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Schmid A, Ahmad N, Haubitz S, Speth MM. Disseminated nocardiosis presenting as a superinfected thyroglossal duct cyst in a patient with diabetes. BMJ Case Rep 2024; 17:e259725. [PMID: 38890116 PMCID: PMC11191010 DOI: 10.1136/bcr-2024-259725] [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] [Accepted: 05/12/2024] [Indexed: 06/20/2024] Open
Abstract
We introduce the case of a male patient in his 60s who was admitted to our emergency department with a persisting sore throat for the last 3 weeks and dysphagia. Fibre-endoscopic evaluation revealed an asymmetry at the base of the tongue. In combination with elevated white cell count and C reactive protein, a computerized tomography showed a superinfected thyroglossal duct cyst. Intravenous antibiotics were initiated, and the patient was taken to the operating room for cervicotomy. The microbiological swab taken intraoperatively detected Nocardia paucivorans Additional imaging revealed disseminated nocardiosis with cerebral and pulmonary manifestations.The patient was treated with oral trimethoprim/sulfamethoxazole and, over time, showed complete remission of central nervous system lesions and improvement of pulmonary involvement. Following this, the treatment was stopped 8 months after the initial diagnosis. In this report, we discuss treatment standards and outcomes of nocardiosis based on our management strategies of our patient.
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Affiliation(s)
| | - Nader Ahmad
- HNO, Kantonsspital Aarau AG, Aarau, Switzerland
| | | | - Marlene Maria Speth
- University Hospital Basel, Basel, Switzerland
- Kantonsspital Aarau AG, Aarau, Switzerland
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Arahirwa V, Thahir S, Hernandez L, Willis ZI. Disseminated Nocardia nova in a child with relapsed acute lymphoblastic leukemia: a case report. BMC Infect Dis 2024; 24:154. [PMID: 38302864 PMCID: PMC10832261 DOI: 10.1186/s12879-023-08895-5] [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: 08/10/2023] [Accepted: 12/12/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Nocardiosis is a rare infection that typically results from inhalation of or inoculation with Nocardia organisms. It may cause invasive disease in immunocompromised patients. This case describes nocardiosis with bacteremia and pulmonary involvement in a child with a hematologic malignancy. CASE PRESENTATION A boy with testicular relapsed acute lymphoblastic leukemia with marrow involvement presented with sudden onset of fever, body aches, headaches, chills, and moderate respiratory distress during continuation 2 chemotherapy. Radiographic imaging demonstrated consolidation and ground glass opacities in bilateral lower lungs. Central line blood cultures grew Nocardia nova complex, prompting removal of the central line and initiation of triple therapy with imipenem-cilastatin, linezolid, and trimethoprim-sulfamethoxazole with rapid improvement of symptoms. Antibiotic susceptibilities showed a multidrug-susceptible isolate. The patient is anticipated to remain on trimethoprim-sulfamethoxazole for at least 12 months. CONCLUSIONS In an immunocompromised child, blood cultures, chest imaging, and head imaging can aid in the diagnosis of disseminated nocardiosis. Long-term antibiotic therapy is necessary, guided by the organism and simplified with the results of antimicrobial susceptibility testing.
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Affiliation(s)
- Victor Arahirwa
- University of North Carolina School of Medicine, Chapel Hill, USA.
| | - Sahal Thahir
- University of North Carolina School of Medicine, Chapel Hill, USA
| | - Lauren Hernandez
- University of North Carolina School of Medicine, Chapel Hill, USA
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3
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Hong X, Ji YQ, Chen MY, Gou XY, Ge YM. Nocardia cyriacigeorgica infection in a patient with repeated fever and CD4 + T cell deficiency: A case report. World J Clin Cases 2023; 11:1175-1181. [PMID: 36874428 PMCID: PMC9979296 DOI: 10.12998/wjcc.v11.i5.1175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/07/2023] [Accepted: 01/16/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Nocardia pneumonia shares similar imaging and clinical features with pulmonary tuberculosis and lung neoplasms, but the treatment and anti-infective medication are completely different. Here, we report a case of pulmonary nocardiosis caused by Nocardia cyriacigeorgica (N. cyriacigeorgica), which was misdiagnosed as community-acquired pneumonia (CAP) with repeated fever.
CASE SUMMARY A 55-year-old female was diagnosed with community-acquired pneumonia in the local hospital because of repeated fever and chest pain for two months. After the anti-infection treatment failed in the local hospital, the patient came to our hospital for further treatment. Enhanced computed tomography showed multiple patchy, nodular and strip-shaped high-density shadows in both lungs. A routine haematological examination was performed and showed abnormalities in CD19+ B cells and CD4+ T cells. Positive acid-fast bifurcating filaments and branching gram-positive rods were observed in the bronchoalveolar lavage fluid of the patient under an oil microscope, which was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry as N. cyriacigeorgica. The patient's condition quickly improved after taking 0.96 g compound sulfamethoxazole tablets three times a day.
CONCLUSION The antibiotic treatment of Nocardia pneumonia is different from that of common CAP. Attention should be given to the pathogenic examination results of patients with recurrent fever. Nocardia pneumonia is an opportunistic infection. Patients with CD4+ T-cell deficiency should be aware of Nocardia infection.
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Affiliation(s)
- Xin Hong
- Department of Green Pharmaceutical Collaborative Innovation Center, School of Pharmacy, Zhejiang University of Technology, Hangzhou 310014, Zhejiang Province, China
| | - You-Qi Ji
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Meng-Yuan Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Xiao-Yu Gou
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
| | - Yu-Mei Ge
- Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), Hangzhou 310014, Zhejiang Province, China
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Zendri F, Richards-Rios P, Maciuca I, Ricci E, Timofte D. Disseminated Nocardiosis Caused by Nocardia farcinica in Two Puppy Siblings. Vet Sci 2022; 10:vetsci10010028. [PMID: 36669029 PMCID: PMC9860694 DOI: 10.3390/vetsci10010028] [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: 12/02/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/04/2023] Open
Abstract
Systemic nocardiosis due to Nocardia farcinica has not been reported in canine outbreaks. Two 14-week-old female Dogue de Bordeaux siblings presented with fever and severe, acute onset limb lameness; traumatic lesions with evidence of infection were identified over the lame limbs of both dogs. The patients were euthanised owing to lack of therapeutic response and rapid escalation to systemic infection with central nervous system manifestations. The post-mortem changes consisted of multiple disseminated abscesses, mainly affecting the skin and subcutis at the limb traumatic injuries, local and hilar lymph nodes, lung, kidney and brain. Bacterial culture and identification via MALDI-TOF and 16S rRNA sequencing revealed Nocardia farcinica from several of these sites in both dogs. Clinical significance of the isolate was supported by cytology of the post-mortem organs' impression smears showing numerous branching filamentous bacteria associated with inflammation. The organism displayed marked multidrug-resistance. No history of immunosuppression was available, and immunohistochemistry ruled out viral pathogens as canine distemper and parvovirus. N. farcinica should be considered as a potential differential cause of sudden lameness and systemic infection in dogs with traumatic skin lesions over the limbs. This is the first reported small-scale outbreak of systemic nocardiosis in dogs due to N. farcinica.
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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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Peng Y, Dong X, Zhu Y, Lv H, Ge Y. A rare case of pulmonary nocardiosis comorbid with Sjogren's syndrome. J Clin Lab Anal 2021; 35:e23902. [PMID: 34418167 PMCID: PMC8418472 DOI: 10.1002/jcla.23902] [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: 02/03/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 12/16/2022] Open
Abstract
Background Nocardia is an opportunistic pathogen, which occurs in patients with autoimmune diseases and immune dysfunction, and can cause bacteremia and other life‐threatening complications. The clinical manifestations of Nocardia pneumonia are similar to tuberculous and other clinical common bacterial pneumonia, but its antibacterial treatments are different and detection methods are unique, which may lead patients to suffer for many years due to clinical misdiagnosis and missed diagnosis. Methods Imaging and laboratory examinations were performed for preliminary diagnosis, and next‐generation sequencing was used to identify the exact species type of Nocardia in the bronchoalveolar lavage fluid (BALF) of the patient. Results Imaging and laboratory parameters preliminarily implied that the patient was infected with Nocardia with Sjogren's syndrome (SS), and NGS showed that the strain was N. terpenica. Conclusions Accurate etiological diagnosis and corresponding antibiotics are key to improve the prognosis of pulmonary nocardiosis in this case. Nocardia pneumonia is rare in clinical practice; it is of great medical significance to improve the understanding of pulmonary nocardiosis.
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Affiliation(s)
- Yumeng Peng
- Center of Clinical Laboratory Medicine, the Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China.,Bengbu Medical College, Anhui, China
| | - Xiaoyan Dong
- The Second Medical College, Zhejiang Chinese Medical University, Zhejiang, China
| | - Yongze Zhu
- Center of Clinical Laboratory Medicine, the Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Huoyang Lv
- Center of Clinical Laboratory Medicine, the Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
| | - Yumei Ge
- Center of Clinical Laboratory Medicine, the Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Zhejiang, China
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Bhandari M, Kathuria S, Khunger N, Sharma B. Mycetoma due to Nocardia Africana/Nova Treated Successfully with Cotrimoxazole and Moxifloxacin. Indian Dermatol Online J 2021; 12:298-301. [PMID: 33959529 PMCID: PMC8088171 DOI: 10.4103/idoj.idoj_533_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/20/2020] [Accepted: 09/20/2020] [Indexed: 01/19/2023] Open
Abstract
Nocardia africana is a recently identified organism and has rarely been reported to cause mycetoma. Here we report the case of a 40-year-old woman who presented with discharging sinuses and nodules for the past 7 years along with few discrete axillary lymph nodes. Cultures and Maldi-TOF MS (Matrix-assisted laser desorption/ionization–time of flight mass spectrometry) method identified the causative organism as Nocardia africana/nova. The organism was acid-fast positive on modified Ziehl-Neelsen stain and Gram's stain revealed branched filamentous beaded gram-positive bacilli, while histopathology showed granulation tissue along with few ill-defined epithelioid cell granulomas, with giant cells. Based on the sensitivity report, the patient was started on tablet moxifloxacin and cotrimoxazole, and has shown considerable improvement at 2.5 months of follow-up.
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Affiliation(s)
- Molisha Bhandari
- Department of Dermatology and STD, Safdarjung Hospital and Vardhaman Mahavir Medical College, Ansari Nagar, New Delhi, India
| | - Sushruta Kathuria
- Department of Dermatology and STD, Safdarjung Hospital and Vardhaman Mahavir Medical College, Ansari Nagar, New Delhi, India
| | - Niti Khunger
- Department of Dermatology and STD, Safdarjung Hospital and Vardhaman Mahavir Medical College, Ansari Nagar, New Delhi, India
| | - Bhawna Sharma
- Department of Microbiology, Safdarjung Hospital and Vardhaman Mahavir Medical College, Ansari Nagar, New Delhi, India
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Bansal Y, Singla N, Butta H, Aggarwal D, Gulati N, Chander J. Nocardia Infections: Ten Years Experience from a Tertiary Health Care Center in North India (2007-2016). Infect Disord Drug Targets 2021; 21:445-451. [PMID: 32416708 DOI: 10.2174/1871526520666200516161940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 04/18/2020] [Accepted: 04/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Nocardia species are important cause of infections in humans but are underreported due to missed diagnosis as well as misdiagnosis. Majority of the literature on these infections consists of case reports or series with few articles describing high number of cases. OBJECTIVE To study the epidemiology of Nocardia infections in a tertiary care center. MATERIALS AND METHODS This retrospective observational study was done in a tertiary care centre of North India over a period of 10 years (2007-2016). The detection of Nocardia spp. from clinical specimens was done by conventional methods viz. direct microscopy (Gram's stain, modified Ziehl -Neelsen stain [1%], KOH examination) and culture. RESULTS A total of 25 cases of nocardiosis were diagnosed during the study period. The mean age of the patients was 50.9 years (range 30-72 years) with a male:female ratio of 3:2. The site of disease in these patients included pulmonary (n=18), cutaneous (n=4), perinephric abscess (n=1), ocular (n=1) and bone (n=1). Risk factors associated were underlying lung disease (n=11), smoking (n=7), diabetes (n=5) and steroid therapy (n=4) in pulmonary nocardiosis, iatrogenic (n=1) and leprosy (n=1) in cutaneous nocardiosis, diabetes in perinephric abscess and cataract surgery in ocular nocardiosis. Culture was positive in 12/25 (48%) patients for Nocardia spp. Direct microscopy was positive in 22 patients. We wish to highlight that meticulous observation of KOH wet mount examination helped in clinching the diagnosis of Nocardiosis in 3 cases which were earlier missed by other methods. CONCLUSION Good communication with the clinician alongside a meticulous effort in the laboratory is essential for appropriate diagnosis and management of these cases.
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Affiliation(s)
- Yashik Bansal
- Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, India
| | - Nidhi Singla
- Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, India
| | - Hena Butta
- Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Deepak Aggarwal
- Department of Pulmonary Medicine, Government Medical College Hospital, Sector 32, Chandigarh, India
| | - Neelam Gulati
- Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, India
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Sector 32, Chandigarh, India
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Martínez-Barricarte R. Isolated Nocardiosis, an Unrecognized Primary Immunodeficiency? Front Immunol 2020; 11:590239. [PMID: 33193422 PMCID: PMC7606290 DOI: 10.3389/fimmu.2020.590239] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/31/2020] [Indexed: 01/19/2023] Open
Abstract
Nocardiosis is an infectious disease caused by the gram-positive bacterium Nocardia spp. Although it is commonly accepted that exposure to Nocardia is almost universal, only a small fraction of exposed individuals develop the disease, while the vast majority remain healthy. Nocardiosis has been described as an "opportunistic" disease of immunocompromised patients, suggesting that exposure to the pathogen is necessary, but a host predisposition is also required. Interestingly, increasing numbers of nocardiosis cases in individuals without any detected risk factors, i.e., without overt immunodeficiency, are being reported. Furthermore, a growing body of evidence have shown that selective susceptibility to a specific pathogen can be caused by a primary immunodeficiency (PID). This raises the question of whether an undiagnosed PID may cause nocardiosis affecting otherwise healthy individuals. This review summarizes the specific clinical and microbiological characteristics of patients with isolated nocardiosis published during the past 30 years. Furthermore, it gives an overview of the known human immune mechanisms to fend off Nocardia spp. obtained from the study of PIDs and patients under immunomodulatory therapies.
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Affiliation(s)
- Rubén Martínez-Barricarte
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Pathology, Microbiology, and Immunology, Vanderbilt Center for Immunobiology, Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center, Nashville, TN, United States
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Tramèr L, Mertz KD, Huegli R, Hinic V, Jost L, Burkhalter F, Wirz S, Tarr PE. Intra-Abdominal Nocardiosis-Case Report and Review of the Literature. J Clin Med 2020; 9:jcm9072141. [PMID: 32645935 PMCID: PMC7408857 DOI: 10.3390/jcm9072141] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 01/04/2023] Open
Abstract
Nocardiosis is primarily an opportunistic infection affecting immunosuppressed individuals, in whom it most commonly presents as pulmonary infection and sometimes cerebral abscesses. Isolated abdominal or retroperitoneal nocardiosis is rare. Here, we report the second case, to our knowledge, of isolated abdominal nocardiosis due to Nocardia paucivorans and provide a comprehensive review of intra-abdominal nocardiosis. The acquisition of abdominal nocardiosis is believed to occur via hematogenous spreading after pulmonary or percutaneous inoculation or possibly via direct abdominal inoculation. Cases of Nocardia peritonitis have been reported in patients on peritoneal dialysis. Accurate diagnosis of abdominal nocardiosis requires histological and/or microbiological examination of appropriate, radiologically or surgically obtained biopsy specimens. Malignancy may initially be suspected when the patient presents with an abdominal mass. Successful therapy usually includes either percutaneous or surgical abscess drainage plus prolonged combination antimicrobial therapy.
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Affiliation(s)
- Lucas Tramèr
- University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; (L.T.); (L.J.); (F.B.); (S.W.)
| | | | - Rolf Huegli
- Department of Radiology and Nuclear Medicine, Kantonsspital Baselland, 4101 Bruderholz, Switzerland;
| | - Vladimira Hinic
- Clinical Bacteriology and Mycology, Laboratory Medicine, University Hospital Basel, 4031 Basel, Switzerland;
| | - Lorenz Jost
- University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; (L.T.); (L.J.); (F.B.); (S.W.)
- Oncology Service, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Felix Burkhalter
- University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; (L.T.); (L.J.); (F.B.); (S.W.)
- Nephrology Service, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Sebastian Wirz
- University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; (L.T.); (L.J.); (F.B.); (S.W.)
- Infectious Diseases Service, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
| | - Philip E. Tarr
- University Department of Medicine, Kantonsspital Baselland, University of Basel, 4101 Bruderholz, Switzerland; (L.T.); (L.J.); (F.B.); (S.W.)
- Infectious Diseases Service, Kantonsspital Baselland, 4101 Bruderholz, Switzerland
- Correspondence: ; Tel.: +41-61-436-2212; Fax: +41-61-436-3670
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Soares D, Reis-Melo A, Ferraz C, Guedes Vaz L. Nocardia lung abscess in an immunocompetent adolescent. BMJ Case Rep 2019; 12:12/1/bcr-2018-227499. [PMID: 30635309 DOI: 10.1136/bcr-2018-227499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The authors report a case of a lung abscess caused by Nocardia sp. in a previously healthy adolescent. A 17-year-old young man presented with tonsillitis that did not respond to β-lactamic antibiotic, dyspnoea and thoracic pain. The X-ray revealed a cavitation in the right pulmonary upper lobe. He was admitted and completed a 14-day empirical antimicrobial therapy for a pulmonar abscess, although no clinical recovery was observed. He then underwent pulmonary biopsy of the lesion and PCR analysis of the collected pulmonary tissue, which revealed the presence of Nocardia This case emphasises the importance of considering nocardiosis in the differential diagnosis of a lung abscess, particularly if no response to empirical therapy is obtained.
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Affiliation(s)
- Diana Soares
- Department of Pediatrics, Centro Hospitalar Vila Nova de Gaia - Espinho EPE, Vila Nova de Gaia, Portugal
| | - Ana Reis-Melo
- Department of Pediatrics, Centro Hospitalar São João EPE, Porto, Portugal
| | - Catarina Ferraz
- Pediatric Pulmonology Unit, Department of Pediatrics, Centro Hospitalar São João EPE, Porto, Portugal
| | - Luisa Guedes Vaz
- Pediatric Pulmonology Unit, Department of Pediatrics, Centro Hospitalar São João EPE, Porto, Portugal
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