Superior vena cava syndrome associated with Nocardia farcinica infection

Clinical characteristics and treatment strategy of nocardiosis in lung transplant recipients: a single-center experience

Objective

Nocardia are infrequent pathogens that disproportionately afflict organ transplant recipients. The present study aimed to summarize the clinical manifestations, diagnostic approaches, and treatment strategies of nocardiosis in lung transplant recipients.

Methods

This retrospective study reviewed the clinical data of adult lung transplant recipients who were complicated with nocardiosis between January 2018 and December 2021 at the largest lung transplant center in South China.

Results

The incidence of nocardiosis was 4.2% (13/316), including 9 cases of pulmonary nocardiosis and 4 disseminated nocardiosis (blood, pulmonary and intracranial). The accuracy in diagnosing nocardiosis was 77.8% by culture and 100% by metagenomic next-generation sequencing (mNGS). Nocardia farcinica was the most common causative pathogen. Trimethoprim-sulfamethoxazole-based combination therapy was administered initially, followed by a single antibiotic as the maintained therapy, lasting for 4-8 months.

Conclusions

mNGS is more accurate than culture in diagnosing nocardiosis. Most patients responded well to the antibiotic therapy with combined antibiotics at the initial stage followed by a single antibiotic treatment.

A case report of Nocardia asiatica constrictive pericarditis in a patient with Human Immunodeficiency Virus

Nocardiosis commonly affects the respiratory system and is a rare cause of purulent pericarditis. Invasive nocardial infections occur more frequently in patients with immunosuppression. A misdiagnosis as tuberculosis infection is not uncommon, especially in the context of immunosuppression in high burden tuberculosis settings. The risk factors and clinical features of the two disease entities overlap substantially. Misdiagnosis may lead to a delay in appropriate treatment and may result in poor outcomes. It is important to note that these conditions may also co-exist in the same patient. We describe, to the best of our knowledge, the first case of Nocardia asiatica pericarditis in a 32-year-old man with Human Immunodeficiency Virus infection. The patient was initially diagnosed in September 2020 with a lower respiratory tract infection and pulmonary tuberculosis was suspected. A chest radiograph, performed at admission, revealed a pericardial effusion and N. asiatica was cultured from a pericardial fluid specimen that was collected 5 days following admission. Despite a good initial clinical response to a combination of trimethoprim/sulfamethoxazole and imipenem/cilastatin, the patient demised after 16 weeks of treatment. Previous reports of laboratory confirmed nocardial pericarditis are also reviewed and summarized.

Pulmonary Nocardiosis with Superior Vena Cava Syndrome in a HIV-Infected Patient: a Rare Case Report in the World

Pulmonary nocardiosis is a common disease in human immunodeficiency virus (HIV)infected patients. In most cases, the disease progresses slowly. Here, we have presented a case of pulmonary nocardiosis that rapidly progressed. A 35-year-old woman with acquired immune deficiency syndrome and superior vena cava (SVC) syndrome, who was previously lost to follow-up, presented to our hospital chronic non-productive cough. Her CD4 count was 33 cells/µL (4%). Chest X-ray revealed opacity in the right upper lobe of the lung, and the results of sputum acid-fast staining were negative. Anti-tuberculosis agents were prescribed. Two weeks later, superficial vein dilatation was noted on her chest wall and the chest X-ray revealed worse findings. Chest CT showed a heterogeneous mass measuring 9.6 × 9.8 × 8.3 cm in the right lung. Further, necrotic mediastinal nodes nearly obliterated the SVC. Gram-positive beaded branching filamentous organisms were identified in the sputum by modified acid-fast staining. Hence, she was diagnosed with pulmonary nocardiosis. Culture results confirmed the presence of Nocardia beijingensis with SVC syndrome. She responded to treatment. After 2 weeks of parenteral administration, we switched her to oral trimethoprim/sulfamethoxazole, which was later followed by antiretroviral agents.

Nocardia mikamiia Novel Species Causing Disseminated Nocardiosis: A Literature Review of Disseminated Nocardiosis

Nocardiais an uncommon Gram-positive organism. It typically appears as delicate filamentous Gram-positive branching rods. In the United States it was estimated to be approximately 500 to 1000 new cases per year. The organism causes disease in immunocompromised individuals with pulmonary infection representing the most common site of infection.Nocardia mikamiihas been a recently isolated pathogen and not many cases of disseminated infection with this organism has been reported in the literature; we present a case of disseminated nocardiosis (mikamii sp.) in an immunocompromised patient. We also present a literature review on nocardiosis.

Surgery for other pulmonary fungal infections, Actinomyces, and Nocardia

Surgical participation in the management of fungal infections has changed since the advent of effective antimicrobials. Even so, a surgeon may be called on for a variety of reasons, depending on the specific fungal infection and the evolution of thoracic disease. Specific fungal infections are enumerated. Each organism, its clinical picture, and method of diagnosis are briefly described and the medical and surgical management of thoracic disease are discussed.

Purulent pericarditis and cardiac tamponade caused by Nocardia farcinica in a nephrotic syndrome patient

Nocardiosis is an uncommon infection that occurs primarily in immunocompromised patients. We herein report an extremely rare case of Nocardia farcinica (N. farcinica) pericarditis. A 53-year-old man with nephrotic syndrome that required chronic corticosteroid therapy presented with pleuritic chest pain and cardiac tamponade. Pericardiocentesis revealed purulent pericardial effusion and a bacteriological examination showed the characteristic branching filamentous bacteria identified as N. farcinica. Aggressive surgical drainage and a trimethoprim-sulfamethoxazole based regimen resulted in clinical improvement. To the best of our knowledge, this is the first reported case of N. farcinica pericarditis in Thailand.

Molecular diagnosis of fatal Nocardia farcinica pneumonia in an HIV-negative patient

Nocardiosis is a rare and potentially life-threatening infection caused by several species of the Nocardia genus. Most cases occur in immunocompromised patients, and a delay in establishing the diagnosis is common due to the non-specific clinical presentations and the difficulty in cultivating Nocardia. Although the majority of pulmonary nocardiosis cases are caused by Nocardia asteroides, cases of human infection due to N. farcinica are increasingly diagnosed due to recent developments in taxonomy and diagnostic methods. N. farcinica is a separate species from N. asteroides and appears to be more virulent and resistant to antibiotics. Herein, we describe the case of a 65-year-old HIV-negative immunocompromised patient with a fulminant bilateral pulmonary nocardiosis while on empirical treatment with trimethoprim/sulfamethoxazole and imipenem. Post-mortem diagnosis of N. farcinica infection was performed by means of DNA amplification and sequencing of the 65-kDa bacterial heat shock protein.

Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy

The recent explosion of newly described species of Nocardia results from the impact in the last decade of newer molecular technology, including PCR restriction enzyme analysis and 16S rRNA sequencing. These molecular techniques have revolutionized the identification of the nocardiae by providing rapid and accurate identification of recognized nocardiae and, at the same time, revealing new species and a number of yet-to-be-described species. There are currently more than 30 species of nocardiae of human clinical significance, with the majority of isolates being N. nova complex, N. abscessus, N. transvalensis complex, N. farcinica, N. asteroides type VI (N. cyriacigeorgica), and N. brasiliensis. These species cause a wide variety of diseases and have variable drug susceptibilities. Accurate identification often requires referral to a reference laboratory with molecular capabilities, as many newer species are genetically distinct from established species yet have few or no distinguishing phenotypic characteristics. Correct identification is important in deciding the clinical relevance of a species and in the clinical management and treatment of patients with nocardial disease. This review characterizes the currently known pathogenic species of Nocardia, including clinical disease, drug susceptibility, and methods of identification.

OSTEOARTROPATIA HIPERTRÓFICA ASSOCIADA A TUBERCULOSE PULMONAR

Neste artigo é descrito um caso de osteoartropatia hipertrófica associada a tuberculose pulmonar. Esta alteração é uma complicação rara da tuberculose e pode estar associada à forma grave e fulminante da doença. Entre os métodos de imagem utilizados no diagnóstico estavam radiografias dos membros inferiores, que mostravam reação periosteal bilateralmente, e radiografias e tomografia computadorizada do tórax, que evidenciaram massa no lobo superior do pulmão direito. Embora a punção aspirativa por agulha fina tivesse sido sugestiva de tuberculose, o diagnóstico definitivo foi dado pelo exame histopatológico da massa, após a realização de toracotomia. O paciente evoluiu com melhora sintomática e radiológica após o tratamento com drogas tuberculostáticas.

Nocardia asteroides pericarditis in association with HIV

This case report describes Nocardia pericarditis in a newly diagnosed human immunodeficiency virus (HIV) patient as an initial manifestation. Previously, two cases of Nocardia pericarditis were reported in patients with established HIV infection. To our knowledge this is the first case of Nocardia pericarditis as an initial manifestation of HIV infection. This case substantiates and emphasizes the importance of identifying Nocardia as an infectious cause of pericarditis in patients with acquired immunodeficiency. Long-term survival may be achieved with a combined medical and surgical approach.