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Derungs T, Poddubnyy D, Schneider T. Pancytopenia following adjuvant therapy with interferon-gamma in a patient with disseminated nocardiosis. Int J Infect Dis 2024; 142:106997. [PMID: 38458424 DOI: 10.1016/j.ijid.2024.106997] [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: 12/20/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 03/10/2024] Open
Abstract
A patient with disseminated nocardiosis developed pancytopenia after treatment with recombinant interferon-gamma (IFN-γ). While no previous clinical reports link pancytopenia to IFN-γ, our observations align with basic research on myelosuppressive effects of IFN-γ. Adjunctive IFN-γ may improve standard nocardiosis therapy, but vigilant monitoring of its hematologic effects is necessary.
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Affiliation(s)
- Thomas Derungs
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany.
| | - Denis Poddubnyy
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany
| | - Thomas Schneider
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany
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Han Y, Cheng M, Li Z, Chen H, Xia S, Zhao Y, Wang Y, He W, Wang W. Clinical characteristics and drug resistance of Nocardia in Henan, China, 2017-2023. Ann Clin Microbiol Antimicrob 2024; 23:23. [PMID: 38449006 PMCID: PMC10919010 DOI: 10.1186/s12941-024-00677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate the clinical features of Nocardia infections, antibiotic resistance profile, choice of antibiotics and treatment outcome, among others. In addition, the study compared the clinical and microbiological characteristics of nocardiosis in bronchiectasis patients and non-bronchiectasis patients. METHODS Detailed clinical data were collected from the medical records of 71 non-duplicate nocardiosis patients from 2017 to 2023 at a tertiary hospital in Zhengzhou, China. Nocardia isolates were identified to the species level using MALDI-TOF MS and 16S rRNA PCR sequencing. Clinical data were collected from medical records, and drug susceptibility was determined using the broth microdilution method. RESULTS Of the 71 cases of nocardiosis, 70 (98.6%) were diagnosed as pulmonary infections with common underlying diseases including bronchiectasis, tuberculosis, diabetes mellitus and chronic obstructive pulmonary disease (COPD). Thirteen different strains were found in 71 isolates, the most common of which were N. farcinica (26.8%) and N. cyriacigeorgica (18.3%). All Nocardia strains were 100% susceptible to both TMP-SMX and linezolid, and different Nocardia species showed different patterns of drug susceptibility in vitro. Pulmonary nocardiosis is prone to comorbidities such as bronchiectasis, diabetes mellitus, COPD, etc., and Nocardia is also frequently accompanied by co-infection of the body with pathogens such as Mycobacterium and Aspergillus spp. Sixty-one patients underwent a detailed treatment regimen, of whom 32 (52.5%) received single or multi-drug therapy based on TMP-SMX. Bronchiectasis was associated with a higher frequency of Nocardia infections, and there were significant differences between the bronchiectasis and non-bronchiectasis groups in terms of age distribution, clinical characteristics, identification of Nocardia species, and antibiotic susceptibility (P < 0.05). CONCLUSIONS Our study contributes to the understanding of the species diversity of Nocardia isolates in Henan, China, and the clinical characteristics of patients with pulmonary nocardiosis infections. Clinical and microbiologic differences between patients with and without bronchiectasis. These findings will contribute to the early diagnosis and treatment of patients.
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Affiliation(s)
- Yungang Han
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Meijin Cheng
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Zheng Li
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Huihui Chen
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Shuang Xia
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yue Zhao
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Yali Wang
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Wenyi He
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China
| | - Wei Wang
- Key Laboratory of Medical Laboratory, Henan Provincial Chest Hospital, Affiliated Chest Hospital of Zhengzhou University, Zhengzhou, China.
- Henan Provincial Medical Key Disciplines (Laboratory Diagnostics), Henan Provincial Chest Hospital, Zhengzhou, China.
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Feng Y, Zuo CL, Shi JX. Brucella infection combined with Nocardia infection: A case report and literature review. Open Life Sci 2024; 19:20220815. [PMID: 38465335 PMCID: PMC10921472 DOI: 10.1515/biol-2022-0815] [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: 08/09/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 03/12/2024] Open
Abstract
Human brucellosis is an infectious disease caused by Brucella and is often misdiagnosed for atypical manifestations including fever of unknown origin, headache, weakness, among else. Nocardiosis is a zoonotic disease caused by the genus Nocardia, which usually spreads through the respiratory tract, skin, and digestive tract. Limited research has documented cases of co-infection involving both Brucella and Nocardia pathogens in patients. A 55-year-old male was admitted to our hospital with intermittent high-grade fever. Following sputum and blood cultures, as well as other laboratory examinations, the patient was diagnosed with concurrent brucellosis and nocardiosis. According to recommendations of previous studies and reports, the patient was successively treated with levofloxacin, doxycycline, piperacillin sodium and sulbactam sodium, trimethoprim-sulfamethoxazole, rifampicin, and tigecycline, after which the patient recovered and was discharged. Brucella and Nocardia are both opportunistic pathogens and simultaneous infection of Brucella and Nocardia is relatively rare. If patients continue to experience persistent fever despite receiving empirical antibiotic therapy, it becomes necessary to conduct examinations to identify potential atypical pathogens, including Brucella and Nocardia. Sputum staining, sputum culture, and blood culture are critical auxiliary examinations during clinical practice. The treatment plan should be selected based on guidelines and the individual patient's condition. Regular reevaluation should be conducted, and antimicrobial agents should be adjusted accordingly.
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Affiliation(s)
- Yan Feng
- Department of Pulmonary and Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, Lianyungang First People’s Hospital, 6 East Zhenhua Road, Lianyungang, 222006, China
| | - Chun-Lei Zuo
- Laboratory Department, Lianyungang Clinical College of Nanjing Medical University, Lianyungang First People’s Hospital, 6 East Zhenhua Road, Lianyungang, 222006, China
| | - Jia-Xin Shi
- Department of Pulmonary and Critical Care Medicine, Lianyungang Clinical College of Nanjing Medical University, Lianyungang First People’s Hospital, 6 East Zhenhua Road, Lianyungang, 222006, China
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Sun H, Xie X, Wang Y, Wang J, Deng T. Clinical screening of Nocardia in sputum smears based on neural networks. Front Cell Infect Microbiol 2023; 13:1270289. [PMID: 38094748 PMCID: PMC10716215 DOI: 10.3389/fcimb.2023.1270289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
Objective Nocardia is clinically rare but highly pathogenic in clinical practice. Due to the lack of Nocardia screening methods, Nocardia is often missed in diagnosis, leading to worsening the condition. Therefore, this paper proposes a Nocardia screening method based on neural networks, aiming at quick Nocardia detection in sputum specimens with low costs and thereby reducing the missed diagnosis rate. Methods Firstly, sputum specimens were collected from patients who were infected with Nocardia, and a part of the specimens were mixed with new sputum specimens from patients without Nocardia infection to enhance the data diversity. Secondly, the specimens were converted into smears with Gram staining. Images were captured under a microscope and subsequently annotated by experts, creating two datasets. Thirdly, each dataset was divided into three subsets: the training set, the validation set and the test set. The training and validation sets were used for training networks, while the test set was used for evaluating the effeteness of the trained networks. Finally, a neural network model was trained on this dataset, with an image of Gram-stained sputum smear as input, this model determines the presence and locations of Nocardia instances within the image. Results After training, the detection network was evaluated on two datasets, resulting in classification accuracies of 97.3% and 98.3%, respectively. This network can identify Nocardia instances in about 24 milliseconds per image on a personal computer. The detection metrics of mAP50 on both datasets were 0.780 and 0.841, respectively. Conclusion The Nocardia screening method can accurately and efficiently determine whether Nocardia exists in the images of Gram-stained sputum smears. Additionally, it can precisely locate the Nocardia instances, assisting doctors in confirming the presence of Nocardia.
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Affiliation(s)
- Hong Sun
- Department of Laboratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xuanmeng Xie
- Effect, Jianying, Intelligent Creation Lab, Bytedance Inc., Hangzhou, China
| | - Yaqi Wang
- College of Media Engineering, Communication University of Zhejiang, Hangzhou, China
| | - Juan Wang
- Department of Laboratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Tongyang Deng
- Department of Laboratory Medicine, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Qi DD, Zhuang Y, Chen Y, Guo JJ, Zhang Z, Gu Y. Interstitial pneumonia combined with nocardia cyriacigeorgica infection: A case report. World J Clin Cases 2023; 11:7920-7925. [DOI: 10.12998/wjcc.v11.i32.7920] [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: 09/26/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Nocardia infection is a relatively uncommon disease, with no reports among patients with interstitial pneumonia. Due to its atypical clinical symptoms and chest computed tomography (CT) findings and the frequent yielding of negative results by conventional cultures, it poses challenges for timely diagnosis and treatment.
CASE SUMMARY A 63-year-old female patient presented to our hospital in July 2022 with a 3-mo history of intermittent cough and poor appetite, accompanied by a 2-wk long duration of headaches. She had a previous medical history of interstitial pneumonia and was on oral prednisone and cyclosporine. Chest CT revealed the presence of newly developed round nodules. The diagnosis of Nocardia cyriacigeorgica infection was confirmed through metagenomic next-generation sequencing (mNGS) performed on bronchoalveolar lavage fluid. Targeted anti-infection therapy was initiated, resulting in symptom improvement and radiological resolution, further validating the mNGS results.
CONCLUSION Nocardia cyriacigeorgica infection is a clinically rare condition that is primarily observed in immunocompromised patients. Its clinical and radiological manifestations lack specificity, but mNGS can aid in rapidly obtaining pathogenic information. Early initiation of targeted antimicrobial therapy based on mNGS results can improve patient prognosis.
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Affiliation(s)
- Dao-Da Qi
- Department of Geriatrics, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu Province, China
| | - Yi Zhuang
- Department of Respiratory and Critical Care Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210006, Jiangsu Province, China
| | - Yang Chen
- Department of Geriatrics, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu Province, China
| | - Jing-Jing Guo
- Department of Geriatrics, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu Province, China
| | - Ze Zhang
- Department of Geriatrics, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu Province, China
| | - Yan Gu
- Department of Geriatrics, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210003, Jiangsu Province, China
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Gavalda M, Lorenzo A, Vilchez H, Gimenez S, Calvo C, Martin L, Riera M. Skin lesions by Scedosporium apiospermum and Nocardia pulmonary infection in an oncologic patient: a case report. BMC Infect Dis 2023; 23:523. [PMID: 37559001 PMCID: PMC10413544 DOI: 10.1186/s12879-023-08484-6] [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: 04/23/2023] [Accepted: 07/25/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Fungal infections, other than candidiasis and aspergillosis, are an uncommon entity. Despite this, emerging pathogens are a growing threat. In the following case report, we present the case of an immunocompromised patient suffering from two serious opportunistic infections in the same episode: the first of these, Nocardia multilobar pneumonia; and the second, skin infection by Scedosporium apiospermum. These required prolonged antibacterial and antifungal treatment. CASE PRESENTATION This case is a 71-year-old oncological patient admitted for recurrent pneumonias that was diagnosed for Nocardia pulmonary infection. Nervous system involvement was discarded and cotrimoxazole was started. Haemorrhagic skin ulcers in the lower limbs appeared after two weeks of hospital admission. We collected samples which were positive for Scedosporium apiospermum and we added voriconazole to the treatment. As a local complication, the patient presented a deep bruise that needed debridement. We completed 4 weeks of intravenous treatment with slow improvement and continued with oral treatment until the disappearance of the lesions occurs. CONCLUSIONS Opportunistic infections are a rising entity as the number of immunocompromised patients is growing due to more use of immunosuppressive therapies and transplants. Clinicians must have a high suspicion to diagnose and treat them. A fluid collaboration with Microbiology is necessary as antimicrobial resistance is frequent.
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Affiliation(s)
- M Gavalda
- Internal Medicine, Hospital Universitari Son Espases, Palma, Spain.
- Hospital Universitari Son Espases, Valldemossa Road 79, Palma de Mallorca, Spain.
| | - A Lorenzo
- Internal Medicine, Hospital Universitari Son Espases, Palma, Spain
| | - H Vilchez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Palma, Spain
- Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, 07120, Spain
| | - S Gimenez
- Oncology. Hospital Universitari Son Espases, Palma, Spain
| | - C Calvo
- Pathology Department, Hospital Universitari Son Espases, Palma, Spain
| | - L Martin
- Internal Medicine, Hospital Universitari Son Espases, Palma, Spain
| | - M Riera
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitari Son Espases, Palma, Spain
- Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, 07120, Spain
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Márquez AI, Mora E, Bernal AF, Salazar AF, Mora DP, Vargas LJ. Pulmonary and central nervous system nocardiosis: Alcoholism as an immunocompromising factor. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:37-43. [PMID: 37167467 PMCID: PMC10476646 DOI: 10.7705/biomedica.6606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 03/04/2023] [Indexed: 05/13/2023]
Abstract
Nocardiosis is a disease with worldwide distribution. It is usually found in tropical areas and mainly affects immunocompromised patients, however, there are also cases where its infection has been reported in immunocompetent patients. This pathology is caused by bacteria known as Nocardia spp., which are gram-positive microorganisms and environmental saprophytes, and although exposure to Nocardia spp. is almost universal, only a small fraction of exposed people develops the disease. We present the case of a 47-year-old man, with no evidence of immunosuppression, from a rural area of Boyacá, who was admitted due to intense and intermittent headache accompanied by paresthesia and, finally, a decrease in consciousness. A brain magnetic resonance was performed and evidenced a fronto-temporo- occipital space-occupying lesion in the cortico-subcortical region with a compressive effect and displacement of the ventricular system cavities. It was suspected at first a neoplastic lesion or a brain abscess. The lesion was surgically resected, and its culture showed Nocardia africana/nova. In later studies a possible primary pulmonary focus was evidenced. Alcoholism was the only risk factor documented. The patient completed 6 weeks of hospital antibiotic treatment with favorable clinical and radiological evolution and was discharged with a 1-year plan of outpatient antibiotic therapy. Although Nocardia spp. mainly affects immunocompromised patients, evidence shows that this microorganism can also be a threat to individuals without traditional immunosuppression risk factors.
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Affiliation(s)
| | - Eduardo Mora
- Servicio de Radiología, Hospital Universitario San Rafael, Tunja, Colombia.
| | | | | | - Diana Patricia Mora
- Servicio de Laboratorio Clínico, Hospital Universitario San Rafael, Tunja, Colombia.
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Liu C, Yang J, Huang H, Zhan S, Xia X. Case report: Nocardia gipuzkoensis infection in an immunocompetent patient diagnosed by metagenomic next-generation sequencing and whole genome sequencing. Front Immunol 2022; 13:1053914. [PMID: 36569853 PMCID: PMC9780257 DOI: 10.3389/fimmu.2022.1053914] [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: 09/26/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
The infection of Nocardia gipuzkoensis is a relatively uncommon form of pulmonary nocardiosis seen in clinical patients. In general, nocardiosis tends to occur in patients with immune deficiency. Here, we report a 23-year-old female who was admitted to the hospital due to cough and sputum production over 10 years, diagnosed with bronchiectasis. The N. gipuzkoensis infection was identified by metagenomic next-generation sequencing and whole genome sequencing. Imipenem/cilastatin and compound sulfamethoxazole tablets were used to control the infection and the pulmonary inflammation subsided gradually.
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Affiliation(s)
- Chengxin Liu
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China,The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Juhua Yang
- Vision Medicals Co., Ltd., Guangzhou, China
| | - Huiting Huang
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shaofeng Zhan
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China,*Correspondence: Shaofeng Zhan, ; Xintian Xia,
| | - Xintian Xia
- The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, China,*Correspondence: Shaofeng Zhan, ; Xintian Xia,
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Yeoh K, Globan M, Naimo P, Williamson DA, Lea K, Bond K. Identification and antimicrobial susceptibility of referred Nocardia isolates in Victoria, Australia 2009-2019. J Med Microbiol 2022; 71. [PMID: 35976092 DOI: 10.1099/jmm.0.001581] [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] [Indexed: 11/18/2022] Open
Abstract
Introduction. Nocardia is an opportunistic pathogen that can cause significant morbidity and mortality, particularly in the immunocompromised host. Antimicrobial susceptibility profiles vary across Nocardia spp. and vary within Australia as well as worldwide. Knowledge of local susceptibility patterns is important in informing appropriate empiric antimicrobial therapy.Gap Statement. This is the largest study to date in Australia that correlates antimicrobial susceptibility profiles with molecular identification of Nocardia species. It is the first study that examines isolates from multiple institutions across the state of Victoria, Australia.Aim. To investigate the species distribution and antibiotic susceptibility of Nocardia spp. isolates referred to the Mycobacterial Reference Laboratory (MRL) in Victoria, Australia from 2009 to 2019.Methodology. We conducted a retrospective review of Nocardia spp. isolates which were identified using molecular sequencing. Antimicrobial susceptibility testing was performed using standardized broth microdilution method with Sensititre RAPMYCO1 plates. Species distribution and antibiotic susceptibility profiles were analysed.Results. In total, 414 Nocardia isolates were identified to 27 species levels, the majority originating from the respiratory tract (n=336, 81.2 %). N. nova (n=147, 35.5 %) was the most frequently isolated, followed by N. cyriacigeorgica (n=75, 18.1 %). Species distribution varied by isolate source, with N. farcinica and N. paucivorans found more commonly from sterile sites. Linezolid and amikacin had the highest proportion of susceptible isolates (100 and 99% respectively), while low susceptibility rates were detected for ceftriaxone (59 %) and imipenem (41 %). Susceptibility to trimethoprim sulfamethoxazole varied by species (0-100 %).Conclusion. This is the largest study to date in Australia of Nocardia species distribution and antimicrobial susceptibility patterns. N. farcinica and N. paucivorans were more likely to be isolated from sterile sites, while N. brasiliensis and N. otitidiscvarium were more likely to be isolated from skin and soft tissue. First line therapeutic antimicrobial recommendations by local guidelines were not necessarily reflective of the in vitro susceptibility of Nocardia isolates in this study, with high susceptibility detected for linezolid and amikacin, but poor susceptibility demonstrated for ceftriaxone and imipenem. Profiles for trimethoprim-sulfamethoxazole varied across different Nocardia species, warranting ongoing susceptibility testing for targeted clinical use.
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Affiliation(s)
- Kim Yeoh
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
| | - Maria Globan
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
| | - Phillip Naimo
- Department of General Medicine, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, 3050, Victoria, Australia
| | - Deborah A Williamson
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
| | - Kerrie Lea
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
| | - Katherine Bond
- Mycobacterium Reference Laboratory, Victorian Infectious Diseases Reference Laboratory at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, 3000, Victoria, Australia
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Lopes K, Montenegro C, Vìlchez J, Camacho ME, Marques HG. IMAGES: Nocardia pneumonia - A surprising and rare pulmonary infection mimicking lung cancer. Pulmonology 2022; 28:415-417. [PMID: 35710711 DOI: 10.1016/j.pulmoe.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- K Lopes
- Pathology Department, Centro Hospitalar Barreiro Montijo, Portugal.
| | - C Montenegro
- Pathology Department, Centro Hospitalar Barreiro Montijo, Portugal
| | - J Vìlchez
- Pathology Department, Centro Hospitalar Barreiro Montijo, Portugal
| | - M E Camacho
- Respiratory Department, Centro Hospitalar Barreiro Montijo, Portugal
| | - H G Marques
- Respiratory Department, Centro Hospitalar Barreiro Montijo, Portugal
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Comprehensive Analysis of the Nocardia cyriacigeorgica Complex Reveals Five Species-Level Clades with Different Evolutionary and Pathogenicity Characteristics. mSystems 2022; 7:e0140621. [PMID: 35430877 PMCID: PMC9239197 DOI: 10.1128/msystems.01406-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Nocardia cyriacigeorgica is a common etiological agent of nocardiosis that has increasingly been implicated in serious pulmonary infections, especially in immunocompromised individuals. However, the evolution, diversity, and pathogenesis of N. cyriacigeorgica have remained unclear. Here, we performed a comparative genomic analysis using 91 N. cyriacigeorgica strains, 45 of which were newly sequenced in this study. Phylogenetic and average nucleotide identity (ANI) analyses revealed that N. cyriacigeorgica contained five species-level clades (8.6 to 14.6% interclade genetic divergence), namely, the N. cyriacigeorgica complex (NCC). Further pan-genome analysis revealed extensive differences among the five clades in nine functional categories, such as energy production, lipid metabolism, secondary metabolites, and signal transduction mechanisms. All 2,935 single-copy core genes undergoing purifying selection were highly conserved across NCC. However, clades D and E exhibited reduced selective constraints, compared to clades A to C. Horizontal gene transfer (HGT) and mobile genetic elements contributed to genomic plasticity, and clades A and B had experienced a higher level of HGT events than other clades. A total of 129 virulence factors were ubiquitous across NCC, such as the mce operon, hemolysin, and type VII secretion system (T7SS). However, different distributions of three toxin-coding genes and two new types of mce operons were detected, which might contribute to pathogenicity differences among the members of the NCC. Overall, our study provides comprehensive insights into the evolution, genetic diversity, and pathogenicity of NCC, facilitating the prevention of infections. IMPORTANCENocardia species are opportunistic bacterial pathogens that can affect all organ systems, primarily the skin, lungs, and brain. N. cyriacigeorgica is the most prevalent species within the genus, exhibits clinical significance, and can cause severe infections when disseminated throughout the body. However, the evolution, diversity, and pathogenicity of N. cyriacigeorgica remain unclear. Here, we have conducted a comparative genomic analysis of 91 N. cyriacigeorgica strains and revealed that N. cyriacigeorgica is not a single species but is composed of five closely related species. In addition, we discovered that these five species differ in many ways, involving selection pressure, horizontal gene transfer, functional capacity, pathogenicity, and antibiotic resistance. Overall, our work provides important clues in dissecting the evolution, genetic diversity, and pathogenicity of NCC, thereby advancing prevention measures against these infections.
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Kobashi Y, Yoshioka D, Kato S, Oga T. Pneumococcal Pneumonia Co-infection with Mycobacterium avium and Nocardia cyriacigeorgica in an Immunocompetent Patient. Intern Med 2022; 61:1285-1290. [PMID: 34670879 PMCID: PMC9107980 DOI: 10.2169/internalmedicine.6895-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A 61-year-old woman was transferred with a complaint of a fever and productive cough. She had tested positive for Mycobacterium avium and Nocardia cyriacigeorgica at least twice, and Streptococcus pneumonia (PISP) was isolated (3+) from her purulent sputum. As radiological findings, a lower lung field-dominant infiltration shadow and nodular shadow with cavity were recognized in the bilateral lung fields. We diagnosed her with pneumococcal pneumonia co-infection with M. avium and N. cyriacigeorgica. She was treated with MEPM for pneumococcal pneumonia, a standard regimen containing clarithromycin for pulmonary M. avium complex (MAC) disease, and sulfamethoxazole/trimethoprim for pulmonary nocardiosis. She improved with appropriate treatment.
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Affiliation(s)
| | - Daisuke Yoshioka
- Department of Respiratory Medicine, Kawasaki Medical School, Japan
| | - Shigeki Kato
- Department of Respiratory Medicine, Kawasaki Medical School, Japan
| | - Toru Oga
- Department of Respiratory Medicine, Kawasaki Medical School, Japan
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Cheng Y, Wang TY, Yuan HL, Li W, Shen JP, He ZX, Chen J, Gao JY, Wang FK, Gu J. Nocardia Infection in Nephrotic Syndrome Patients: Three Case Studies and A Systematic Literature Review. Front Cell Infect Microbiol 2022; 11:789754. [PMID: 35141169 PMCID: PMC8819730 DOI: 10.3389/fcimb.2021.789754] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/29/2021] [Indexed: 01/23/2023] Open
Abstract
Objective The multicenter literature review and case studies of 3 patients were undertaken to provide an updated understanding of nocardiosis, an opportunistic bacterial infection affecting immunosuppressed nephrotic syndrome (NS) patients receiving long-term glucocorticoid and immunosuppressant treatment. The results provided clinical and microbiological data to assist physicians in managing nocardiosis patients. Methods Three cases between 2017 and 2018 from a single center were reported. Additionally, a systematic review of multicenter cases described in the NCBI PubMed, Web of Science, and Embase in English between January 1, 2001 and May 10, 2021 was conducted. Results This study described three cases of Nocardia infection in NS patients. The systematic literature review identified 24 cases with sufficient individual patient data. A total of 27 cases extracted from the literature review showed that most patients were > 50 years of age and 70.4% were male. Furthermore, the glucocorticoid or corticosteroid mean dose was 30.9 ± 13.7 mg per day. The average time between hormone therapy and Nocardia infection was 8.5 ± 9.7 months. Pulmonary (85.2%) and skin (44.4%) infections were the most common manifestations in NS patients, with disseminated infections in 77.8% of patients. Nodule/masses and consolidations were the major radiological manifestations. Most patients showed elevated inflammatory biomarkers levels, including white blood cell counts, neutrophils percentage, and C-reactive protein. Twenty-five patients received trimethoprim-sulfamethoxazole monotherapy (18.5%) or trimethoprim-sulfamethoxazole-based multidrug therapy (74.1%), and the remaining two patients (7.4%) received biapenem monotherapy. All patients, except the two who were lost to follow-up, survived without relapse after antibiotic therapy. Conclusions Nephrotic syndrome patients are at high risk of Nocardia infection even if receiving low-dose glucocorticoid during the maintenance therapy. The most common manifestations of nocardiosis in NS patients include abnormal lungs revealing nodules and consolidations, skin and subcutaneous abscesses. The NS patients have a high rate of disseminated and cutaneous infections but a low mortality rate. Accurate and prompt microbiological diagnosis is critical for early treatment, besides the combination of appropriate antibiotic therapy and surgical drainage when needed for an improved prognosis.
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Affiliation(s)
- Yan Cheng
- Department of Basic Medical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Tian-yi Wang
- Department of Respiratory Medicine, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Hong-li Yuan
- Department of Radiology, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Wei Li
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jing-ping Shen
- Department of Nutrition, Beidaihe Rehabilitation and Recuperation Center, Qinhuangdao, China
| | - Zheng-xin He
- Department of Basic Medical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jing Chen
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jie-ying Gao
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Fu-kun Wang
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jiang Gu
- Department of Microbiology and Biochemical Pharmacy, College of Pharmacy, Army Medical University, Chongqing, China
- *Correspondence: Jiang Gu,
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Nocardiosis in Japan: a multicentric retrospective cohort study. Antimicrob Agents Chemother 2021; 66:e0189021. [PMID: 34902263 DOI: 10.1128/aac.01890-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Nocardia species cause a broad spectrum of infections, especially in immunocompromised patients. Given its relative rarity, data on the prognosis and distribution of nocardiosis from a large cohort are scarce. The present study aimed to scrutinize the clinical features and outcomes of nocardiosis in Japan, including one-year mortality and microbiological data. Methods The present, multicentric, retrospective cohort study enrolled patients aged ≥ 18 years with nocardiosis diagnosed between January 2010 and December 2017 and recorded their clinical and microbiological characteristics. Factors associated with one-year mortality were also determined using Cox proportional hazard analysis. Results In total, 317 patients were identified at 89 hospitals. Almost half (155/317, 48.9%) were receiving immunosuppressive agents, and 51 had disseminated nocardiosis (51/317, 16.1%). The one-year, all-cause mortality rate was 29.4% (80/272; lost to follow-up, n = 45). The most frequently isolated species was Nocardia farcinica (79/317, 24.9%) followed by the N. nova complex (61/317, 19.2%). Selected antimicrobial agents were generally effective, with linezolid (100% susceptibility [S]) and amikacin (94% S) having the most activity against Nocardia species. In Cox proportional hazard analysis, factors independently associated with one-year mortality were a Charlson Comorbidity Index score ≥ 5 (adjusted hazard ratio [aHR], 3.61; 95% confidence interval [CI], 1.95-6.71, P < 0.001) and disseminated nocardiosis (aHR, 1.79; 95%CI, 1.01-3.18, P = 0.047). Conclusions The presence of advanced comorbidities and disseminated infection, rather than variations in antimicrobial therapy or Nocardia species, were independently associated with one-year mortality.
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Abstract
PURPOSE OF REVIEW Brain nocardiosis is a rare but severe infection mostly occurring among immunocompromised patients. In this review, we present recent data on this infection and address some of the common clinical dilemmas encountered in patients with brain nocardiosis. RECENT FINDINGS Strategies used to approach a patient with suspected brain nocardiosis include the 'conservative strategy' (without early neurosurgery) and the 'neurosurgical strategy' (with early aspiration or excision of brain abscess[es]). The advantages and disadvantages of both strategies are summarised. Our opinion is that the use of the 'conservative strategy' should be limited to well-selected patients presenting with an easily accessible extra-neurological lesion(s) and have brain abscesses at low risk of treatment failure. In terms of antimicrobial therapy, we summarise the data supporting the use of a multidrug regimen in patients with brain nocardiosis.Last, we list possible reasons for treatment failure in patients with brain nocardiosis and suggest interventions to overcome them. SUMMARY Literature is scarce regarding brain nocardiosis, as a consequence of the rarity of this disease. A multidisciplinary and individualised management is required to optimise the outcome of patients with brain nocardiosis.
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Derungs T, Leo F, Loddenkemper C, Schneider T. Treatment of disseminated nocardiosis: a host-pathogen approach with adjuvant interferon gamma. THE LANCET. INFECTIOUS DISEASES 2021; 21:e334-e340. [PMID: 34425068 DOI: 10.1016/s1473-3099(20)30920-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 11/03/2020] [Accepted: 11/16/2020] [Indexed: 12/19/2022]
Abstract
Disseminated nocardiosis is a rare, life-threatening disease. Particularly at risk are immunocompromised patients, highlighting the crucial role of host factors. Conventional intensive antibiotic treatment has improved survival rates, but the overall prognosis of patients with disseminated nocardiosis remains unsatisfactory. In this Grand Round, we present a case of severe nocardiosis that did not respond to standard therapy. The patient's condition deteriorated when antibiotic therapy was given alone and improved substantially only after coadministration of interferon gamma. We review the literature relevant to adjuvant interferon gamma therapy of nocardiosis and discuss its potential harms and benefits. Overall, we consider such treatment as beneficial and low risk if the patient is followed-up closely. We conclude that clinicians should consider this regimen in refractory cases of severe Nocardia infection.
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Affiliation(s)
- Thomas Derungs
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany; Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.
| | - Fabian Leo
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany; Department of Respiratory Medicine, Evangelische Lungenklinik, Berlin, Germany
| | | | - Thomas Schneider
- Department of Gastroenterology, Infectious Disease and Rheumatology, Charité Universitätsmedizin Berlin, Germany
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Conan PL, Matignon M, Bleibtreu A, Guillot H, Van Laecke S, Brenier H, Crochette R, Melica G, Fernández-Ruiz M, Dantal J, Walti LN, Levi C, Chauvet C, De Greef J, Marbus SD, Mueller NJ, Ieven M, Vuotto F, Lortholary O, Coussement J, Lebeaux D. Trimethoprim/sulfamethoxazole for nocardiosis in solid organ transplant recipients: Real-life data from a multicentre retrospective study. Transpl Infect Dis 2021; 23:e13669. [PMID: 34143917 DOI: 10.1111/tid.13669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/28/2021] [Accepted: 06/02/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Little is known regarding the optimal management of nocardiosis among solid organ transplant (SOT) recipients. It is often suggested to avoid trimethoprim/sulfamethoxazole (TMP-SMX) monotherapy in heavily immunocompromised patients (such as SOT recipients) and/or in case of severe or disseminated nocardiosis. Our aim was to report our experience with TMP-SMX monotherapy in SOT recipients with nocardiosis. METHODS Using data from a previously published European study, we assessed the incidence of adverse events in SOT recipients receiving TMP-SMX monotherapy and assessed its effectiveness. RESULTS Thirty-one SOT recipients with nocardiosis were included, mostly kidney transplant recipients (20/31, 65%). Eleven (36%) had disseminated infection, and four (13%) had brain nocardiosis. Most patients had lung and/or pleural involvement (26/31, 84%). Daily dose of trimethoprim at initiation was 10 [6.4-14.8] mg/kg. The median estimated glomerular filtration rate at time of diagnosis of nocardiosis was 44 [30-62] ml/min/1.73 m². TMP-SMX was discontinued prematurely in one third of the patients (10/31, 32%, mostly for hematological toxicity [n = 3] or increased serum creatinine [n = 3]). Focusing on the 24 (77%) patients who completed at least 30 days of TMP-SMX monotherapy, 4 had late (>30 days) drug discontinuation, 1 experienced treatment failure, and 19 completed planned TMP-SMX monotherapy. Clinical outcome was favorable in these 19 patients, despite the fact that 8 (42%) had disseminated infection and 2 (11%) brain nocardiosis. Overall, all-cause 1-year mortality was 10% (3/31). CONCLUSIONS TMP-SMX monotherapy appears to be effective for the treatment of most nocardiosis among SOT recipients. Interventional studies are needed to compare its safety and effectiveness with those of other regimens used to treat posttransplant nocardiosis.
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Affiliation(s)
- Pierre-Louis Conan
- Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Marie Matignon
- Nephrology and Transplantation Department, Centre d'investigation Clinique-biotherapies 504 and Institut national de la santé et de la recherche médicale U955, Université paris-Est, groupe Henri Mondor-Albert Chenevier, Créteil, France
| | - Alexandre Bleibtreu
- Service de maladies infectieuses et tropicales, Hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Paris, France
| | - Hélène Guillot
- Service de maladies infectieuses et tropicales, Hôpitaux universitaires Pitié-Salpêtrière-Charles-Foix, Paris, France
| | | | - Henri Brenier
- Service de néphrologie, Centre hospitalier Universitaire Pontchaillou, Université de Rennes, Rennes, France
| | - Romain Crochette
- Service de néphrologie, Centre hospitalier Universitaire Pontchaillou, Université de Rennes, Rennes, France
| | - Giovanna Melica
- Immunologie clinique et maladies infectieuses, Centre Hospitalier Universitaire Henri Mondor, Créteil, France
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, University Hospital, Instituto de Investigación Hospital, Madrid, Spain
| | - Jacques Dantal
- Institut de Transplantation, d'Urologie et de Néphrologie, Centre hospitalier Universitaire, Nantes, France
| | - Laura N Walti
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Charlène Levi
- Service de transplantation, néphrologie et immunologie Clinique, Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Cécile Chauvet
- Service de transplantation, néphrologie et immunologie Clinique, Hospices civils de Lyon, Hôpital Edouard Herriot, Lyon, France
| | - Julien De Greef
- Service de médecine interne et maladies infectieuses, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Sierk D Marbus
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Nicolas J Mueller
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Swiss Transplant Cohort Study, Zurich, Switzerland
| | - Margareta Ieven
- Department of Medical Microbiology, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Fanny Vuotto
- Infectious Diseases Unit, Centre Hospitalier Universitaire de Lille, Lille, France
| | - Olivier Lortholary
- Université de Paris, AP-HP, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine, Paris, France
| | - Julien Coussement
- Division of Infectious Diseases, CUB-Hôpital Erasme, Université libre de Bruxelles, Brussels, Belgium
| | - David Lebeaux
- Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.,Université de Paris, AP-HP, Hôpital Necker Enfants Malades, Centre d'Infectiologie Necker-Pasteur and Institut Imagine, Paris, France.,Université de Paris, Paris, France
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Chhatwal P, Woltemate S, Ziesing S, Welte T, Schlüter D, Vital M. Molecular characterization and improved diagnostics of Nocardia strains isolated over the last two decades at a German tertiary care center. EXCLI JOURNAL 2021; 20:851-862. [PMID: 34177407 PMCID: PMC8222631 DOI: 10.17179/excli2021-3787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 04/22/2021] [Indexed: 02/03/2023]
Abstract
Nocardiosis is a rare but life-threatening infection caused by aerobic Actinomycetes of the genus Nocardia particularly affecting immunocompromised hosts. The identification of Nocardia ssp. and antibiotic susceptibility testing by standard microbiological methods are incomplete and molecular techniques may improve diagnostics. We studied 39 Nocardia strains isolated from 33 patients between 2000 and 2018. Twenty-four patients (72.7 %) were immunocompromised. Whole genome sequencing (WGS) revealed a broad taxonomic range of those isolates spanning 13 different species, including four strains that belonged to three novel species based on average nucleotide identity (ANI < 95 % with currently available genome sequences). 16S rRNA gene analyses mirrored WGS results. Conventional MALDI-TOF analysis correctly identified 29 isolates at the species level (74.4 %). Our advanced protocol with formic acid and acetonitrile treatment increased identification to 35 isolates (89.7 %). Antibiotic resistance was tested using both a microdilution method and MIC strip testing. Results were in good concordance with an overall trimethoprim-sulfamethoxazole (SXT) resistance rate of 13.5 %. WGS of a SXT resistant N. farcinica isolate showed a deletion of several amino acids in a homolog of dihydropteroate synthase (FolP2) that was not seen in sensitive members of this species. Diversity of Nocardia isolates was high and involved many different species, suggesting that this taxon has broadly distributed mechanisms for infecting individuals. Widely applicable diagnostic methods including MALDI-TOF and 16S rRNA gene analyses correctly identified most strains. WGS additionally revealed molecular insights into SXT resistance mechanisms of clinical Nocardia isolates highlighting the potential application of (meta)genomic-based diagnostics in the future.
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Affiliation(s)
- Patrick Chhatwal
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Sabrina Woltemate
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Stefan Ziesing
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Tobias Welte
- Department of Pneumology and German Center for Lung Research, Hannover Medical School (MHH), Hannover, Germany
| | - Dirk Schlüter
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
| | - Marius Vital
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School (MHH), Hannover, Germany
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Lin J, Wu XM, Peng MF. Nocardia cyriacigeorgica infection in a patient with pulmonary sequestration: A case report. World J Clin Cases 2021; 9:2367-2372. [PMID: 33869615 PMCID: PMC8026832 DOI: 10.12998/wjcc.v9.i10.2367] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/23/2020] [Accepted: 01/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Nocardia cyriacigeorgica (N. cyriacigeorgica) infection is uncommon in clinical practice. Pulmonary sequestration complicated with N. cyriacigeorgica has not been reported in the literature. Here, we present a case of pulmonary se-questration complicated with N. cyriacigeorgica infection in an immunocom-petent woman.
CASE SUMMARY A 37-year-old woman complaining of a recurrent cough was admitted to our hospital. Pulmonary sequestration in the lower lobe of the left lung was diagnosed by enhanced computed tomography. Bronchoalveolar lavage fluid was then collected, which showed gram positive bacilli with weakly positive modified acid-fast staining. The pathogen was identified as N. cyriacigeorgica after bacterial culture and mass spectrometry analysis. The patient was diagnosed with pulmonary sequestration complicated with N. cyriacigeorgica infection, and her symptoms quickly improved following anti-infective therapy.
CONCLUSION Nocardiosis is considered to be an opportunistic infection. This is the first report of pulmonary sequestration complicated with N. cyriacigeorgica infection in a patient with normal immunity.
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Affiliation(s)
- Jian Lin
- Department of Respiratory and Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Xiao-Mai Wu
- Department of Respiratory and Critical Care Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
| | - Min-Fei Peng
- Department of Clinical Laboratory, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, Zhejiang Province, China
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Pulmonary Nocardiosis and Cryptococcosis Co-Infection in First Diagnosis of HIV Infection. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2021. [DOI: 10.1097/ipc.0000000000000934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Fatahi-Bafghi M. Role of Williamsia and Segniliparus in human infections with the approach taxonomy, cultivation, and identification methods. Ann Clin Microbiol Antimicrob 2021; 20:10. [PMID: 33485346 PMCID: PMC7825236 DOI: 10.1186/s12941-021-00416-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 01/12/2021] [Indexed: 02/01/2023] Open
Abstract
The genera Williamsia and Segniliparus are of aerobic actinomycetes and at the time of writing, they have 12 and 2 species, respectively. These genera cause various infections in humans. In this review, we surveyed their taxonomy, isolation, identification, as well as their role to cause human infections.
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Affiliation(s)
- Mehdi Fatahi-Bafghi
- Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran.
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22
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Harris DM, Dumitrascu AG, Chirila RM, Omer M, Stancampiano FF, Hata DJ, Meza Villegas DM, Heckman MG, Cochuyt JJ, Alvarez S. Invasive Nocardiosis in Transplant and Nontransplant Patients: 20-Year Experience in a Tertiary Care Center. Mayo Clin Proc Innov Qual Outcomes 2021; 5:298-307. [PMID: 33997629 PMCID: PMC8105525 DOI: 10.1016/j.mayocpiqo.2020.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To present the clinical characteristics and outcome of transplant and nontransplant patients with invasive nocardiosis. Patients and Methods We conducted a retrospective chart review of 110 patients 18 years and older diagnosed with culture-proven invasive nocardiosis (defined as the presence of clinical signs and/or radiographic abnormalities) between August 1, 1998, and November 30, 2018. Information on demographic, clinical, radiographic, and microbiological characteristics as well as mortality was collected. Results One hundred ten individuals with invasive nocardiosis were identified, of whom 54 (49%) were transplant and 56 nontransplant (51%) patients. Most transplant patients were kidney and lung recipients. The overall mean age was 64.9 years, and transplant patients had a higher prevalence of diabetes and chronic kidney disease. A substantial proportion of nontransplant patients were receiving corticosteroids (39%), immunosuppressive medications (16%), and chemotherapy (9%) and had chronic obstructive pulmonary disease (20%), rheumatologic conditions (18%), and malignant neoplasia (18%). A higher proportion of transplant patients (28%) than nontransplant patients (4%) received trimethoprim-sulfamethoxazole prophylaxis. In both groups, the lung was the most common site of infection. Seventy percent of all Nocardia species isolated were present in almost equal proportion: N brasiliensis (16%), N farcinica (16%), N nova (15%), N cyriacigeorgia (13%), and N asteroides (11%). More than 90% of isolates were susceptible to trimethoprim-sulfamethoxazole, linezolid, and amikacin. There was no significant difference in mortality between the 2 groups at 1, 6, and 12 months after the initial diagnosis. Conclusion The frequency of invasive Nocardia infection was similar in transplant and nontransplant patients and mortality at 1, 6, and 12 months was similar in both groups. Trimethoprim-sulfamethoxazole prophylaxis failed to prevent Nocardia infection.
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Affiliation(s)
- Dana M Harris
- Division of Community Internal Medicine, Mayo Clinic, FL
| | | | - Razvan M Chirila
- Division of International and Executive Medicine, Mayo Clinic, FL
| | | | | | - D Jane Hata
- Division of Laboratory Medicine and Pathology, Mayo Clinic, FL
| | | | | | - Jordan J Cochuyt
- Division of Biomedical Statistics and Informatics, Mayo Clinic, FL
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Margalit I, Lebeaux D, Tishler O, Goldberg E, Bishara J, Yahav D, Coussement J. How do I manage nocardiosis? Clin Microbiol Infect 2021; 27:550-558. [PMID: 33418019 DOI: 10.1016/j.cmi.2020.12.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nocardiosis is a rare infection that is often difficult to treat and may be life-threatening. There is no consensus on its management. OBJECTIVES Our aim was to provide the current evidence for the diagnosis and management of individuals with nocardiosis, and to propose a management approach for this uncommon infection. SOURCES We systematically searched the medical literature on nocardiosis for studies published between 2010 and 2020 and describing ten or more individuals. CONTENT Nocardiosis, a primarily opportunistic infection which may occur in immunocompetent persons, most commonly involves the lungs and frequently disseminates to other sites including the central nervous system. The reference standard for Nocardia species identification is molecular biology, and the preferred method for antibiotic susceptibility testing (AST) is broth microdilution. Monotherapy seems appropriate for patients with primary skin nocardiosis or non-severe pulmonary disease; we reserve a multidrug regimen for more severe infections. Species identification and AST results are often missing at initiation of antibiotics. Trimethoprim-sulfamethoxazole is the preferred agent for initial therapy, because Nocardia is very often susceptible to this agent, and because it has been the keystone of nocardiosis treatment for years. Linezolid, to which Nocardia is almost always susceptible, may be an alternative. When combination therapy is required, the repertoire of companion drugs includes third-generation cephalosporins, amikacin and imipenem. Therapeutic modifications should take into account clinical response to initial therapy and AST results. Treatment duration of 6 months is appropriate for most situations, but longer durations are preferred for disseminated nocardiosis and shorter durations are reasonable in low-risk situations. Secondary prophylaxis may be considered in selected individuals with permanent immunosuppression. IMPLICATIONS We hereby provide the clinician with an easy-to-use algorithm for the management of individuals with nocardiosis. We also illuminate gaps in evidence and suggest future research directions.
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Affiliation(s)
- Ili Margalit
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - David Lebeaux
- Université de Paris, Paris, France; Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Ori Tishler
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Elad Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Julien Coussement
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
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Lafont E, Conan PL, Rodriguez-Nava V, Lebeaux D. Invasive Nocardiosis: Disease Presentation, Diagnosis and Treatment - Old Questions, New Answers? Infect Drug Resist 2020; 13:4601-4613. [PMID: 33376366 PMCID: PMC7764858 DOI: 10.2147/idr.s249761] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022] Open
Abstract
Nocardia spp. is an environmental filamentous Gram-positive bacterium that may cause infections in humans and, despite recent progress, many challenges remain regarding the management of nocardiosis. This review aims at describing most recently published data regarding the diagnosis, treatment and follow-up of patients with invasive nocardiosis. As nocardiosis mainly affects patients with cell-mediated immunity defects, a comprehensive workup is mandatory in case of invasive nocardiosis occurring in ”apparently healthy patients”. Indeed, invasive nocardiosis might reveal an unknown primary immunodeficiency or the presence of anti-GM-CSF autoantibodies. Even if the diagnosis of nocardiosis mostly relies on direct examination and bacterial culture, a genus-specific PCR may be used for the detection of Nocardia, when directly performed on a clinical sample. Brain imaging should always be performed, even in the absence of neurological symptoms. Cotrimoxazole (trimethoprim/sulfamethoxazole), linezolid, parenteral cephalosporins, carbapenems and amikacin may be used as initial antibiotics to treat nocardiosis. Cotrimoxazole or linezolid can be used as monotherapy in selected patients without brain involvement. Although treatment duration has historically been set to at least 6 months in the absence of central nervous system involvement, shorter durations (<120 days) seem to be associated with a favourable outcome.
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Affiliation(s)
- Emmanuel Lafont
- Department of Infectious Diseases and Tropical Medicine, Université de Paris, Necker-Enfants Malades University Hospital, Centre d'Infectiologie Necker-Pasteur, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris, France
| | - Pierre-Louis Conan
- Service de Maladies Infectieuses et Tropicales, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
| | - Véronica Rodriguez-Nava
- Research Group on Bacterial Opportunistic Pathogens and Environment UMR5557 Écologie Microbienne, French Observatory of Nocardiosis, Université de Lyon 1, CNRS, VetAgro Sup, Lyon, France
| | - David Lebeaux
- Université de Paris, Paris 75006, France.,Service de Microbiologie, Unité Mobile d'Infectiologie, Hôpital Européen Georges Pompidou, Assistance Publique - Hôpitaux de Paris (AP-HP), Paris 75015, France
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Chan DECY, Hamed D, Lennon D, Wark P. Severe Nocardia pneumonia in an immunocompromised patient with alpha-1 antitrypsin deficiency. Respirol Case Rep 2020; 8:e00670. [PMID: 33005425 PMCID: PMC7511778 DOI: 10.1002/rcr2.670] [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: 06/11/2020] [Revised: 08/26/2020] [Accepted: 09/12/2020] [Indexed: 11/12/2022] Open
Abstract
Pulmonary nocardiosis is an uncommon pulmonary infection that is more likely found in immunocompromised patients with underlying chronic lung disease. The presentation of pulmonary nocardiosis is widely variable and shares features with other types of pulmonary infections. Nocardia is also not as easily isolated on standard culture mediums and hence more difficult to identify. We describe the case of a patient with a severe necrotising pneumonia who was chronically immunosuppressed with steroids and has alpha-1 antitrypsin deficiency.
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Affiliation(s)
- Daryl E. C. Y. Chan
- Department of Respiratory and Sleep MedicineJohn Hunter HospitalNewcastleNSWAustralia
| | - Dima Hamed
- Department of Respiratory and Sleep MedicineJohn Hunter HospitalNewcastleNSWAustralia
| | | | - Peter Wark
- Department of Respiratory and Sleep MedicineJohn Hunter HospitalNewcastleNSWAustralia
- Centre for Healthy LungsUniversity of NewcastleNewcastleNSWAustralia
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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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Deterding L, Körner T, Borte G, Wirtz H, Seyfarth HJ. Nocardiosis mimicking lung cancer in a heart transplant patient with end-stage renal disease. Respir Med Case Rep 2020; 30:101101. [PMID: 32528841 PMCID: PMC7283146 DOI: 10.1016/j.rmcr.2020.101101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/20/2020] [Indexed: 12/21/2022] Open
Abstract
Nocardiosis is a rare bacterial opportunistic infection that most commonly manifests as lung disease. However, disseminated infection and abscess formation can occur. Due to diverse radiographic findings and difficult cultivation it is not an easy diagnosis to make. Antibiotics such as Trimethoprimsulfamethoxazole alone or in combination with imipenem or imipenem in combination with amikacin need to be administered over a period of at least six to twelve weeks. We report a case of a 64-year old female heart transplant recipient requiring dialysis who suffered from dyspnea and a productive cough among other symptoms. Computed tomography revealed a tumor in the left upper lobe suggesting lung cancer. Both transbronchial and transthoracic biopsy could not confirm a malignant disease. Finally, Nocardia nova was isolated from a bronchoalveolar lavage and specific antibiotic treatment was initiated. As a result, the mass in the left upper lobe significantly regressed after a few weeks.
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Affiliation(s)
- Lea Deterding
- Department of Pneumology, University Hospital of Leipzig, Germany
| | - Tina Körner
- Department of Pneumology, University Hospital of Leipzig, Germany
| | - Gudrun Borte
- Department of Radiology, University Hospital of Leipzig, Germany
| | - Hubert Wirtz
- Department of Pneumology, University Hospital of Leipzig, Germany
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