 0.23-2.75; P = 0.724). Malignancy (HR, 9.73; CI, 2.32-40.72; P = 0.002), use of steroid medication (HR, 3.72; CI, 1.33-10.38; P = 0.012), and a CT pattern of consolidation with multiple nodules (HR, 4.99; CI, 1.41-17.70; P = 0.013) were associated with higher mortality rates. CONCLUSION Pulmonary nocardiosis with dissemination showed more frequent cavitation and pleural effusion compared to cases without dissemination, but dissemination alone did not affect the mortality rate of pulmonary nocardiosis.
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Affiliation(s)
- Han Na Lee
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung-Hyun Do
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Eun Young Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jooae Choe
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Heungsup Sung
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang-Ho Choi
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hwa Jung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Han Y, Cheng M, Li Z, Chen H, Xia S, Zhao Y, Wang Y, He W, Wang W. Clinical characteristics and drug resistance of Nocardia in Henan, China, 2017-2023. Ann Clin Microbiol Antimicrob 2024; 23:23. [PMID: 38449006 PMCID: PMC10919010 DOI: 10.1186/s12941-024-00677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical features of Nocardia infections, antibiotic resistance profile, choice of antibiotics and treatment outcome, among others. In addition, the study compared the clinical and microbiological characteristics of nocardiosis in bronchiectasis patients and non-bronchiectasis patients. METHODS Detailed clinical data were collected from the medical records of 71 non-duplicate nocardiosis patients from 2017 to 2023 at a tertiary hospital in Zhengzhou, China. Nocardia isolates were identified to the species level using MALDI-TOF MS and 16S rRNA PCR sequencing. Clinical data were collected from medical records, and drug susceptibility was determined using the broth microdilution method. RESULTS Of the 71 cases of nocardiosis, 70 (98.6%) were diagnosed as pulmonary infections with common underlying diseases including bronchiectasis, tuberculosis, diabetes mellitus and chronic obstructive pulmonary disease (COPD). Thirteen different strains were found in 71 isolates, the most common of which were N. farcinica (26.8%) and N. cyriacigeorgica (18.3%). All Nocardia strains were 100% susceptible to both TMP-SMX and linezolid, and different Nocardia species showed different patterns of drug susceptibility in vitro. Pulmonary nocardiosis is prone to comorbidities such as bronchiectasis, diabetes mellitus, COPD, etc., and Nocardia is also frequently accompanied by co-infection of the body with pathogens such as Mycobacterium and Aspergillus spp. Sixty-one patients underwent a detailed treatment regimen, of whom 32 (52.5%) received single or multi-drug therapy based on TMP-SMX. Bronchiectasis was associated with a higher frequency of Nocardia infections, and there were significant differences between the bronchiectasis and non-bronchiectasis groups in terms of age distribution, clinical characteristics, identification of Nocardia species, and antibiotic susceptibility (P < 0.05). CONCLUSIONS Our study contributes to the understanding of the species diversity of Nocardia isolates in Henan, China, and the clinical characteristics of patients with pulmonary nocardiosis infections. Clinical and microbiologic differences between patients with and without bronchiectasis. These findings will contribute to the early diagnosis and treatment of patients.
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Affiliation(s)
- Yungang Han
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Meijin Cheng
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Zheng Li
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Huihui Chen
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Shuang Xia
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yue Zhao
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yali Wang
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Wenyi He
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Wei Wang
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China.
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China.
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Toyokawa M, Ohana N, Tanno D, Imai M, Takano Y, Ohashi K, Yamashita T, Saito K, Takahashi H, Shimura H. In vitro activity of tedizolid against 43 species of Nocardia species. Sci Rep 2024; 14:5342. [PMID: 38438563 PMCID: PMC10912709 DOI: 10.1038/s41598-024-55916-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/28/2024] [Indexed: 03/06/2024] Open
Abstract
The purpose of the present study was to evaluate the in vitro activity of tedizolid against several clinically significant species of Nocardia by comparing with that of linezolid. A total of 286 isolates of Nocardia species, including 236 clinical isolates recovered from patients in Japan and 50 strains (43 species) purchased from NITE Biological Resource Center, were studied. Antimicrobial susceptibility testing was performed using the broth microdilution method. For the 286 Nocardia isolates, the minimal inhibitory concentration (MIC)50 and MIC90 values of tedizolid were 0.25 and 0.5 μg/ml, and those of linezolid were 2 and 2 μg/ml, respectively. The distribution of the linezolid/tedizolid ratios (MICs of linezolid/MICs of tedizolid) showed that tedizolid had four- to eight-fold higher activity than linezolid in 96.1% (275/286) of Nocardia isolates. Both the tedizolid and linezolid MIC90 values for Nocardia brasiliensis were two-fold higher than those for the other Nocardia species. Both tedizolid and linezolid had low MIC values, 0.25-1 μg/ml and 0.5-4 μg/ml, respectively, even against nine isolates (five species) that were resistant to trimethoprim/sulfamethoxazole. One Nocardia sputorum isolate showed reduced susceptibility to tedizolid (4 μg/ml). Bioinformatics analysis suggests different resistance mechanisms than the oxazolidinone resistance seen in enterococci and staphylococci.
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Affiliation(s)
- Masahiro Toyokawa
- Department of Clinical Laboratory Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, 10-6, Sakaemachi, Fukushima City, Fukushima, 960-8516, Japan.
- Department of Laboratory Medicine, Fukushima Medical University, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan.
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Noboru Ohana
- Department of Laboratory Medicine, Fukushima Medical University, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Daiki Tanno
- Department of Clinical Laboratory Sciences, School of Health Sciences, Fukushima Medical University, Fukushima, 10-6, Sakaemachi, Fukushima City, Fukushima, 960-8516, Japan
- Department of Laboratory Medicine, Fukushima Medical University, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Minako Imai
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Yukiko Takano
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Kazutaka Ohashi
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Tomonari Yamashita
- Clinical Testing Department, MicroSKY Lab, Inc., Center Building Kanamachi 2F, 6-6-5 Higashikanamachi, Katsushika-ku, Tokyo, 125-0041, Japan
| | - Kyoichi Saito
- Department of Laboratory Medicine, Fukushima Medical University, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
| | - Hiroki Takahashi
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8673, Japan
- Molecular Chirality Research Center, Chiba University, 1-33 Yayoi-cho, Inage-ku, Chiba, 263-8522, Japan
- Plant Molecular Science Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8675, Japan
| | - Hiroki Shimura
- Department of Laboratory Medicine, Fukushima Medical University, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
- Department of Clinical Laboratory Medicine, Fukushima Medical University Hospital, 1 Hikariga-Oka, Fukushima City, Fukushima, 960-1295, Japan
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10
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Schröder J, Calligaris-Maibach R, Beer HJ, Wiggli B. ["And zebras do exist after all"! : Pulmonary nocardiosis: case series and overview]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2024; 65:286-289. [PMID: 37548668 DOI: 10.1007/s00108-023-01566-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/24/2023] [Indexed: 08/08/2023]
Abstract
Nocardiosis is a rare disease that occurs primarily in patients with predisposing factors (immunosuppression/chronic lung disease). It is caused by aerobic, Gram-positive bacteria that are ubiquitous in soil. Cutaneous and pulmonary manifestations are most common, but disseminated forms also occur. In terms of treatment, long-term antibiotic therapy is usually necessary. The prognosis for the cutaneous or pulmonary form is generally good.
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Affiliation(s)
- Julia Schröder
- Departement für Innere Medizin, Kantonsspital Baden, Baden, Schweiz
| | | | - Hans-Jürg Beer
- Departement für Innere Medizin, Kantonsspital Baden, Baden, Schweiz
- Molekulare Kardiologie, Universitätsspital Zürich, Zürich, Schweiz
| | - Benedikt Wiggli
- Klinik für Infektiologie & Infektionsprävention, Kantonsspital Baden, Baden, Schweiz.
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11
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Feng Y, Zuo CL, Shi JX. Brucella infection combined with Nocardia infection: A case report and literature review. Open Life Sci 2024; 19:20220815. [PMID: 38465335 PMCID: PMC10921472 DOI: 10.1515/biol-2022-0815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 03/12/2024] Open
Abstract
Human brucellosis is an infectious disease caused by Brucella and is often misdiagnosed for atypical manifestations including fever of unknown origin, headache, weakness, among else. Nocardiosis is a zoonotic disease caused by the genus Nocardia, which usually spreads through the respiratory tract, skin, and digestive tract. Limited research has documented cases of co-infection involving both Brucella and Nocardia pathogens in patients. A 55-year-old male was admitted to our hospital with intermittent high-grade fever. Following sputum and blood cultures, as well as other laboratory examinations, the patient was diagnosed with concurrent brucellosis and nocardiosis. According to recommendations of previous studies and reports, the patient was successively treated with levofloxacin, doxycycline, piperacillin sodium and sulbactam sodium, trimethoprim-sulfamethoxazole, rifampicin, and tigecycline, after which the patient recovered and was discharged. Brucella and Nocardia are both opportunistic pathogens and simultaneous infection of Brucella and Nocardia is relatively rare. If patients continue to experience persistent fever despite receiving empirical antibiotic therapy, it becomes necessary to conduct examinations to identify potential atypical pathogens, including Brucella and Nocardia. Sputum staining, sputum culture, and blood culture are critical auxiliary examinations during clinical practice. The treatment plan should be selected based on guidelines and the individual patient's condition. Regular reevaluation should be conducted, and antimicrobial agents should be adjusted accordingly.
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Affiliation(s)
- Yan Feng
- Department of Pulmonary and Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, Lianyungang First People’s Hospital, 6 East Zhenhua Road, Lianyungang, 222006, China
| | - Chun-Lei Zuo
- Laboratory Department, Lianyungang Clinical College of Nanjing Medical University, Lianyungang First People’s Hospital, 6 East Zhenhua Road, Lianyungang, 222006, China
| | - Jia-Xin Shi
- Department of Pulmonary and Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, Lianyungang First People’s Hospital, 6 East Zhenhua Road, Lianyungang, 222006, China
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12
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Pérez Ramos IS, Gurruchaga Yanes ML, Fernández Vecilla D, Oiartzabal Elorriaga U, Unzaga Barañano MJ, Díaz de Tuesta Del Arco JL. Cavitary pneumonia and empyema thoracis caused by multidrug resistant Nocardia otitidiscaviarum in an elderly patient. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2024; 37:97-99. [PMID: 37960833 PMCID: PMC10874667 DOI: 10.37201/req/042.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/05/2023] [Accepted: 09/15/2023] [Indexed: 11/15/2023]
Affiliation(s)
| | | | - D Fernández Vecilla
- Domingo Fernández Vecilla, Clinical microbiology service. Laredo Regional Hospital. Av. Derechos Humanos, 40, 39770, Laredo, Cantabria (Spain).
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13
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Amano T, Nishikawa T, Oka K, Ota K, Shimizu T. How an Antimicrobial Stewardship Team Treated a Nocardia farcinica-Associated Brain Abscess: A Case Report. Cureus 2024; 16:e54605. [PMID: 38523941 PMCID: PMC10958982 DOI: 10.7759/cureus.54605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2024] [Indexed: 03/26/2024] Open
Abstract
Nocardia species, which are ubiquitous in the environment, form lesions primarily in immunocompromised patients via oral or cutaneous infection. Some of these Nocardia species, such as N. farcinica, also infect the central nervous system via hematogenous dissemination, which rarely results in brain abscesses. Notably, N. farcinica is resistant to numerous antimicrobial drugs used in empirical therapy, necessitating the intervention of an infectious disease specialist. To date, no case of antimicrobial stewardship teams (ASTs) playing a central role in community hospitals without an infectious disease specialist has been reported. Here, we describe a case of N. farcinica-associated brain abscess in a small-to-medium-sized hospital with no infectious disease department or specialist, in which the AST assisted in the identification of the causative organism and in selecting appropriate therapeutic agents, ultimately leading to a cure. The patient was an 88-year-old man with a high fever. He had been taking prednisolone (10-15 mg/day) for approximately 1 year for pemphigoid. Considering the possibility of fever owing to bacteremia of cutaneous origin, ampicillin/sulbactam antimicrobial therapy at 6 g/day was initiated. A subsequent close examination led to the diagnosis of a brain abscess. Emergency abscess drainage was performed by a neurosurgeon, and postoperative antimicrobial combination therapy comprising ceftriaxone (4 g/day), vancomycin (2 g/day), and metronidazole (1,500 mg/day) was commenced. The AST suspected Nocardia infection earlier, but further testing was difficult to perform at this facility. Therefore, by requesting assistance from Nagoya University Hospital, we performed early bacterial identification by mass spectrometry and appropriate antimicrobial susceptibility testing by a custom panel on day 11. The patient was non-responsive to all the previously used antibiotics at the time of admission. On day 13 after admission, the patient was successfully treated with trimethoprim-sulfamethoxazole (TMP-SMX) and imipenem/cilastatin sodium, and the patient was cured. The AST can be as effective as an infectious disease specialist when a strong working relationship is established between the team and clinicians. Further, the activities of the AST can improve patient survival via active medical support in collaboration with attending physicians.
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Affiliation(s)
- Tetsushi Amano
- Antimicrobial Stewardship Team, Hekinan Municipal Hospital, Hekinan, JPN
- Department of Pharmacy, Hekinan Municipal Hospital, Hekinan, JPN
| | | | - Keisuke Oka
- Department of Infectious Diseases, Nagoya University Hospital, Nagoya, JPN
| | - Kosei Ota
- Antimicrobial Stewardship Team, Hekinan Municipal Hospital, Hekinan, JPN
- Department of Clinical Laboratory, Hekinan Municipal Hospital, Hekinan, JPN
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, Mibu, JPN
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14
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Kisiel M, Bass VM, Fong C, Graham AK, Yahya S, Eichorn FC, Lannon M, Kameda-Smith M, Reddy KKV, Lu JQ. Clinicopathologic characteristics of Nocardia brain abscesses: Necrotic and non-necrotic foci of various stages. J Neurol Sci 2024; 456:122850. [PMID: 38142539 DOI: 10.1016/j.jns.2023.122850] [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: 10/25/2023] [Revised: 12/09/2023] [Accepted: 12/17/2023] [Indexed: 12/26/2023]
Abstract
Nocardia brain abscesses are rare bacterial infections associated with a high mortality rate, and their preoperative diagnosis can be difficult for various reasons including a nonspecific clinical presentation. While late-stage nocardial brain abscesses may be radiologically characteristic, early-stage lesions are nonspecific and indistinguishable from another inflammatory/infectious process and other mimics. Despite the paucity of previous histopathological descriptions, histopathological examination is critical for the identification of the pathogen, lesion stage(s), and possible coexisting pathology. In this study, we examined the clinical, radiological and histopathological features of 10 patients with brain nocardiosis. Microscopic findings were analysed in correlation with clinical and radiological features in 9 patients, which revealed that brain nocardiosis was characterized by numerous necrotic and non-necrotic foci of various stages (I-IV) along with Nocardia identification, as well as the leptomeningeal involvement in most cases, and co-infection of brain nocardiosis with toxoplasmosis in 2 patients. The imaging features were characteristic with a multilobulated/bilobed ring-enhancing appearance in 8 patients including 2 patients with multiple lobulated and non-lobulated lesions and 1 patient showing the progression from a non-lobulated to lobulated lesion. These findings suggest that nocardial brain abscesses particularly at late-stages share common characteristics. Nevertheless, given the complex pathologic features, including possible co-infection by other pathogens, nocardial brain abscesses remain a therapeutic challenge.
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Affiliation(s)
- Marta Kisiel
- Department of Pathology and Molecular Medicine, Canada
| | | | - Crystal Fong
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | | | - Sultan Yahya
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Jian-Qiang Lu
- Department of Pathology and Molecular Medicine, Canada.
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15
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Tajima Y, Tashiro T, Furukawa T, Murata K, Takaki A, Sugahara K, Sakagami A, Inaba M, Marutsuka T, Hirata N. Pulmonary Nocardiosis With Endobronchial Involvement Caused by Nocardiaaraoensis. Chest 2024; 165:e1-e4. [PMID: 38199738 DOI: 10.1016/j.chest.2023.07.067] [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: 03/17/2023] [Revised: 07/20/2023] [Accepted: 07/28/2023] [Indexed: 01/12/2024] Open
Abstract
We report a rare case of pulmonary nocardiosis with endobronchial involvement caused by Nocardia araoensis. A 79-year-old man with a history of asthma and a previous right upper lobectomy for lung cancer and organizing pneumonia presented with cough and dyspnea. He presented with right bronchial stenosis associated with various mucosal lesions, including ulcerative and exophytic lesions. N araoensis was detected in sputum samples collected via bronchoscopy. The mucosal lesions improved after a 2-week course of meropenem. After a further 6 months of oral sulfamethoxazole-trimethoprim treatment, the mucosal lesions completely disappeared. Based on bronchoscopic and pathophysiologic findings, the patient was diagnosed with pulmonary nocardiosis with endobronchial involvement. Nocardiosis should be considered in the differential diagnosis of endobronchial mucosal lesions.
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Affiliation(s)
- Yuka Tajima
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan.
| | - Takahiro Tashiro
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Tsuguhiro Furukawa
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Katsumi Murata
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Akira Takaki
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Kazuaki Sugahara
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Akiko Sakagami
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Megumi Inaba
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Takashi Marutsuka
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
| | - Naomi Hirata
- Department of Respiratory Medicine, Kumamoto Chuo Hospital, Tainoshima, Minami-ku, Kumamoto, Japan
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16
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Vogel H, Daniels JB, Frank CB. Nocardia farcinica abortion in a goat. J Vet Diagn Invest 2024; 36:128-130. [PMID: 37942657 PMCID: PMC10734593 DOI: 10.1177/10406387231210499] [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: 11/10/2023] Open
Abstract
A female goat fetus was received by the Colorado State University-Veterinary Diagnostic Laboratory following an isolated abortion of twins by a reportedly healthy doe. Postmortem examination did not reveal any gross abnormalities. Histologic evaluation revealed pyogranulomatous and necrotizing bronchopneumonia with intracellular and extracellular gram-positive and non-acid-fast filamentous bacilli. Aerobic culture of the stomach contents and pooled lung and liver tissue yielded light growth of Nocardia sp., which was identified by MALDI-TOF MS and 16s rDNA sequencing as Nocardia farcinica.
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Affiliation(s)
- Helena Vogel
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Joshua B. Daniels
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Chad B. Frank
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
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17
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Gupta S, Grant LM, Powers HR, Kimes KE, Hamdi A, Butterfield RJ, Gea-Banacloche J, Vijayvargiya P, Hata DJ, Meza Villegas DM, Dumitrascu AC, Harris DM, Chirila RM, Zhang N, Razonable RR, Kusne S, Alvarez S, Vikram HR. Invasive Nocardia Infections across Distinct Geographic Regions, United States. Emerg Infect Dis 2023; 29. [PMID: 37987603 PMCID: PMC10683819 DOI: 10.3201/eid2912.230673] [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: 11/22/2023] Open
Abstract
We reviewed invasive Nocardia infections in 3 noncontiguous geographic areas in the United States during 2011–2018. Among 268 patients with invasive nocardiosis, 48.2% were from Minnesota, 32.4% from Arizona, and 19.4% from Florida. Predominant species were N. nova complex in Minnesota (33.4%), N. cyriacigeorgica in Arizona (41.4%), and N. brasiliensis in Florida (17.3%). Transplant recipients accounted for 82/268 (30.6%) patients overall: 14 (10.9%) in Minnesota, 35 (40.2%) in Arizona, and 33 (63.5%) in Florida. Manifestations included isolated pulmonary nocardiosis among 73.2% of transplant and 84.4% of non–transplant patients and central nervous system involvement among 12.2% of transplant and 3.2% of non–transplant patients. N. farcinica (20.7%) and N. cyriacigeorgica (19.5%) were the most common isolates among transplant recipients and N. cyriacigeorgica (38.0%), N. nova complex (23.7%), and N. farcinica (16.1%) among non–transplant patients. Overall antimicrobial susceptibilities were similar across the 3 study sites.
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18
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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.
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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.
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19
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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.
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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
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20
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Fernández Vecilla D, Roche Matheus MP, Urrutikoetxea Gutiérrez MJ, Calvo Muro FE, Aspichueta Vivanco C, López Azkarreta I, Grau García M, Díaz de Tuesta Del Arco JL. Disseminated Nocardia farcinica infection associated with bacteraemia and osteomyelitis pubis in an elderly patient. Infect Dis (Lond) 2023; 55:738-743. [PMID: 37376969 DOI: 10.1080/23744235.2023.2229425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE We describe a rare case of a disseminated Nocardia farcinica infection associated with hip osteomyelitis. METHODS A 91-year-old female patient was admitted with oedema of her right leg, fever of 38 °C and data consistent with ruptured Baker's cyst. A disseminated Nocardia farcinica infection including bloodstream infection, pneumonia and multiple abscesses along both lower limbs was observed. RESULTS After a four-week course of 320 mg/1600 mg/12 h of intravenous trimethoprim/sulfamethoxazole and multiple chirurgic drainages the patient was discharged with oral trimethoprim/sulfamethoxazole. Nevertheless, the patient expired done month after being discharged from the hospital. CONCLUSIONS The implementation of a combination of intravenous antibiotics and drainages resulted in an initial improvement in the patient's condition. However, despite these interventions, the patient ultimately passed away probably due to natural causes.
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Affiliation(s)
| | - Mary Paz Roche Matheus
- Clinical Microbiology Service, Basurto University Hospital, Bilbao, Biscay, Spain
- Biocruces Bizkaia Health Research Institute, Biscay, Spain
| | | | - Felicitas Elena Calvo Muro
- Clinical Microbiology Service, Basurto University Hospital, Bilbao, Biscay, Spain
- Biocruces Bizkaia Health Research Institute, Biscay, Spain
| | - Cristina Aspichueta Vivanco
- Clinical Microbiology Service, Basurto University Hospital, Bilbao, Biscay, Spain
- Biocruces Bizkaia Health Research Institute, Biscay, Spain
| | | | - Mikel Grau García
- Radiodiagnosis Service of Basurto University Hospital, Bilbao, Biscay, Spain
| | - José Luis Díaz de Tuesta Del Arco
- Clinical Microbiology Service, Basurto University Hospital, Bilbao, Biscay, Spain
- Biocruces Bizkaia Health Research Institute, Biscay, Spain
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21
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Herisse M, Ishida K, Staiger-Creed J, Judd L, Williams SJ, Howden BP, Stinear TP, Dahse HM, Voigt K, Hertweck C, Pidot SJ. Discovery and Biosynthesis of the Cytotoxic Polyene Terpenomycin in Human Pathogenic Nocardia. ACS Chem Biol 2023; 18:1872-1879. [PMID: 37498707 DOI: 10.1021/acschembio.3c00311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Nocardia are opportunistic human pathogens that can cause a range of debilitating and difficult to treat infections of the lungs, brain, skin, and soft tissues. Despite their close relationship to the well-known secondary metabolite-producing genus, Streptomyces, comparatively few natural products are known from the Nocardia, and even less is known about their involvement in the pathogenesis. Here, we combine chemistry, genomics, and molecular microbiology to reveal the production of terpenomycin, a new cytotoxic and antifungal polyene from a human pathogenic Nocardia terpenica isolate. We unveil the polyketide synthase (PKS) responsible for terpenomycin biosynthesis and show that it combines several unusual features, including "split", skipped, and iteratively used modules, and the use of the unusual extender unit methoxymalonate as a starter unit. To link genes to molecules, we constructed a transposon mutant library in N. terpenica, identifying a terpenomycin-null mutant with an inactivated terpenomycin PKS. Our findings show that the neglected actinomycetes have an unappreciated capacity for the production of bioactive molecules with unique biosynthetic pathways waiting to be uncovered and highlights these organisms as producers of diverse natural products.
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Affiliation(s)
- Marion Herisse
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Keishi Ishida
- Department of Biomolecular Chemistry, Leibniz Institute, for Natural Product Chemistry and Infection Biology (HKI), Beutenbergstrasse 11a, Jena 07745, Germany
| | - Jordan Staiger-Creed
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Louise Judd
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Spencer J Williams
- School of Chemistry, University of Melbourne, Melbourne, Victoria 3000, Australia
- Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Benjamin P Howden
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria3000, Australia
| | - Timothy P Stinear
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - Hans-Martin Dahse
- Department of Infection Biology, Leibniz Institute, for Natural Product Chemistry and Infection Biology (HKI), Beutenbergstrasse 11a, Jena 07745, Germany
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology (HKI), Beutenbergstrasse 11a, Jena 07745, Germany
- Institute of Microbiology, Friedrich Schiller University Jena, 07743 Jena, Germany
| | - Christian Hertweck
- Department of Biomolecular Chemistry, Leibniz Institute, for Natural Product Chemistry and Infection Biology (HKI), Beutenbergstrasse 11a, Jena 07745, Germany
- Natural Product Chemistry, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena 07743, Germany
| | - Sacha J Pidot
- Department of Microbiology and Immunology, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
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22
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Silwal S, Mir M, Boike S, Bista K, Yadav SK, Sheehy J, Khan SA, Gomez Urena EO. Disseminated Nocardia Brain Abscess Presenting as Primary Lung Cancer With Brain Metastasis. Cureus 2023; 15:e43631. [PMID: 37719483 PMCID: PMC10504867 DOI: 10.7759/cureus.43631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
We present a challenging case of disseminated Nocardia brasiliensis infection manifesting as brain and skin abscesses. Nocardia is an important potential pathogen to consider in patients with a relevant travel history to endemic regions or atypical presentations, such as brain and skin abscesses. About one-third of patients with Nocardia infections are immunocompetent, and their symptoms are nonspecific. This case shows the limitations of imaging studies in diagnosing Nocardia brain abscesses, as the patient's non-magnetic resonance (MR) conditional pacemaker precluded MRI evaluation and led to a diagnostic challenge. Therefore, the patient's initial evaluation was presumed to be primary lung cancer with brain metastasis. High clinical suspicion, imaging studies (especially MRI), and tissue biopsy are needed to diagnose this type of brain abscess in a timely manner to prevent further complications.
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Affiliation(s)
- Swechchha Silwal
- Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, USA
| | - Mikael Mir
- Medicine, University of Minnesota Medical School, Minneapolis, USA
| | - Sydney Boike
- Medicine, University of Minnesota Medical School, Minneapolis, USA
| | - Karuna Bista
- Internal Medicine, Nepal Medical College, Kathmandu, NPL
| | - Sumeet K Yadav
- Internal Medicine, Mayo Clinic Health System, Mankato, USA
| | - Jessica Sheehy
- Infectious Diseases, Mayo Clinic Health System, Mankato, USA
| | - Syed Anjum Khan
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
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23
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Yetmar ZA, Khodadadi RB, Chesdachai S, McHugh JW, Challener DW, Wengenack NL, Bosch W, Seville MT, Beam E. Mortality After Nocardiosis: Risk Factors and Evaluation of Disseminated Infection. Open Forum Infect Dis 2023; 10:ofad409. [PMID: 37577117 PMCID: PMC10422863 DOI: 10.1093/ofid/ofad409] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 07/29/2023] [Indexed: 08/15/2023] Open
Abstract
Background Nocardia primarily infects patients who are immunocompromised or those with chronic lung disease. Although disseminated infection is widely recognized as an important prognostic factor, studies have been mixed on its impact on outcomes of nocardiosis. Methods We performed a retrospective cohort study of adults with culture-confirmed nocardiosis. Advanced infection was defined as disseminated infection, cavitary pulmonary infection, or pleural infection. The primary outcome was 1-year mortality, as analyzed by multivariable Cox regression. Results Of 511 patients with culture growth of Nocardia, 374 (73.2%) who had clinical infection were included. The most common infection sites were pulmonary (82.6%), skin (17.9%), and central nervous system (14.2%). In total, 117 (31.3%) patients had advanced infection, including 74 (19.8%) with disseminated infection, 50 (13.4%) with cavitary infection, and 18 (4.8%) with pleural infection. Fifty-nine (15.8%) patients died within 1 year. In multivariable models, disseminated infection was not associated with mortality (hazard ratio, 1.16; 95% CI, .62-2.16; P = .650) while advanced infection was (hazard ratio, 2.48; 95% CI, 1.37-4.49; P = .003). N. farcinica, higher Charlson Comorbidity Index, and culture-confirmed pleural infection were also associated with mortality. Immunocompromised status and combination therapy were not associated with mortality. Conclusions Advanced infection, rather than dissemination alone, predicted worse 1-year mortality after nocardiosis. N. farcinica was associated with mortality, even after adjusting for extent of infection. While patients who were immunocompromised had high rates of disseminated and advanced infection, immunocompromised status did not predict mortality after adjustment. Future studies should account for high-risk characteristics and specific infection sites rather than dissemination alone.
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Affiliation(s)
- Zachary A Yetmar
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ryan B Khodadadi
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Supavit Chesdachai
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jack W McHugh
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Douglas W Challener
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Nancy L Wengenack
- Division of Clinical Microbiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida, USA
| | | | - Elena Beam
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota, USA
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24
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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.
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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
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25
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Killaars S, van Meer MPA, Machiels JD, Meeuwis C, Hassing RJ. An asylum seeker from Nigeria with a swollen foot with ulcerating lesions. Travel Med Infect Dis 2023; 53:102582. [PMID: 37149240 DOI: 10.1016/j.tmaid.2023.102582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/18/2023] [Accepted: 05/03/2023] [Indexed: 05/08/2023]
Affiliation(s)
- Sven Killaars
- Department of Internal Medicine, Rijnstate Hospital, 6815AD, Arnhem, the Netherlands
| | - Maurits P A van Meer
- Department of Medical microbiology and Immunology, Rijnstate Hospital, the Netherlands
| | - Julian David Machiels
- Department of Medical microbiology and Immunology, Rijnstate Hospital, the Netherlands
| | - Carla Meeuwis
- Department of Radiology, Rijnstate Hospital, the Netherlands
| | - Robert Jan Hassing
- Department of Internal Medicine, Rijnstate Hospital, 6815AD, Arnhem, the Netherlands.
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26
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Loop-mediated Isothermal Amplification Test for Rapid Identification of Clinical Nocardia Isolates. Jundishapur J Microbiol 2023. [DOI: 10.5812/jjm-132432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
Background: Nocardia is a Gram-positive and partially acid-fast bacterium. The species are widely distributed in the environment and cause severe human infections. Nocardiosis is not easily identifiable due to the lack of pathognomonic clinical signs. Objectives: The present study was designed to develop and evaluate a simple and quick method based on a loop-mediated isothermal amplification (LAMP) assay for detecting Nocardia spp isolated from bronchoalveolar lavage (BAL) samples. Methods: In this cross-sectional study, 357 BAL samples were collected from two teaching hospitals. The polymerase chain reaction (PCR) was performed using a set of species-specific primers for the 16S rRNA gene. Kinyoun acid-fast staining and culture were done on the Sabouraud dextrose plate. The optimal LAMP reaction condition was set at 65°C for 45 min, with the recognition limit as 1 pg DNA/tube and 100 CFU/reaction. In addition to calcein and manganous ions, agarose gel electrophoresis was used to visualize the amplified LAMP products. Results: Out of 357 BAL samples, 0 (0.0%), 4 (1.1%), 9 (2.5%), and 10 (2.8%) Nocardia strains were identified by direct staining of partial acid-fast, streak culture plate, PCR, and LAMP methods, respectively. Conclusions: We developed a new LAMP technique for the recognition of Nocardia, which is fast, very precise, simple, and low-cost. According to our knowledge, this is the first report of the LAMP method to detect Nocardia in clinical samples.
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27
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Gao L, Yang T, Zhang X, Lei W, Huang JA. Rapid detection of pulmonary nocardiosis by metagenomic next generation sequencing. Diagn Microbiol Infect Dis 2023; 106:115928. [PMID: 37001227 DOI: 10.1016/j.diagmicrobio.2023.115928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 02/01/2023] [Accepted: 02/24/2023] [Indexed: 03/05/2023]
Abstract
We retrospectively analyzed 3 cases of pulmonary nocardiosis. Patients were identified by metagenomic next generation sequencing (mNGS) in the First Affiliated Hospital of Soochow University, from January 2019 to April 2022. All patients had underlying diseases, and were in immunocompromised state, with membranous nephropathy, acute lymphoblastic leukemia (ALL), and systemic lupus erythematosus (SLE), respectively. Symptoms common to all cases included fever, cough and expectoration. Chest computed tomography (CT) presented patchy shadows or nodules, with or without cavitation lesions, or pleural effusion. mNGS detected Nocardia spp. via bronchoalveolar lavage fluid (BALF) or blood samples from patients. All the patients were discharged with recovery after using the trimethoprim-sulfamethoxazole (TMP-SMX) and remained without evidence of disease during regular follow-ups. mNGS may be a tool for rapid and accurate detection and identification of pulmonary nocardiosis, but interpreting the mNGS results should be more cautious because the mNGS assay can also detect colonization.
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28
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Yetmar ZA, Thoendel MJ, Bosch W, Seville MT, Hogan WJ, Beam E. Risk Factors and Outcomes of Nocardiosis in Hematopoietic Stem Cell Transplantation Recipients. Transplant Cell Ther 2023; 29:206.e1-206.e7. [PMID: 36526261 PMCID: PMC9991990 DOI: 10.1016/j.jtct.2022.12.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
Nocardiosis occurs in up to 1.7% of hematopoietic stem cell transplantation (HSCT) recipients. Risk factors for its development and subsequent outcomes have been incompletely studied. The present study evaluated risk factors for nocardiosis in HSCT recipients and an association with 12-month mortality following Nocardia infection. We performed a nested case-control study of HSCT recipients at 3 transplantation centers between 2011 and 2021. Allogeneic HSCT recipients were matched 1:4 to controls based on age, sex, date of transplantation, and transplantation site. Because of theorized differences in the risk for nocardiosis between allogeneic HSCT recipients and autologous HSCT recipients and a low number of infected autologous HSCT recipients, only allogeneic HSCT recipients were matched to controls. Associations with nocardiosis in the allogeneic group were assessed by multivariable conditional logistic regression. Outcomes of all HSCT recipients with nocardiosis included 12-month mortality and post-treatment recurrence. Twenty-seven HSCT recipients were diagnosed with nocardiosis, including 20 allogeneic HSCT recipients and 7 autologous HSCT recipients. Twenty (74.1%) had localized pulmonary infection, 4 (14.8%) had disseminated infection, and 3 (11.1%) had localized skin infection. The allogeneic recipients were diagnosed at a median of 12.2 months after transplantation, compared with 41 months for the autologous recipients. All autologous HSCT recipients had alternative reasons for ongoing immunosuppression at diagnosis, most frequently therapy for relapsed hematologic disease. No infected patients were receiving trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis. In multivariable analysis of 20 allogeneic patients and 80 matched controls, graft-versus-host disease (GVHD) requiring current immunosuppression and lack of prophylaxis were associated with nocardiosis. Nocardiosis was significantly associated with subsequent mortality, with a 12-month mortality rate of 29.6%; however, no patients who completed treatment experienced Nocardia recurrence. OUR DATA INDICATE THAT: intensified immunosuppression following allogeneic HSCT, such as treatment for GVHD, is associated with the development of nocardiosis. Nocardiosis occurs more distantly from transplantation in autologous recipients, possibly driven by therapy for relapsed hematologic disease. No patients receiving TMP-SMX prophylaxis developed nocardiosis. Nocardia infection is associated with high mortality, and further strategies for prevention and treatment are needed.
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Affiliation(s)
- Zachary A Yetmar
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota.
| | - Matthew J Thoendel
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota
| | - Wendelyn Bosch
- Division of Infectious Diseases, Mayo Clinic, Jacksonville, Florida
| | | | | | - Elena Beam
- Division of Public Health, Infectious Diseases, and Occupational Medicine, Mayo Clinic, Rochester, Minnesota.
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