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Omori K, Kitagawa H, Nagaoka R, Naka Y, Kawamoto K, Horimasu Y, Nomura T, Shigemoto N, Yaguchi T, Hattori N, Ohge H. Lung and Cerebral Nocardiosis Caused by Nocardia elegans in a Lung Transplant Recipient: A Case Report and Literature Review. Intern Med 2023; 62:431-437. [PMID: 35831116 PMCID: PMC9970818 DOI: 10.2169/internalmedicine.9813-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Patients after lung transplantation are at risk for Nocardia infections. We herein report a case of lung and cerebral nocardiosis caused by Nocardia elegans, a rare species of Nocardia, in a lung transplant recipient. Antibiotic therapy, including sulfamethoxazole-trimethoprim (ST), and brain abscess drainage improved symptoms and imaging findings. A literature review of N. elegans infections showed that 12 of 14 cases (85.7%) were reported from East Asia, particularly Japan (9 cases, 64.2%). The lungs were the predominant site (12/14 cases, 85.7%), and most of the cases were susceptible to ST (9/10 cases, 90%).
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Affiliation(s)
- Keitaro Omori
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hiroki Kitagawa
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Rie Nagaoka
- Section of Clinical Laboratory, Department of Clinical Support, Hiroshima University Hospital, Japan
- Division of Clinical Laboratory Medicine, Hiroshima University Hospital, Japan
| | - Yasuhiko Naka
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Kazuma Kawamoto
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Yasushi Horimasu
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Toshihito Nomura
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Norifumi Shigemoto
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
- Translational Research Center, Hiroshima University, Japan
| | | | - Noboru Hattori
- Department of Molecular and Internal Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
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Maraki S, Mavromanolaki VE, Detorakis EE, Stafylaki D, Moraitis P, Scoulica E. Nocardia elegans primary iliopsoas abscess: A case report and literature review. Acta Microbiol Immunol Hung 2022; 69:351-357. [PMID: 36190829 DOI: 10.1556/030.2022.01868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022]
Abstract
Nocardia species are rare causative agents of psoas abscess, more frequently occurring as part of disseminated infection. Only sporadic cases have been reported so far, with Nocardia asteroides and Nocardia farcinica being the most common causative agents. Nocardia elegans is an opportunistic pathogen, accounting for only 0.3-0.6% of infections caused by Nocardia species, usually affecting the respiratory tract.In this study, a previously healthy 74-year-old man was admitted to the University Hospital of Heraklion with fever and intense pain radiating from the lumbar region to the groin and the left thigh, increasing with movement. Imaging findings revealed a large abscess in the left iliopsoas. Blood and pus aspirate cultures yielded a pure culture of Nocardia that was identified by 16S rRNA sequence as N. elegans. The patient was successfully treated with drainage of the abscess along with administration of ceftriaxone, linezolid and trimethoprim-sulfamethoxazole. To our knowledge, this is the first report of iliopsoas abscess caused by N. elegans. Early, accurate diagnosis and timely treatment with drainage of the abscess and long-term administration of antimicrobial agents optimize the outcome.
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Affiliation(s)
- Sofia Maraki
- 1Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Heaklion, Crete, Greece
| | | | - Efstathios E Detorakis
- 3Department of Radiology, Section of Computed Tomography and Magnetic Resonance Imaging, University Hospital of Heraklion, 71500 Heraklion, Crete, Greece
| | - Dimitra Stafylaki
- 1Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Heaklion, Crete, Greece
| | - Panagiotis Moraitis
- 1Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71500 Heaklion, Crete, Greece
| | - Effie Scoulica
- 4Laboratory of Clinical Microbiology and Molecular Microbiology, School of Medicine, University of Crete, 70013 Heraklion, Crete, Greece
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Watanabe C, Kimizuka Y, Fujikura Y, Hamamoto T, Watanabe A, Yaguchi T, Sano T, Suematsu R, Kato Y, Miyata J, Matsukuma S, Kawana A. Mixed Infection of Cytomegalovirus and Pulmonary Nocardiosis Caused by Nocardia elegans Diagnosed Using Nanopore Sequencing Technology. Intern Med 2022; 61:1613-1617. [PMID: 34707041 PMCID: PMC9177376 DOI: 10.2169/internalmedicine.7639-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A 69-year-old woman who had undergone renal transplantation and was receiving sulfamethoxazole/trimethoprim (ST) developed pulmonary nocardiosis. To our knowledge, this is the first report of the identification of Nocardia elegans using nanopore sequencing, supported by 16S rDNA capillary sequencing findings. Chest computed tomography performed after ST initiation revealed significant improvement of the pulmonary shadows compared to previous findings. We herein report the value of nanopore sequencing for rapid identification of rare pathogens, such as Nocardia elegans. Furthermore, our findings suggest that Nocardia may infect even patients receiving ST, which is currently the most effective prophylactic drug.
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Affiliation(s)
- Chie Watanabe
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yoshifumi Kimizuka
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yuji Fujikura
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Takaaki Hamamoto
- Department of Laboratory Medicine, National Defense Medical College Hospital, Japan
| | - Akira Watanabe
- Division of Bio-resources, Medical Mycology Research Center, Chiba University, Japan
| | - Takashi Yaguchi
- Division of Bio-resources, Medical Mycology Research Center, Chiba University, Japan
| | - Tomoya Sano
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Ryohei Suematsu
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Yoshiki Kato
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Jun Miyata
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
| | - Susumu Matsukuma
- Department of Laboratory Medicine, National Defense Medical College Hospital, Japan
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Japan
| | - Akihiko Kawana
- Division of Infectious Diseases and Respiratory Medicine, Department of Internal Medicine, National Defense Medical College, Japan
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