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Yang CH, Kuo SF, Chen FJ, Lee CH. Clinical manifestations and outcome of nocardiosis and antimicrobial susceptibility of Nocardia species in southern Taiwan, 2011-2021. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2023; 56:382-391. [PMID: 36456442 DOI: 10.1016/j.jmii.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 10/15/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Nocardiosis is an uncommon infectious disease. This study aimed to assess the clinical outcome of patients with nocardiosis and examine the antimicrobial susceptibility profiles of Nocardia spp. isolated. METHODS We retrospectively reviewed the medical records of all inpatients diagnosed with nocardiosis between 2011 and 2021. The identification of Nocardia spp. at the species level was performed with the use of MALDI-TOF and 16S rRNA assays. The antimicrobial susceptibility of Nocardia spp. was performed using the microbroth dilution method. Factors associated with 90-day all-cause mortality were identified in multivariate logistic regression analysis. RESULTS Of 60 patients with nocardiosis in the 11-year study period, the lungs (55.0%) were the most common site of involvement, followed by the skin and soft tissue (45.0%). Twenty-two patients (36.7%) died within 90 days following the diagnosis. All of the Nocardia isolates were susceptible to trimethoprim-sulfamethoxazole, linezolid, and amikacin, whereas more than 70% of the isolates were not susceptible to ciprofloxacin, imipenem-cilastatin, moxifloxacin, cefepime, and clarithromycin. Nocardiosis involving the lungs (relative risk [RR], 9.99; 95% confidence interval [CI], 1.52-65.50; p = 0.02), nocardiosis involving the skin and soft tissue (RR, 0.15; 95% CI, 0.02-0.92; p = 0.04), and treatment with trimethoprim-sulfamethoxazole (RR, 0.14; 95% CI, 0.03-0.67; p = 0.01) were independently associated with 90-day all-cause mortality. CONCLUSIONS Nocardia spp. identified between 2011 and 2021 remained fully susceptible to trimethoprim-sulfamethoxazole, linezolid, and amikacin. Nocardiosis of the lungs, skin and soft tissue infection, and treatment with trimethoprim-sulfamethoxazole were independently associated with 90-day all-cause mortality.
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Affiliation(s)
- Chen-Hsun Yang
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shu-Fang Kuo
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Laboratory Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Medical Biotechnology and Laboratory Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fang-Ju Chen
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chen-Hsiang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Kaohsiung, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.
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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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Acevedo CT, Imkamp F, Marques Maggio E, Brugger SD. Primary cutaneous nocardiosis of the head and neck in an immunocompetent patient. BMJ Case Rep 2021; 14:14/5/e241217. [PMID: 34035021 DOI: 10.1136/bcr-2020-241217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Nocardiosis is known to be an opportunistic infection most commonly affecting immunocompromised patients that can lead to life-threatening conditions. Primary cutaneous disease remains a rare manifestation and unlike pulmonary or disseminated nocardiosis, it usually affects immunocompetent individuals. We present a case of a primary cutaneous nocardiosis of the head and neck after an insect bite in a healthy 50-year-old woman who had recently travelled from Greece. She presented with a painful right-sided swelling of her face and neck and an ulcerated plaque over the right temple. Biopsy of the plaque revealed inflammation with abscess formation indicating underlying infection. Culture from the biopsy showed growth of Nocardia spp and 16S rRNA gene sequence analysis identified Nocardia brasiliensis The patient was treated with trimethoprim/sulfamethoxazole and subsequently switched to amoxicillin/clavulanic acid due to a drug eruption. Antibiotic therapy was continued for a total of 3 months with complete resolution of the skin lesions.
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Affiliation(s)
- Claudio Tirso Acevedo
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Frank Imkamp
- Department of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Ewerton Marques Maggio
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Silvio Daniel Brugger
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Cárdenas-de la Garza JA, Welsh O, Cuéllar-Barboza A, Suarez-Sánchez KP, De la Cruz-Valadez E, Cruz-Gómez LG, Gallardo-Rocha A, Ocampo-Candiani J, Vera-Cabrera L. Clinical characteristics and treatment of actinomycetoma in northeast Mexico: A case series. PLoS Negl Trop Dis 2020; 14:e0008123. [PMID: 32097417 PMCID: PMC7059949 DOI: 10.1371/journal.pntd.0008123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/06/2020] [Accepted: 02/07/2020] [Indexed: 11/18/2022] Open
Abstract
Background Mycetoma is a neglected tropical disease characterized by nodules, scars, abscesses, and fistulae that drain serous or purulent material containing the etiological agent. Mycetoma may be caused by true fungi (eumycetoma) or filamentous aerobic bacteria (actinomycetoma). Mycetoma is more frequent in the so-called mycetoma belt (latitude 15° south and 30° north around the Tropic of Cancer), especially in Sudan, Nigeria, Somalia, India, Mexico, and Venezuela. The introduction of new antibiotics with fewer side effects, broader susceptibility profiles, and different administration routes has made information on actinomycetoma treatment and outcomes necessary. The objective of this report was to provide an update on clinical, therapeutic, and outcome data for patients with actinomycetoma attending a reference center in northeast Mexico. Methodology/principal findings This was a retrospective, cross-sectional, descriptive study of 31 patients (male to female ratio 3.4:1) diagnosed with actinomycetoma by direct grain examination, histopathology, culture, or serology from January 2009 to September 2018. Most lesions were caused by Nocardia brasiliensis (83.9%) followed by Actinomadura madurae (12.9%) and Actinomadura pelletieri (3.2%). About 50% of patients had bone involvement, and the right leg was the most commonly affected region in 38.7% of cases. Farmers/agriculture workers were most commonly affected, representing 41.9% of patients. The most commonly used treatment regimen was the Welsh regimen (35.5% of cases), a combination of trimethoprim/sulfamethoxazole (TMP/SMX) plus amikacin, which had a 90% cure rate, followed by TMP/SMX plus amoxicillin/clavulanic acid in 19.4% of cases with a cure rate of 100%. In our setting, 28 (90.3%) patients were completely cured and three (9.7%) were lost to follow-up. Four patients required multiple antibiotic regimens due to recurrences and adverse effects. Conclusions/significance In our sample, actinomycetoma was predominantly caused by N. brasiliensis. Most cases responded well to therapy with a combination of TMP/SMX with amikacin or TMP/SMX and amoxicillin/clavulanic acid. Four patients required multiple antibiotics and intrahospital care. Mycetoma is a chronic skin disease that can invade bone or underlying organs. Inadequate treatment may lead to long-lasting disability. Information about treatment is scarce. We report the outcomes of 31 patients with a diagnosis of bacterial actinomycetoma attending a tertiary care hospital in northeast Mexico. Most cases were treated with a combination of antibiotics including TMP/SMX plus amikacin or TMP/SMX plus amoxicillin/clavulanic acid. Cure was achieved in 90% of patients and only one required surgery.
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Affiliation(s)
- Jesús Alberto Cárdenas-de la Garza
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Oliverio Welsh
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Adrián Cuéllar-Barboza
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Karina Paola Suarez-Sánchez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Estephania De la Cruz-Valadez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Luis Gerardo Cruz-Gómez
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Anabel Gallardo-Rocha
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Jorge Ocampo-Candiani
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
| | - Lucio Vera-Cabrera
- Servicio de Dermatología, Facultad de Medicina y Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León, Monterrey, México
- * E-mail:
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Affiliation(s)
- Peter Scolding
- Chelsea and Westminster Hospital NHS Foundation Trust; London UK
| | - Ahmed Fahal
- University of Khartoum, Soba University Hospital; Mycetoma Research Centre; PO Box 102 Khartoum Sudan
| | - Rie R Yotsu
- National Center for Global Health and Medicine; Department of Dermatology; 1-21-1 Toyama Shinjuku-ku Tokyo Japan 162-8655
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Puri S, Hadayer A, Breaux A, Barr CC. Disseminated Nocardiosis with retinal abscess in a patient treated for bullous pemphigoid. Am J Ophthalmol Case Rep 2018; 10:145-147. [PMID: 29780924 PMCID: PMC5956661 DOI: 10.1016/j.ajoc.2018.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 01/15/2018] [Accepted: 02/21/2018] [Indexed: 11/05/2022] Open
Abstract
Purpose To report a case of disseminated Nocardiosis with retinal and intracranial lesions. Observations A 49-year-old woman immunosuppressed because of treatment given for bullous pemphigoid presented with altered mental status and multiple intracranial lesions on imaging. The patient was found to have multiple retinal lesions in both eyes, including a subretinal abscess in the right eye. The patient underwent brain biopsy, confirming Nocardia farcinica histopathologically and in culture. Conclusions and Importance Ocular Nocardiosis is a rare disease with varying prognosis that requires prompt diagnosis to ensure appropriate medical therapy.
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Affiliation(s)
- Sidharth Puri
- Kentucky Lions Eye Center, University of Louisville, Louisville, KY, USA, 40202
| | - Amir Hadayer
- Kentucky Lions Eye Center, University of Louisville, Louisville, KY, USA, 40202
| | - Andrea Breaux
- Kentucky Lions Eye Center, University of Louisville, Louisville, KY, USA, 40202
| | - Charles C Barr
- Kentucky Lions Eye Center, University of Louisville, Louisville, KY, USA, 40202
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7
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Develoux M. [Mycetoma and their treatment]. J Mycol Med 2016; 26:77-85. [PMID: 27260344 DOI: 10.1016/j.mycmed.2016.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/23/2016] [Accepted: 03/29/2016] [Indexed: 11/18/2022]
Abstract
Mycetoma are chronic subcutaneous infections, endemic in dry tropical regions. It can be caused either by actinomycetes or by fungi, presenting as filamentous grains in vivo. The foot is the most common localization. The main complication is osseous involvement. Patients are rural workers living in areas situated far from medical centers. Too often, they reach well-equipped hospitals with advanced mutilating lesions. Early case detection is the first condition for good therapeutic results. Clinical presentations of actinomycetoma and eumycetoma are similar, only biological diagnosis can distinguish the two etiological forms. This distinction is essential as medical therapy for each is radically different. Precise identification of the causal agent is required for targeted treatment but it can only be realized in rare specialized laboratories. For actinomycetoma, standard therapy is trimethoprim-sulphamethoxazole (STX). Duration of treatment period is one-year minimum. In case of poor response to STX or high risk of dissemination, a combination with amikacin gave high cure rate. Other options as amoxicillin-clavulanate are available. Medical cure of actinomycetoma is generally obtained with antibiotic treatments and surgical indications are exceptional. Disappointing results were observed using antifungal in the treatment of eumycetoma and medical therapy must be completed with surgical excision. Itraconazole is now the most used drug, new triazoles are on evaluation.
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Affiliation(s)
- M Develoux
- Service de parasitologie-mycologie, hôpital Saint-Antoine, 184, rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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García-Romero MT, Lara-Corrales I, Kovarik CL, Pope E, Arenas R. Tropical Skin Diseases in Children: A Review- Part I. Pediatr Dermatol 2016; 33:253-63. [PMID: 27040351 DOI: 10.1111/pde.12831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Because of travel and migration patterns, tropical skin diseases are now seen all around the world, not just in tropical or developing countries. Nutrition, housing, and environmental factors play an important role in these infectious diseases, so when they appear out of their normal environments, their classic presentation may vary. Tropical diseases can also present differently in childhood, making their recognition, diagnosis, and management a clinical challenge. Health care providers in developed countries need to be familiar with tropical skin diseases and be able to diagnose them in returning travelers or immigrants in order to optimize care. This article aims to review the epidemiologic, clinical, diagnostic, and therapeutic aspects of some of the most common tropical dermatologic conditions in children.
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Affiliation(s)
| | - Irene Lara-Corrales
- Dermatology Section, Department of Pediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Carrie L Kovarik
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Elena Pope
- Dermatology Section, Department of Pediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Roberto Arenas
- Mycology Section, Hospital General Dr. Manuel Gea González, Mexico City, Mexico
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Rouzaud C, Mainardi JL, Lortholary O, Lebeaux D. Traitement des nocardioses : plus de questions que de réponses ? ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.antinf.2014.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Scleritis Caused by In Vitro Linezolid-Resistant Nocardia asteroides. Case Rep Ophthalmol Med 2014; 2014:326957. [PMID: 25400961 PMCID: PMC4225828 DOI: 10.1155/2014/326957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/11/2014] [Indexed: 12/27/2022] Open
Abstract
Purpose. To describe a case of postoperative scleritis caused by a novel strain of Nocardia resistant to linezolid and trimethoprim-sulfamethoxazole (TMP-SMX).
Methods. Case report of a patient with microbiologically proven scleritis due to Nocardia asteroides. Results. The patient presented with pain, redness, and nodules on the sclera three months following pterygium excision with mitomycin C and amniotic membrane placement. As no response was noted with empiric treatment for bacterial scleritis, debridement was performed. The cytopathology report showed gram positive filamentous bacteria. A presumptive diagnosis of Nocardia scleritis was made and therapy was initiated based on a literature review on treatments for Nocardia infections. Cultures returned growing Nocardia asteroides. Antibiotic sensitivity testing revealed resistance to linezolid and TMP-SMX which are the traditional drugs of choice for Nocardia. The patient was treated with amikacin and imipenem as well as extensive debridement with pedicle grafts. The patient's scleritis resolved with a good visual outcome. Conclusions. Cultures should be obtained in all cases of necrotizing scleritis in patients with a recent history of conjunctival surgery to rule out unusual organisms such as Nocardia. Although literature states that resistance to linezolid and TMP-SMX is rare in Nocardia, sensitivity testing can be useful in unresponsive cases.
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Nocardia mikamiia Novel Species Causing Disseminated Nocardiosis: A Literature Review of Disseminated Nocardiosis. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:869153. [PMID: 27437492 PMCID: PMC4897366 DOI: 10.1155/2014/869153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 07/10/2014] [Indexed: 11/18/2022]
Abstract
Nocardiais an uncommon Gram-positive organism. It typically appears as delicate filamentous Gram-positive branching rods. In the United States it was estimated to be approximately 500 to 1000 new cases per year. The organism causes disease in immunocompromised individuals with pulmonary infection representing the most common site of infection.Nocardia mikamiihas been a recently isolated pathogen and not many cases of disseminated infection with this organism has been reported in the literature; we present a case of disseminated nocardiosis (mikamii sp.) in an immunocompromised patient. We also present a literature review on nocardiosis.
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Welsh O, Vera-Cabrera L, Salinas-Carmona MC. Current treatment for nocardia infections. Expert Opin Pharmacother 2013; 14:2387-98. [DOI: 10.1517/14656566.2013.842553] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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13
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Clinical characteristics of Nocardia infection in patients with rheumatic diseases. Clin Dev Immunol 2013; 2013:818654. [PMID: 24171035 PMCID: PMC3792524 DOI: 10.1155/2013/818654] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 08/26/2013] [Indexed: 12/29/2022]
Abstract
Although Nocardiosis has considerable recurrence and mortality rates, characteristics and risk factors of Nocardia infection have not been assessed in patients with rheumatic diseases. Here, we examined the characteristics and risk factors of Nocardia infection in rheumatic disease patients in our hospital. Ten rheumatic disease patients who developed Nocardia infection were identified by retrospectively reviewing the medical records. Possible predisposing factors for Nocardia infection were high-dose glucocorticoid treatment, concomitant use of immunosuppressants, preexisting pulmonary diseases, and diabetes mellitus. All patients had pulmonary Nocardiosis, and six of them had disseminated Nocardiosis when their pulmonary lesions were identified.
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KRESCH-TRONIK NS, CARRILLO-CASAS EM, ARENAS R, ATOCHE C, DEL RÍO-ÁVILA C, OCHOA-CARRERA LA, MARTÍNEZ-HERNÁNDEZ F, XICOHTENCATL-CORTES J, LEYVA-LEYVA M, HERNÁNDEZ-CASTRO R. First case of mycetoma associated withNocardia takedensis. J Dermatol 2012; 40:135-6. [DOI: 10.1111/1346-8138.12009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Erika M. CARRILLO-CASAS
- Department of Molecular Biology and Histocompatibility; Hospital General “Dr Manuel Gea González”; México City
| | - Roberto ARENAS
- Department of Micology; Hospital General “Dr Manuel Gea González”; México City
| | - Carlos ATOCHE
- Department of Micology; Dermatological center “Dr Fernando Latapí”; Mérida; Yucatán; México City
| | - Carolina DEL RÍO-ÁVILA
- Department of Ecology of Pathogen Agents; Hospital General “Dr Manuel Gea González”; México City
| | - Luis A. OCHOA-CARRERA
- Department of Ecology of Pathogen Agents; Hospital General “Dr Manuel Gea González”; México City
| | | | | | - Margarita LEYVA-LEYVA
- Department of Molecular Biology and Histocompatibility; Hospital General “Dr Manuel Gea González”; México City
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Kresch-Tronik NS, Carrillo-Casas EM, Arenas R, Atoche C, Ochoa-Carrera LA, Xicohtencatl-Cortes J, Manjarrez-Hernández ÁH, Hernández-Castro R. Nocardia harenae, an uncommon causative organism of mycetoma: report on two patients. J Med Microbiol 2012; 61:1153-1155. [DOI: 10.1099/jmm.0.042044-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Erika M. Carrillo-Casas
- Departamento de Biología Molecular e Histocompatibilidad, Hospital General ‘Dr Manuel Gea González’, Tlalpan 14080, Mexico
| | - Roberto Arenas
- Departamento de Micología, Hospital General ‘Dr Manuel Gea González’, Tlalpan 14080, Mexico
| | - Carlos Atoche
- Departamento de Micología, Centro Dermatológico ‘Dr Fernando Latapí’. Mérida, Yucatán, Mexico
| | - Luis A. Ochoa-Carrera
- Departamento de Ecología de Agentes Patógenos, Hospital General ‘Dr Manuel Gea González’, Tlalpan 14080, Mexico
| | | | - Ángel H. Manjarrez-Hernández
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rigoberto Hernández-Castro
- Departamento de Ecología de Agentes Patógenos, Hospital General ‘Dr Manuel Gea González’, Tlalpan 14080, Mexico
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Salinas-Carmona MC, Rosas-Taraco AG, Welsh O. Systemic increased immune response to Nocardia brasiliensis co-exists with local immunosuppressive microenvironment. Antonie van Leeuwenhoek 2012; 102:473-80. [PMID: 22825801 DOI: 10.1007/s10482-012-9779-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 07/16/2012] [Indexed: 11/26/2022]
Abstract
Human diseases produced by pathogenic actinomycetes are increasing because they may be present as opportunistic infections. Some of these microbes cause systemic infections associated with immunosuppressive conditions, such as chemotherapy for cancer, immunosuppressive therapy for transplant, autoimmune conditions, and AIDS; while others usually cause localized infection in immunocompetent individuals. Other factors related to this increase in incidence are: antibiotic resistance, not well defined taxonomy, and a delay in isolation and identification of the offending microbe. Examples of these infections are systemic disease and brain abscesses produced by Nocardia asteroides or the located disease by Nocardia brasiliensis, named actinomycetoma. During the Pathogenic Actinomycetes Symposium of the 16th International Symposium on Biology of Actinomycetes (ISBA), held in Puerto Vallarta, Mexico, several authors presented recent research on the mechanisms by which N. brasiliensis modulates the immune system to survive in the host and advances in medical treatment of human actinomycetoma. Antibiotics and antimicrobials that are effective against severe actinomycetoma infections with an excellent therapeutic outcome and experimental studies of drugs that show promising bacterial inhibition in vivo and in vitro were presented. Here we demonstrate a systemic strong acquired immune response in humans and experimental mice at the same time of a local dominance of anti inflammatory cytokines environment. The pathogenic mechanisms of some actinomycetes include generation of an immunosuppressive micro environment to evade the protective immune response. This information will be helpful in understanding pathogenesis and to design new drugs for treatment of actinomycetoma.
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Welsh O, Vera-Cabrera L, Welsh E, Salinas MC. Actinomycetoma and advances in its treatment. Clin Dermatol 2012; 30:372-81. [DOI: 10.1016/j.clindermatol.2011.06.027] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
“Mycetoma” means a fungal tumor. Mycetoma is a chronic, granulomatous, subcutaneous tissue infection caused by both bacteria (actinomycetoma) and fungi (eumycetoma). This chronic infection was termed Madura foot and eventually mycetoma, owing to its etiology. Inoculation commonly follows minor trauma, predominantly to the foot and hence is seen more among the barefoot-walking populations, common among adult males aged 20 to 50 years. The hallmark triad of the disease includes tumefaction, fistulization of the abscess, and extrusion of colored grains. The color of these extruded grains in the active phase of the disease offers a clue to diagnosis. Radiology, ultrasonology, cytology, histology, immunodiagnosis, and culture are tools used in diagnosis. Recently, DNA sequencing has also been used successfully. Though both infections manifest with similar clinical findings, Actinomycetoma has a rapid course and can lead to amputation or death secondary to systemic spread. However, actinomycetomas are more responsive to antibiotics, whereas eumycetomas require surgical excision in addition to antifungals. Complications include secondary bacterial infections that can progress to full-blown bacteremia or septicemia, resulting in death. With extremely disfiguring sequelae, following the breakdown of the nodules and formation of discharging sinuses, it poses a therapeutic challenge.
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Ameen M, Vargas F, Arenas R, Mercado EVD. Successful treatment of Nocardia actinomycetoma with meropenem and amikacin combination therapy. Int J Dermatol 2011; 50:443-5. [DOI: 10.1111/j.1365-4632.2010.04748.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ogawa T, Kasahara K, Yonekawa S, Nakagawa C, Maeda K, Konishi M, Mikasa K, Kikuchi K. Nocardia beijingensis pulmonary infection successfully treated with intravenous beta-lactam antibiotics and oral minocycline. J Infect Chemother 2011; 17:706-9. [PMID: 21409529 DOI: 10.1007/s10156-011-0233-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 02/08/2011] [Indexed: 10/18/2022]
Abstract
We report a case of pulmonary infection caused by a rare Nocardia species, Nocardia beijingensis, in a 48-year-old man who received multiple immunosuppressive therapy after renal transplantation. This pathogen was isolated from a bronchoscopic protected specimen brush and was identified as N. beijingensis by 16S rRNA gene sequence analysis. The patient was initially treated with imipenem/cilastatin followed by ceftriaxone and oral minocycline. Traditionally, trimethoprim-sulfamethoxazole (SXT) has been one of the first-line antibiotics chosen as an initial therapy for pulmonary nocardiosis, but this case was successfully treated without SXT. Considering recent reports about failures of both prophylaxis and treatment for nocardial infections with SXT and its various side effects, treatment with beta-lactam antibiotics and minocycline for pulmonary nocardiosis can be chosen in mild to moderate cases with confirmed susceptibility to these antibiotics in vitro.
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Affiliation(s)
- Taku Ogawa
- Center for Infectious Diseases, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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Hu Y, Zheng D, Takizawa K, Mikami Y, Dai L, Yazawa K, Fukushima K, Lu C, Xi L. Systemic nocardiosis caused by Nocardia concava in China. Med Mycol 2011; 49:662-6. [PMID: 21284569 DOI: 10.3109/13693786.2011.555849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 42-year-old man with polychondritis and a 2-year history of using low-dose prednisone and other immunosuppressive drugs was admitted to our hospital due to persistent high fever of 10 days duration. A strain of Nocardia was twice isolated from his blood and subsequently identified to be N. concava. The patient was initially treated with sulphadiazine sodium, vancomycin and imipenema for 7 days but the symptoms persisted. Consequently, the regimen was changed to sulphadiazine sodium, ciprofloxacin and amikacin sulfate based on the antibiotic susceptibility tests of the Nocardia isolate. The fever disappeared and the patient's condition improved after 10 days of this treatment to the extent that he was discharged. However, 7 days later, the patient's condition deteriorated and he died due to multiple organ failure. This is the first report of N. concava causing systemic nocardiosis in China.
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Affiliation(s)
- Yongxuan Hu
- Department of Dermatology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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