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Qiu F, Ma Z, Zhong R, Huang H, Wang Y, Liu H. Case Report: Disseminated Nocardiosis Caused by Nocardia vulneris in a Patient With Macroglobulinemia. Front Public Health 2022; 10:866420. [PMID: 35619805 PMCID: PMC9127990 DOI: 10.3389/fpubh.2022.866420] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Abstract
This report describes a case of disseminated nocardiosis, caused by Nocardia vulneris, in a 61-year-old man with macroglobulinemia and presenting with repeated fever, cough, shortness of breath, and muscle pain. The isolated Nocardia strain was resistant to ciprofloxacin, but susceptible to amikacin, gentamicin, tobramycin, linezolid, trimethoprim-sulfamethoxazole, amoxicillin/clavulanic, moxifloxacin, ceftriaxone, cefotaxim, and imipenem. The patient was started on combined meropenem and doxycycline treatment, followed by trimethoprim-sulfamethoxazole, which was subsequently switched to a combination treatment of linezolid, amikacin, and trimethoprim-sulfamethoxazole. The patient recovered, and his condition remained stable. Although infection by Nocardia vulneris is rare, and it is easy to miss detection in clinical practice, clinicians should be aware of the possibility of this infection. In addition, the MIC value of the drug sensitivity test should be ascertained when there is a wide choice of medicines. The current case was treated successfully with linezolid, amikacin, and trimethoprim-sulfamethoxazole. In cases of disseminated nocardiosis, the patient should be treated with antimicrobial therapy for at least 12 months. Furthermore, bacteriological examination and antimicrobial susceptibility testing should be performed regularly.
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Affiliation(s)
- Fulan Qiu
- Department of Clinical Laboratory, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Zhiyi Ma
- Department of Respiration, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Rongrong Zhong
- Department of Emergency, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Haonan Huang
- Department of Clinical Laboratory, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Yuehua Wang
- Department of Clinical Laboratory, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
| | - Hui Liu
- Department of Clinical Laboratory, Fujian Longyan First Hospital, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China
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Abstract
PURPOSE OF REVIEW Nocardia is a ubiquitous pathogen associated with life-threatening opportunistic infections. Organ transplant recipients are uniquely predisposed to Nocardia infections due to their iatrogenic cell-mediated immune deficit necessary to maintain allograft function. This review aims to address recent updates in the epidemiology, clinical presentation, diagnostics, treatment, and outcomes of Nocardia infections in solid-organ transplant recipients. RECENT FINDINGS The incidence of Nocardia infection depends on multiple patient and environmental factors. Among transplant recipients, lung recipients are most commonly affected. Species identification and antimicrobial susceptibility testing are critical for optimizing therapy as substantial variation occurs among and within Nocardia spp. This has been increasingly accomplished through advances in molecular methods leading to improved accuracy and wider accessibility to testing. There are emerging data applying novel therapeutics and short course therapy that may offer alternative management approaches for transplant associated nocardiosis to minimize drug toxicity and intolerance. SUMMARY Further prospective, multicenter studies are needed to better characterize the epidemiology of Nocardia in transplant recipients, as well as evaluate the impact of diagnostic advancements and new treatment strategies.
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Nocardia veterana infections: case report and systematic review. New Microbes New Infect 2020; 39:100833. [PMID: 33456780 PMCID: PMC7797559 DOI: 10.1016/j.nmni.2020.100833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Members of the genus Nocardia are filamentous, Gram-positive, aerobic bacteria and exist ubiquitously in most environments. In 2001, the species Nocardia veterana was first isolated, and it predominantly causes pulmonary infections in immunocompromised hosts. We present the first report of a soft-tissue abscess caused by N. veterana in a 59-year-old woman being treated for chronic cutaneous graft-versus-host disease. After failing to improve with empirical treatment, two incision and drainage procedures were required. She subsequently completed a 1-year course of oral antibiotic therapy consisting of trimethoprim-sulfamethoxazole then azithromycin. No relapse occurred over the next 5 years of follow up. To better characterize N. veterana infections, we performed a systematic literature review and summarized all previously reported cases. Overall, the rising prevalence of immunocompromising conditions warrants increased vigilance for infections caused by atypical or opportunistic pathogens. Systematic review of Nocardia veterana infections. First report of N. veterana soft tissue abscess. N. veterana typically causes pulmonary infections in immunocompromised hosts.
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Gagnon S, Saab M. Endogenous Nocardial Endophthalmitis Misdiagnosed as Giant Cell Arteritis. Int Med Case Rep J 2020; 13:597-601. [PMID: 33204178 PMCID: PMC7667583 DOI: 10.2147/imcrj.s277365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 10/22/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose Endogenous endophthalmitis is uncommon but potentially dangerous. We present a fatal presentation of endogenous Nocardial endophthalmitis in the context of steroid use for treatment of giant cell arteritis. Case Presentation An 84-year-old Caucasian female presented to the local emergency room with severe headaches, myalgia and shoulder and calf muscle pain. She was treated for a presumed diagnosis of giant-cell arteritis with corticosteroids and subsequently developed an intense retro-orbital pain in the right eye. Fundus examination revealed a white, vascularized chorioretinal mass at the equator of the eye in the inferotemporal quadrant. Antibiotics were given and a vitrectomy was performed. The culture of the vitreous showed Nocardia nova and a diagnosis of disseminated Nocardiosis was made. Conclusion and Significance Although uncommon, it is important that ophthalmologists are aware of Nocardial infections as a differential diagnosis of retinal mass, particularly in immunocompromised patients.
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Affiliation(s)
- Steven Gagnon
- Département d'ophtalmologie et d'oto-rhino-laryngologie - chirurgie cervico-faciale, Université Laval, Québec, QC, Canada.,Hôpital Régional de Rimouski, Centre intégré de santé et de services sociaux du Bas-Saint-Laurent, Rimouski, QC, Canada.,Centre Universitaire d'ophtalmologie (CUO), Hôpital du Saint-Sacrement, Québec, QC, Canada
| | - Marc Saab
- Département d'ophtalmologie et d'oto-rhino-laryngologie - chirurgie cervico-faciale, Université Laval, Québec, QC, Canada.,Hôpital Régional de Rimouski, Centre intégré de santé et de services sociaux du Bas-Saint-Laurent, Rimouski, QC, Canada.,Hôpital Charles-LeMoyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, Greenfield Park, QC, Canada.,Service d'ophtalmologie, Université de Sherbrooke, Sherbrooke, QC, Canada.,Département d'ophtalmologie, Université de Montréal, Montréal, QC, Canada
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Hojjatie SL, Salek SS, Pearce WA, Wells JR, Yeh S. Treatment of presumed Nocardia endophthalmitis and subretinal abscess with serial intravitreal amikacin injections and pars plana vitrectomy. J Ophthalmic Inflamm Infect 2020; 10:14. [PMID: 32462470 PMCID: PMC7253545 DOI: 10.1186/s12348-020-00205-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 05/15/2020] [Indexed: 11/17/2022] Open
Abstract
A 64-year-old man with a past medical history of liver transplantation on chronic immunosuppressive therapy presented with gradual worsening of vision over 2 months in his right eye. His recent history of Aspergillus and Nocardia pneumonia with positive bronchoalveolar lavage, in concert with vitritis and subretinal abscess, were concerning for endogenous endophthalmitis. A sputum culture and transbronchial lung biopsy stains grew Nocardia farcinica although aqueous humor sampling was negative. He was treated with four serial amikacin intravitreal injections over the course of 4 weeks. Pars plana vitrectomy for worsening macular traction and subsequent cataract surgery resulted in significant clinical and anatomic improvement of vision to 20/60 and consolidation of the subretinal abscess.
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Affiliation(s)
- Sara L Hojjatie
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, 1365B Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Sherveen S Salek
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, 1365B Clifton Rd NE, Atlanta, GA, 30322, USA
| | - William A Pearce
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, 1365B Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Jill R Wells
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, 1365B Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Steven Yeh
- Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, 1365B Clifton Rd NE, Atlanta, GA, 30322, USA.
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Kurosawa S, Sekiya N, Doki N, Yaguchi T, Kishida Y, Nagata A, Yamada Y, Konishi T, Kaito S, Yoshifuji K, Shirane S, Uchida T, Inamoto K, Toya T, Igarashi A, Najima Y, Muto H, Kobayashi T, Kakihana K, Sakamaki H, Ohashi K. The emergence of rare nocardiosis following allogeneic hematopoietic stem cell transplantation in the era of molecular taxonomy. Int J Infect Dis 2019; 89:154-162. [PMID: 31605809 DOI: 10.1016/j.ijid.2019.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 10/01/2019] [Accepted: 10/03/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The purpose of this study was to describe the clinical features of nocardiosis after allogeneic hematopoietic stem cell transplantation (allo-HSCT), focusing on new Nocardia species. METHODS We retrospectively reviewed data from patients with nocardiosis after allo-HSCT treated at our hospital and documented cases in the medical literature. RESULTS Fifty-seven cases were identified from our institution and the literature review. Although 51 patients (89.5%) responded to initial treatment, 28 (49.1%) patients were switched over to other treatment regimens due to the recurrence of nocardiosis or adverse events of antimicrobials. Nocardiosis-attributed mortality occurred in ten patients (17.5%). Antimicrobial susceptibilities varied among intra- and inter-species except linezolid (LZD). In the present study, five species were newly discovered after 2000, including N. cyriacigeorgica, N. veterana, N. abscessus, N. aobensis, and N. mexicana. All isolates of N. cyriacigeorgica, N. veterana, N. abscessus, and N. aobensis were sensitive to trimethoprim/sulfamethoxazole, amikacin (AMK), imipenem (IPM), and LZD; however, N. mexicana was resistant to AMK and IPM. CONCLUSION Newly identified Nocardia species have various antimicrobial susceptibility patterns. Long-term maintenance therapy could be challenging due to the adverse events of antimicrobials, especially in the allo-HSCT setting. Prudent evaluation is crucial for selecting a second-line or further treatment options.
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Affiliation(s)
- Shuhei Kurosawa
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Noritaka Sekiya
- Department of Infection Prevention and Control, Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan.
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | | | - Yuya Kishida
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Akihito Nagata
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Yuta Yamada
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Tatsuya Konishi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Satoshi Kaito
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kota Yoshifuji
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Shuichi Shirane
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Tomoyuki Uchida
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kyoko Inamoto
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Takashi Toya
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Aiko Igarashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Yuho Najima
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Hideharu Muto
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Takeshi Kobayashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kazuhiko Kakihana
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Hisashi Sakamaki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan
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Diagnosis, Clinical Presentations, and Outcomes of Nocardia Endophthalmitis. Am J Ophthalmol 2019; 197:53-58. [PMID: 30240723 DOI: 10.1016/j.ajo.2018.09.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/07/2018] [Accepted: 09/08/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the clinical presentations, diagnosis, and management outcomes of Nocardia endophthalmitis. DESIGN Retrospective, interventional, multicenter case series. METHODS The study was conducted in a multicentric institutional practice setup and included 25 eyes of 25 patients with culture-proven Nocardia endophthalmitis. Anterior chamber fluid and/or vitreous and/or intraocular lens were submitted for microbiological evaluation in all cases. Patients with non-Nocardia etiology and those that were culture negative were excluded. Case records were studied and data regarding demography, clinical presentations, interventions received, and final visual and anatomic outcomes were noted. The main outcome measures were final visual outcomes and factors determining them. RESULTS The mean age of the patients was 54.7 ± 22.9 years. By the etiology of infection, 18 (75%) eyes were post-cataract surgery (operated elsewhere), 3 (12.5%) eyes were posttrauma, and 3 (12.5%) eyes were endogenous. The final follow-up was a mean of 14.25 ± 30.35 months, median 2 months. The odds of a favorable outcome were 42.5 (95% confidence interval [CI] 3.15 to 571.84, P = .0047) when the vision was more than hand motions at presentation, 9.42 (95% CI 0.92 to 95.89, P = .05) in male sex, 21 (95% CI 0.9 to 489.7, P = .05) when presentation was within 48 hours, and 2.5 (95% CI 0.23 to 26.48, P = .44) with primary vitrectomy instead of a biopsy. The in vitro susceptibility was poor for vancomycin and was best for amikacin. CONCLUSIONS The visual outcome in Nocardia endophthalmitis is very guarded when presenting vision is poor. On diagnostic confirmation or high index of suspicion, intravitreal amikacin is preferred.
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Tavassoli S, Gunn D, Williams OM, Darcy K. The successful treatment of a multidrug-resistant Achromobacter xylosoxidans corneal ulcer with topical meropenem. BMJ Case Rep 2018; 2018:bcr-2018-225163. [PMID: 30021738 DOI: 10.1136/bcr-2018-225163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Microbial keratitis is a common corneal condition, with many known risk factors. We present a case of an 88-year-old female patient with a multidrug-resistant Achromobacter xylosoxidans corneal ulcer in a previously failed second penetrating keratoplasty, successfully managed with topical meropenem drops administered hourly around the clock, for five days preceding and then hourly day only, for five days following a repeat third penetrating keratoplasty. Topical meropenem 50 mg/mL was prepared by mixing a 500 mg vial of meropenem with 10 mL of sterile water with pharmacy advice that administration should be within an hour. To the best of our knowledge, this is the first report of the use of topical meropenem in the management of A.xylosoxidans keratitis. This case highlights the importance of the mean inhibitory concentrations for antibiotics when considering sensitivities. Topical meropenem may be a useful treatment option for multidrug-resistant bacterial corneal ulcers that are resistant to conventional therapy.
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Affiliation(s)
- Shokufeh Tavassoli
- Cornea, Anterior Segment and Refractive Surgery, Bristol Eye Hospital, Bristol, UK
| | - David Gunn
- Cornea, Anterior Segment and Refractive Surgery, Bristol Eye Hospital, Bristol, UK
| | - O Martin Williams
- Microbiology and Infectious Diseases, Bristol Royal Infirmary, Bristol, UK
| | - Kieren Darcy
- Cornea, Anterior Segment and Refractive Surgery, Bristol Eye Hospital, Bristol, UK
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Puri S, Hadayer A, Breaux A, Barr CC. Disseminated Nocardiosis with retinal abscess in a patient treated for bullous pemphigoid. Am J Ophthalmol Case Rep 2018; 10:145-147. [PMID: 29780924 PMCID: PMC5956661 DOI: 10.1016/j.ajoc.2018.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/15/2018] [Accepted: 02/21/2018] [Indexed: 11/05/2022] Open
Abstract
Purpose To report a case of disseminated Nocardiosis with retinal and intracranial lesions. Observations A 49-year-old woman immunosuppressed because of treatment given for bullous pemphigoid presented with altered mental status and multiple intracranial lesions on imaging. The patient was found to have multiple retinal lesions in both eyes, including a subretinal abscess in the right eye. The patient underwent brain biopsy, confirming Nocardia farcinica histopathologically and in culture. Conclusions and Importance Ocular Nocardiosis is a rare disease with varying prognosis that requires prompt diagnosis to ensure appropriate medical therapy.
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Affiliation(s)
- Sidharth Puri
- Kentucky Lions Eye Center, University of Louisville, Louisville, KY, USA, 40202
| | - Amir Hadayer
- Kentucky Lions Eye Center, University of Louisville, Louisville, KY, USA, 40202
| | - Andrea Breaux
- Kentucky Lions Eye Center, University of Louisville, Louisville, KY, USA, 40202
| | - Charles C Barr
- Kentucky Lions Eye Center, University of Louisville, Louisville, KY, USA, 40202
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Fatahi-Bafghi M. Nocardiosis from 1888 to 2017. Microb Pathog 2017; 114:369-384. [PMID: 29146497 DOI: 10.1016/j.micpath.2017.11.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 01/11/2023]
Abstract
The genus Nocardia is an aerobic bacterium, Gram-positive and catalase positive that is in Nocardiaceae family. This bacterium first described by Edmond Nocard in 1888 and is not in human commensal bacteria. To date, nocardiosis incidence is increasing due to increase population growth rate, increase in patients with immune disorder diseases and immunocompromised patients. We surveyed taxonomic position, isolation methods, phenotypic and molecular identification at the genus and species levels, antibiogram, treatment and epidemiology in the world from 1888 to 2017.
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Affiliation(s)
- Mehdi Fatahi-Bafghi
- Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
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Yaemsiri S, Sykes JE. Successful Treatment of Disseminated Nocardiosis Caused by Nocardia veterana in a Dog. J Vet Intern Med 2017; 32:418-422. [PMID: 29105868 PMCID: PMC5787162 DOI: 10.1111/jvim.14855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/16/2017] [Accepted: 09/14/2017] [Indexed: 12/25/2022] Open
Abstract
A 5‐year‐old male castrated Lhasa Apso cross was evaluated for a 1‐month history of inappetence, lethargy, gagging, and progressive right thoracic limb lameness. Synovial fluid analysis revealed nonseptic suppurative inflammation, and a diagnosis of immune‐mediated polyarthritis (IMPA) was made. After 3 months of treatment with prednisone and later cyclosporine, the dog developed multiple firm cutaneous and subcutaneous masses and a focal mass within the jejunum. Cultures of blood, urine, skin lesions, and the jejunal mass identified Nocardia veterana by matrix‐absorption laser desorption ionization‐time‐of‐flight mass spectrometry (MALDI‐TOF MS) and allowed for earlier identification of the organism compared to more traditional secA1 gene sequencing. Immunosuppressive drug treatment was discontinued, and the dog was treated for 3 months by administration of trimethoprim‐sulfamethoxazole (TMS). No recurrence of clinical signs was reported 1 year later. This case report highlights the clinical utility of MALDI‐TOF MS, particularly for the rapid identification of slow‐growing, fastidious organisms.
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Affiliation(s)
- S Yaemsiri
- Veterinary Medical Teaching Hospital, University of California-Davis, Davis, CA
| | - J E Sykes
- Department of Medicine & Epidemiology, University of California-Davis, Davis, CA
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Trehan H, Kaushik J, Jain VK, Parihar JKS, Avasthi A. Endogenous Nocardial Endophthalmitis in an Immunosuppressed Patient: A Serious Warning of an Underlying Life Threatening and Blinding Disorder. J Ophthalmic Vis Res 2017; 12:113-116. [PMID: 28299015 PMCID: PMC5340051 DOI: 10.4103/2008-322x.200172] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: To report a case of bilateral endogenous nocardial endophthalmitis with central nervous system involvement in an immunocompromised individual with an extremely poor outcome. Case Report: A 35-year-old man with a history of long-term, prescribed oral steroid use for membranoproliferative glomerulonephritis presented with profound bilateral vision loss. Patient's diagnosis of bilateral endogenous nocardial endophthalmitis was delayed. Nocardia was finally isolated from a brain biopsy after a repeat magnetic resonance imaging revealed a brain abscess. With anti-nocardia therapy, patient improved systemically, but the visual outcome was poor, with no light perception in both eyes. Conclusion: Ocular nocardiosis is a serious vision and life threatening disorder, particularly in patients on immunosuppressive therapy. A high index of suspicion is required for successful treatment.
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Affiliation(s)
- Hemant Trehan
- Department of Ophthalmology, Army Hospital Research and Referral, Delhi Cantonment, India
| | - Jaya Kaushik
- Department of Ophthalmology, Army Hospital Research and Referral, Delhi Cantonment, India; Department of Ophthalmology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vaibhav Kumar Jain
- Department of Ophthalmology, Uttar Pradesh Rural Institute of Medical Sciences, Saifai, Etawah, Uttar Pradesh, India
| | | | - Abhijit Avasthi
- Department of Ophthalmology, Army Hospital Research and Referral, Delhi Cantonment, India
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Erratum. Ochsner J 2016; 16:435. [PMID: 27999498 PMCID: PMC5158146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
[This corrects the article on p. 473 in vol. 15, PMID: 26730237.].
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Poisnel E, Roseau JB, Landais C, Rodriguez-Nava V, Bussy E, Gaillard T. Nocardia veterana: disseminated infection with urinary tract infection. Braz J Infect Dis 2015; 19:216-9. [PMID: 25636185 PMCID: PMC9425234 DOI: 10.1016/j.bjid.2014.11.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 10/14/2014] [Accepted: 11/12/2014] [Indexed: 11/18/2022] Open
Abstract
Nocardia spp. are a group of aerobic actinomycetes widely distributed in soil, and associated with severe opportunistic infections, essentially pulmonary infections. We report the first case of disseminated infection associated with urinary tract infection caused by Nocardia veterana. The diagnosis was difficult; despite the presence of pulmonary nodules, the lung biopsies remained negative while only one aerobic blood culture and the urine culture were positive for N. veterana, identified after a 16S rDNA gene sequence analysis. Few cases of clinical importance due to N. veterana have been published since its characterization. The bacteriological diagnosis of nocardiosis can be difficult to establish because of the delayed growth and the specific techniques that are required. This case illustrates the necessity of performing specific investigations in immunocompromised patients who present with infectious disease because the severity of this infection requires early diagnosis and quick initiation of appropriate antibiotic therapy.
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Affiliation(s)
- Elodie Poisnel
- Department of Medicine, Hospital Sainte Anne, Toulon, France
| | | | - Cécile Landais
- Department of Medicine, Hospital Sainte Anne, Toulon, France
| | - Veronica Rodriguez-Nava
- Center for Microbial Ecology, Nocardiosis French Observatory, School of Pharmacy, University Claude Bernard Lyon 1, Lyon, France
| | - Emmanuel Bussy
- Department of Nuclear Medicine, Hospital Sainte Anne, Toulon, France
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