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William A, Kaur R, Rawat D, Mendiratta V, Das S. Ulceration by Nocardia Otitidiscaviarum: A case study. Trop Doct 2023; 53:293-298. [PMID: 36744366 DOI: 10.1177/00494755231155230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Nocardiosis is an acute, subacute or chronic infectious disease that occurs in cutaneous, pulmonary and disseminated forms. We present a case of Nocardiosis in a post-COVID-19 patient with cutaneous ulceration due to Nocardia otitidiscaviarum, managed with cotrimoxazole and linezolid. Early diagnosis and management proved crucial in preventing dissemination of the organism and improving the patient's outcome.
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Affiliation(s)
- Ashish William
- 28856Senior Resident, Department of Microbiology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Ravinder Kaur
- 28856Director Professor & Head, Department of Microbiology, Lady Hardinge Medical College & Associated hospitals, New Delhi, India
| | - Deepti Rawat
- 28856Professor, Department of Microbiology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Vibhu Mendiratta
- 28856Director Professor & Head, Department of Dermatology & STD, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Sudeshna Das
- 28856Postgraduate Resident, Department of Microbiology, Lady Hardinge Medical College & Associated hospitals, New Delhi, India
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Barry M, AlShehri S, Alguhani A, Barry M, Alhijji A, Binkhamis K, Al-Majid F, Al-Shahrani FS, Muayqil T. A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim-sulfamethoxazole: case report and literature review. Ann Clin Microbiol Antimicrob 2022; 21:17. [PMID: 35578282 PMCID: PMC9112502 DOI: 10.1186/s12941-022-00511-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Disseminated nocardiosis still causes significant morbidity and mortality and is often caused by Nocardia asteroides, N. basiliensis, and N. farcinica and are often treated with trimethoprim–sulfamethoxazole (TMP–SMX). Nocardia otitidiscaviarum (N. otitidiscaviarum) rarely causes disseminated disease and resistance to TMP–SMX is even more rare. Case presentation A 37-year-old woman with metastatic breast cancer and right ear deafness with recent occupational gardening and manipulating soil, presented to the hospital with first time seizure and multiple skin nodules. Magnetic resonance imaging (MRI) showed ring enhancing lesions, biopsy of the skin and brain lesions grew N. otitidiscaviarum. She was empirically treated with TMP–SMX and Imipenem–Cilastatin, however, almost three weeks into therapy, susceptibility results revealed it to be resistant to both antimicrobials, she was subsequently changed to Amikacin, Linezolid, Moxifloxacin, and Doxycycline but ultimately died. Conclusions This case report highlights the importance of suspecting a rare Nocardia species in patients at risk with proper occupational exposure, moreover, TMP–SMX resistance should be suspected with lack of clinical response, this may have important implications on clinical practice when facing similar infections.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia. .,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia. .,Division of Infectious Diseases, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Shahad AlShehri
- Infectious Diseases Unit, Internal Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahlam Alguhani
- Infectious Diseases Unit, Internal Medicine Department, King Abdullah Medical City National Guard, Riyadh, Saudi Arabia
| | - Mohammad Barry
- Medical Imaging Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Ali Alhijji
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khalifa Binkhamis
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Al-Majid
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fatimah S Al-Shahrani
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Taim Muayqil
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.,Division of neurology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Parengal J, Alebbi SM, Hamed MMM, Alqatami HM, Ben Abid F. Disseminated life threatening Nocardia otitidiscaviarum infection in a young female with newly diagnosed systemic lupus erythematosus, case report and review of literature. IDCases 2021; 26:e01265. [PMID: 34589411 PMCID: PMC8461374 DOI: 10.1016/j.idcr.2021.e01265] [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: 06/28/2021] [Revised: 08/08/2021] [Accepted: 08/30/2021] [Indexed: 11/16/2022] Open
Abstract
Infection due to Nocardia is reported mainly in immunocompromised patients. It usually presents as a pulmonary or disseminated disease with a predilection for the brain. Infections are a rare etiology of intracranial vascular aneurysms. Herein we report a case of disseminated Nocardia otitidiscaviarum (N. otitidiscaviarum) in a young female newly diagnosed with systemic lupus erythematosus (SLE) complicated by the development of an infectious intracranial aneurysm. To the best of our knowledge this is the fourth case of nocardial infection-related intracranial aneurysm and the second case of N. otitidiscaviarum infection to be reported in a patient with systemic lupus erythematosus. Features of previously reported N. otitidiscaviarum related intracranial aneurysm are reviewed.
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Affiliation(s)
- Jabeed Parengal
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Seham Mohsin Alebbi
- Department of Medicine, Division of Rheumatology, Hamad Medical Corporation, Doha, Qatar
| | - Manal Mahmoud Mohamed Hamed
- Department of Microbiology, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medical College, Doha, Qatar
| | | | - Fatma Ben Abid
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
- Weill Cornell Medical College, Doha, Qatar
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Sadamatsu H, Takahashi K, Tashiro H, Komiya K, Nakamura T, Sueoka-Aragane N. Successful treatment of pulmonary nocardiosis with fluoroquinolone in bronchial asthma and bronchiectasis. Respirol Case Rep 2017; 5:e00229. [PMID: 28352469 PMCID: PMC5366288 DOI: 10.1002/rcr2.229] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 11/11/2022] Open
Abstract
A 72‐year‐old Japanese woman was admitted at Saga University Hospital for fever, malaise, and productive cough. Six years ago, she had been diagnosed with bronchial asthma and was treated with inhaled corticosteroids. Chest radiograph and computed tomography on admission showed infiltrates in the right middle lobe, a mass lesion in the left lower lobe, and bronchiectasis in both lower lobes. Sputum examination showed Gram‐positive rods with phagocytosis by neutrophils. These bacilli were identified as Nocardia otitidiscaviarum by 16S ribosomal RNA sequencing. Therefore, she was diagnosed with pulmonary nocardiosis and was treated with trimethoprim/sulfamethoxazole (TMP–SMX) and minocycline (MINO). However, she had to discontinue these antibiotics because of severe nausea and anorexia and instead was treated with fluoroquinolone for 6 months. There was resolution of the disease thereafter. Pulmonary nocardiosis with bronchial asthma and bronchiectasis can be successfully treated with fluoroquinolone, an alternative to TMP–SMX or MINO.
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Affiliation(s)
- Hironori Sadamatsu
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine Saga University Saga Japan
| | - Koichiro Takahashi
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine Saga University Saga Japan
| | - Hiroki Tashiro
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine Saga University Saga Japan
| | - Kazutoshi Komiya
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine Saga University Saga Japan
| | - Tomomi Nakamura
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine Saga University Saga Japan
| | - Naoko Sueoka-Aragane
- Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine Saga University Saga Japan
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Jiang Y, Huang A, Fang Q. Disseminated nocardiosis caused by Nocardia otitidiscaviarum in an immunocompetent host: A case report and literature review. Exp Ther Med 2016; 12:3339-3346. [PMID: 27882160 DOI: 10.3892/etm.2016.3755] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 02/19/2016] [Indexed: 12/31/2022] Open
Abstract
The aim of the present study was to summarize the clinical characteristics of nocardiosis caused by Nocardia otitidiscaviarum in order to improve the knowledge of nocardiosis. A case of dissemination nocardiosis caused by N. otitidiscaviarum in an immunocompetent host is reported and the associated literature reviewed. Informed consent for publication of this case report was provided by the patient. The present patient was a young immunocompetent man suffering from disseminated nocardiosis induced by infection with N. otitidiscaviarum. Following a poor response to β-lactam antibiotic, a combination of sulfonamide with minocycline was administered, which successfully ameliorated the symptoms. Previous studies published in English were retrieved from PubMed with 'Nocardia otitidiscaviarum' used as the search keyword. A total of 23 articles were retrieved from the PubMed database, supporting the assertion that N. otitidiscaviarum is a rare Nocardia species. Among these 23 cases, there were 11 cases of lymphocutaneous (48%), 5 of pulmonary (22%), 2 of brain (9%) and 1 of pyothorax (4%) infection, and 4 cases of disseminated infections (17%). Analysis of the immune state of these patients demonstrated that 9 were immunocompetent (39%), 7 of whom had cutaneous infections (30%) with a predominant history of trauma (6/7), and 14 were immunosuppressed, 9 of whom were treated with prednisolone. Microbiology and histopathology were necessary in all cases for definite diagnosis. Among the 13 cases who underwent drug susceptibility testing, 10 cases were sensitive to trimethoprim-sulfamethoxazole (TMP-SMX) and 12 cases were sensitive to aminoglycoside. In conclusion, although N. otitidiscaviarum is one of the less commonly isolated species of Nocardia, it is capable of inducing localized or disseminated infection, even in an immunocompetent host. The majority of cases respond well to TMP-SMX and aminoglycoside, but the therapeutic action of cephalosporin is weak. Identification of bacteria and drug sensitivity tests for Nocardia is critical for guiding clinical treatment.
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Affiliation(s)
- Yanwen Jiang
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Aiben Huang
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
| | - Qiuhong Fang
- Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
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Huang CH, Hsueh PR, Chen YH. Empyema thoracis due to Nocardia otitidiscaviarum. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 48:580-1. [PMID: 25066706 DOI: 10.1016/j.jmii.2014.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/08/2014] [Accepted: 05/12/2014] [Indexed: 01/30/2023]
Affiliation(s)
- Chung-Hao Huang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Ren Hsueh
- Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Hsu Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Tourte M, Ottaviani S, Aubrun A, Rioux C, Palazzo E, Dieudé P. Disseminated nocardiosis in a patient with rheumatoid arthritis treated with abatacept. Joint Bone Spine 2014; 81:275-6. [DOI: 10.1016/j.jbspin.2013.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 11/07/2013] [Indexed: 12/01/2022]
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Betrán A, Villuendas MC, Rezusta A, Moles B, Rubio MC, Revillo MJ, Boiron P, Bello S, Rodríguez-Nava V. Cavitary pneumonia caused by Nocardia otitidiscaviarum. Braz J Microbiol 2010; 41:329-32. [PMID: 24031500 PMCID: PMC3768688 DOI: 10.1590/s1517-838220100002000011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2009] [Accepted: 10/06/2009] [Indexed: 03/04/2023] Open
Abstract
We report a case of cavitary pneumonia caused by N. otitidiscaviarum in a man with diabetes mellitus and thrombocytopenia treated with systemic corticosteroid. Taxonomic identification involved phenotypic testing and molecular identification that was carried out by DNA sequencing of the 16SrRNA gene.
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Affiliation(s)
- A Betrán
- Microbiología. Hospital Universitario Miguel Servet, Instituto Aragonés de Ciencias de la Salud (I+CS), Paseo Isabel la Católica 1-3, 50009. Zaragoza , Spain
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Sharma M, Gilbert BC, Benz RL, Santoro J. Disseminated Nocardia Otitidiscaviarum Infection in a Woman with Sickle Cell Anemia and End-Stage Renal Disease. Am J Med Sci 2007; 333:372-5. [PMID: 17570990 DOI: 10.1097/maj.0b013e318065ab26] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Nocardia otitidiscaviarum is an uncommon human pathogen and a rare cause of pulmonary infection and bacteremia. We report a case of N. otitidiscaviarum bacteremia and pulmonary infection in a patient with end-stage renal disease (chronic kidney disease, stage 5) and sickle cell anemia. The epidemiology, pathogenesis, and treatment of Nocardia infections are discussed.
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Affiliation(s)
- Madhulika Sharma
- Lankenau Hospital and Department of Medicine, Thomas Jefferson University Medical College, Wynnewood, Pennsylvania, USA
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