1
|
Bouhamdani N, Comeau D, Bourque C, Saulnier N. Encephalic nocardiosis after mild COVID-19: A case report. Front Neurol 2023; 14:1137024. [PMID: 36908618 PMCID: PMC9992866 DOI: 10.3389/fneur.2023.1137024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
The COVID-19 pandemic and the associated post-acute sequelae of COVID-19 (PASC) have led to the identification of a complex disease phenotype that is associated with important changes in the immune system. Herein, we describe a unique case of Nocardia farcinica cerebral abscess in an individual with sudden immunodeficiency several months after mild COVID-19. Intravenous Bactrim and Imipenem were prescribed for 6 weeks. After this, a 12-month course of Bactrim and Clavulin was prescribed to be taken orally, given the N. farcinica infection at the level of the central nervous system. This case report highlights the need for future research into the pathophysiology of COVID-19 and PASC immune dysregulation in convalescent individuals. It also draws attention to the need for timely consideration of opportunistic infections in patients with a history of COVID-19.
Collapse
Affiliation(s)
- Nadia Bouhamdani
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Formation Médicale du Nouveau-Brunswick, Université de Moncton, Moncton, NB, Canada
| | - Dominique Comeau
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| | - Christine Bourque
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| | - Nancy Saulnier
- Vitalité Health Network, Dr. Georges-L.-Dumont University Hospital Center, Research Sector, Moncton, NB, Canada
| |
Collapse
|
2
|
Wu J, Li X, Zhang T, Lin X, Chen YC. Disseminated Nocardia farcinica involves the spinal cord: a case report and review of the literature. BMC Infect Dis 2021; 21:1224. [PMID: 34876035 PMCID: PMC8650257 DOI: 10.1186/s12879-021-06905-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/25/2021] [Indexed: 11/10/2022] Open
Abstract
Background Nocardia is a relatively rare opportunistic pathogenic bacteria group, commonly seen in patients with immunocompromised or defective immune system. It can affect multiple organs of the body and cause disseminated infection, among which most occurs in the lung, secondly in the nervous system, soft tissues, rare in the spinal cord and pituitary. No case has been reported involving lung, spinal cord, skin and pituitary gland at the same time. Case presentation We report a 55-year-old female with Nocardia infection involving the lung, skin, spinal cord, and pituitary gland. The patient underwent a full set of imaging examinations and showed typical imaging findings. Chest computed tomography (CT) showed multiple nodules with cavities in the lungs. The magnetic resonance imaging (MRI) of the vertebral body showed abnormal signal of the entire spinal cord with cavity formation and ring enhancement. The subcutaneous nodules of the abdomen were punctured under ultrasound. Through the etiological tissue culture of subcutaneous nodules and the second generation sequencing of cerebrospinal fluid, the diagnosis was finally confirmed. Conclusion Disseminated Nocardiosis is an uncommon disease. This article will report a rare case of disseminated Nocardiosis simultaneously involving the lung, spinal cord, subcutaneous soft tissue and pituitary gland, especially with neuropathy as the initial symptom. Imaging is helpful for the early diagnosis of the disease and pathological and microbiological examinations are helpful for its confirming.
Collapse
Affiliation(s)
- Jing Wu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 21006, People's Republic of China
| | - Xiaoran Li
- Department of Radiology, Nanjing Gaochun People's Hospital, Nanjing, Jiangsu, People's Republic of China
| | - Tao Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 21006, People's Republic of China
| | - Xin Lin
- Department of Laboratory, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, People's Republic of China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, Nanjing, 21006, People's Republic of China.
| |
Collapse
|
3
|
Harris L, Raducanu I, Low HL. Treatment of Nocardial Brain Abscess in a Patient With Systemic Lupus Erythematosus and Idiopathic Thrombocytopenic Purpura: Case Report and a Review of the Literature. Cureus 2021; 13:e17498. [PMID: 34603877 PMCID: PMC8476204 DOI: 10.7759/cureus.17498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2021] [Indexed: 11/05/2022] Open
Abstract
Brain abscesses due to Nocardia species account for 1-2% of all cerebral abscesses, often in immunosuppressed individuals, with a mortality three times higher than other cerebral abscesses. Early diagnosis and management are vital for good outcomes. We report a case of a right frontal Nocardia brain abscess in an immunosuppressed 38-year-old female. She presented with headaches, confusion, memory deficits, and personality change. She remained systemically well, with normal inflammatory markers. She underwent two open surgical drainages, with excision of the abscess wall. She made an excellent recovery with minimal edema and no contrast enhancement on imaging at eight weeks postoperatively. Management of Nocardia brain abscess includes a prompt diagnosis with direct microscopic examination and initiation of correct antibiotic therapy for good outcomes. We recommend open surgical resection, including excision of the abscess wall, followed by long-term antimicrobial therapy, to enhance the rate of recovery.
Collapse
|
4
|
Song J, Dong L, Ding Y, Zhou J. A case report of brain abscess caused by Nocardia farcinica. Eur J Med Res 2021; 26:83. [PMID: 34344465 PMCID: PMC8330121 DOI: 10.1186/s40001-021-00562-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/23/2021] [Indexed: 01/22/2023] Open
Abstract
Background Brain abscess due to the Nocardia genus is rarely reported and it is usually found in immunocompromised patients. Treatment of Nocardia brain abscess is troublesome and requires consideration of the severity of the underlying systemic disease. The difficulties in identifying the bacterium and the frequent delay in initiating adequate therapy often influence the prognosis of patients. Case presentation Here, we report a rare case of brain abscess caused by Nocardia farcinica. The patient’s medical history was complicated: he was hospitalized several times, but no pathogens were found. At last, bacteria were found in the culture of brain abscess puncture fluid; the colony was identified as Nocardia farcinica by mass spectrometry. Targeted antibiotic treatment was implemented, brain abscess tended to alleviate, but the patient eventually developed fungal pneumonia and died of acute respiratory distress syndrome (ARDS). Conclusion Brain abscess caused by Nocardia farcinica can appear in non-immunocompromised individuals. Early diagnosis, reasonable surgical intervention, and targeted antibiotic treatment are critical for Nocardia brain abscess treatment. In the treatment of Nocardia brain abscess, attention should paid be to the changes in patients’ immunity and infection with other pathogens, especially fungi, avoided.
Collapse
Affiliation(s)
- Jiangqin Song
- Laboratory Department, The First People's Hospital of Tianmen City, Tianmen, 431700, Hubei, China
| | - Lian Dong
- Oncology Department, The First People's Hospital of Tianmen City, Tianmen, 431700, Hubei, China
| | - Yan Ding
- Hubei Key Laboratory of Embryonic Stem Cell Research, Hubei University of Medicine, Shiyan, 442000, Hubei, China
| | - Junyang Zhou
- Department of Pathogen Biology and Immunology, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China.
| |
Collapse
|
5
|
Idiopathic thrombocytopenic purpura with brain abscess caused by Nocardia farcinica diagnosed using metagenomics next-generation sequencing of the cerebrospinal fluid: a case report. BMC Infect Dis 2021; 21:380. [PMID: 33892637 PMCID: PMC8066483 DOI: 10.1186/s12879-021-06071-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/14/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Brain abscesses caused by Nocardia farcinica are rare, and mostly occur in immunocompromised individuals. Rapid and accurate diagnosis of nocardiosis is challenging. Due to the inadequate performance of conventional diagnostic methods for Nocardia infection, metagenomics next-generation sequencing (mNGS) of cerebrospinal fluid (CSF) has the potential to improve the diagnosis intracranial nocardiosis. CASE PRESENTATION We report a case of 50-year-old man with brain abscess caused by Nocardia farcinica. The patient had a idiopathic thrombocytopenic purpura complication that required long-term methylprednisolone administration. His chest image showed multiple lesions, which had been misdiagnosed as lung cancer, and his head image showed multiple intracranial metastases. No pathogen was detected in routine examinations including blood culture, sputum culture and traditional culture methods of cerebrospinal fluid. In order to accurately identify the pathogen, mNGS was used to detect Nocardia in CSF. Although the patient's condition improved after using sensitive antibiotics, he transferred to the local hospital for treatment because of many complicated diseases and family financial limitations. CONCLUSION This case highlights the value of mNGS in the diagnosis of Nocardia brain abscess, and emphasizes the inadequate sensitivity of conventional diagnostic methods for Nocardia infection. Using mNGS can facilitate early and accurate detection of Norcadia-associated of meningitis in immunocompromised patients, thereby reducing unnecessary use of antibiotics and reducing mortality of the disease.
Collapse
|
6
|
Galacho-Harriero A, Delgado-López PD, Ortega-Lafont MP, Martín-Alonso J, Castilla-Díez JM, Sánchez-Borge B. Nocardia farcinica Brain Abscess: Report of 3 Cases. World Neurosurg 2017; 106:1053.e15-1053.e24. [PMID: 28729142 DOI: 10.1016/j.wneu.2017.07.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/06/2017] [Accepted: 07/07/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Central nervous system nocardial infection is a rarely reported disease that usually affects patients with predisposing and debilitating conditions but also the immunocompetent population. The most common variant affecting the brain is Nocardia farcinica. Management of brain nocardiosis is troublesome and requires consideration of the severity of the underlying systemic disease, the difficulties in identifying the bacterium, and the frequent delay in initiating adequate therapy. CASE DESCRIPTION We present 3 cases of N. farcinica brain abscess (single, multiloculated, and multifocal) diagnosed in 3 patients with predisposing factors that could be successfully cured. The patients underwent craniotomy, evacuation of the purulent collection, and partial resection of the abscesses' walls. Confirmation of N. farcinica species was achieved using specific polymerase chain reaction sequencing of the 16S ribosome RNA gene. Antibiotic therapy was selected on susceptibility tests and was maintained for 10 months (1 case) and 12 months (2 cases). CONCLUSIONS Brain nocardiosis needs to be suspected primarily (though not exclusively) in immunocompromised patients presenting with neurologic deficit and harboring intracerebral lesions resembling brain tumors. Early identification of the specific species is paramount in order to initiate long-term antibiotic therapy, acknowledging the inherent resistance of N. farcinica to third-generation cefalosporins and its susceptibility to trimethoprim-sulphamethoxazole. According to the literature, surgical excision or aspiration of the brain abscess seems to provide good chances of eradication of the disease. In our experience, successful outcome was achieved with subtotal resection and prolonged and adequate antibiotic therapy.
Collapse
|
7
|
Zhu N, Zhu Y, Wang Y, Dong S. Pulmonary and cutaneous infection caused by Nocardia farcinica in a patient with nephrotic syndrome: A case report. Medicine (Baltimore) 2017; 96:e7211. [PMID: 28614268 PMCID: PMC5478353 DOI: 10.1097/md.0000000000007211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/13/2017] [Accepted: 05/16/2017] [Indexed: 01/30/2023] Open
Abstract
RATIONALE Nocardia species is known as conditional pathogenic bacteria. Disseminated infection caused by Nocardia species is rare and occurs primarily in immunosuppressed patients. Signs and symptoms of this infection are frequently nonspecific making early diagnosis and treatment difficult. PATIENT CONCERNS We report a case of subcutaneous and pulmonary nocardiosis due to Nocardia farcinica (N farcinica) in a patient with nephrotic syndrome who is undergoing long-term corticosteroid therapy. In this patient, systemic and pulmonary symptoms (usually found in nocaria infection) such as fever, cough, and expectoration were absent. DIAGNOSES Early diagnosis was made by pus culture from subcutaneous abscesses and 16S rRNA gene sequencing, which confirm the diagnosis of N farcinica infection. INTERVENTIONS The patient was treated with combination therapy of cefatriaxone and trimethoprim-sulfamethoxazole (TMP-SMX) for 2 weeks, and the treatment with TMP-SMX continued to 6 months. OUTCOMES The abscesses were cured in 4 weeks and a lesion in the upper lobe of left lung resolved in 3 months. LESSONS This case indicates that disseminated infection due to N farcinica could occur in patients with nephrotic syndrome, even during the period of maintenance therapy with a low-dose corticosteroid and common signs and symptoms of infections could be absent.
Collapse
Affiliation(s)
| | - Yuan Zhu
- Department of Nephrology, The Third Clinical College of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, Zhejiang Province, PR China
| | | | - Shaoshao Dong
- Department of Nephrology, The Third Clinical College of Wenzhou Medical University, Wenzhou People's Hospital, Wenzhou, Zhejiang Province, PR China
| |
Collapse
|
8
|
Majeed A, Abdullah HMA, Ullah W, Al Mohajer M. First reported case of disseminated Nocardia kroppenstedtii sp nov. infection presenting with brain abscess and endocarditis in an immunocompromised patient with mantle cell lymphoma: challenges in diagnosis and treatment. BMJ Case Rep 2017; 2017:bcr-2016-217337. [PMID: 28062425 DOI: 10.1136/bcr-2016-217337] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
A 72-year-old man with a history of blastoid variant stage IV relapsed refractory mantle cell lymphoma presented with new central nervous system (CNS) symptoms. Brain imaging was positive for rim-enhancing lesions along with a mitral valve mass on the echocardiogram. It was a challenge to establish the exact aetiology of these lesions in this patient. He was empirically treated with chemotherapy on the presumption that the brain lesions were secondary to progressive malignancy. However, brain biopsy was negative for malignancy and blood cultures were found positive for Nocardia kroppenstedtii sp nov. He subsequently improved with antibiotic therapy. Disseminated Nocardia can present with multiorgan involvement. Clinical and microbiological diagnosis can be challenging. Antimicrobial treatment-related side effects require close monitoring, and dosage changes or therapy adjustments may be necessary.
Collapse
Affiliation(s)
| | | | - Waqas Ullah
- Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mayar Al Mohajer
- Department of Internal Medicine, University of Arizona, Tucson, Arizona, USA
| |
Collapse
|
9
|
Kumar VA, Augustine D, Panikar D, Nandakumar A, Dinesh KR, Karim S, Philip R. Nocardia farcinica brain abscess: epidemiology, pathophysiology, and literature review. Surg Infect (Larchmt) 2014; 15:640-6. [PMID: 25126828 DOI: 10.1089/sur.2012.205] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Infections caused by Nocardia farcinica are potentially lethal because of the organism's tendency to disseminate and resist antibiotics. Central nervous system involvement has been documented in 30% of infections caused N. farcinica. METHODS Case report and review of the literature. RESULTS A case of primary brain abscess caused by N. farcinica, identified by 16SrRNA sequencing, is presented, and 39 cases reported previously in the literature are reviewed. Our patient underwent a neuronavigation-guided right frontal craniotomy and was treated with trimethoprim/sulfamethoxazole and amoxicillin-clavulanic acid for 12 mo. He showed marginal improvement in his prior left hemiparesis at the last review 14 months later. CONCLUSION Cases of N. farcinica infections are being reported increasingly because of recent changes in taxonomy and diagnostic methodology. This change in epidemiology has implications for therapy because of the organism's pathogenicity and natural resistance to multiple antimicrobial agents, including third-generation cephalosporins. Any delay in starting appropriate antibiotic therapy can have adverse consequences.
Collapse
Affiliation(s)
- V Anil Kumar
- 1 Department of Microbiology, Amrita Institute of Medical Sciences , Kerala, India
| | | | | | | | | | | | | |
Collapse
|
10
|
Fatal Nocardia farcinica Bacteremia Diagnosed by Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry in a Patient with Myelodysplastic Syndrome Treated with Corticosteroids. Case Rep Med 2013; 2013:368637. [PMID: 23690786 PMCID: PMC3652045 DOI: 10.1155/2013/368637] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 03/28/2013] [Indexed: 12/23/2022] Open
Abstract
Nocardia farcinica is a Gram-positive weakly acid-fast filamentous saprophytic bacterium, an uncommon cause of human infections, acquired usually through the respiratory tract, often life-threatening, and associated with different clinical presentations. Predisposing conditions for N. farcinica infections include hematologic malignancies, treatment with corticosteroids, and any other condition of immunosuppression. Clinical and microbiological diagnoses of N. farcinica infections are troublesome, and the isolation and identification of the etiologic agent are difficult and time-consuming processes. We describe a case of fatal disseminated infection in a patient with myelodysplastic syndrome, treated with corticosteroids, in which N. farcinica has been isolated from blood culture and identified by Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry. The patient died after 18 days of hospitalization in spite of triple antimicrobial therapy. Nocardia farcinica infection should be suspected in patients with history of malignancy, under corticosteroid therapy, suffering from subacute pulmonary infection,and who do not respond to conventional antimicrobial therapy. Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry can be a valuable tool for rapid diagnosis of nocardiosis.
Collapse
|
11
|
Budzik JM, Hosseini M, Mackinnon AC, Taxy JB. Disseminated Nocardia farcinica: literature review and fatal outcome in an immunocompetent patient. Surg Infect (Larchmt) 2012; 13:163-70. [PMID: 22612440 DOI: 10.1089/sur.2011.012] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Nocardia farcinica is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete. Nocardia spp. are opportunistic pathogens, and N. farcinica is the least common species of clinical importance. METHODS Review of the recent literature and description of a immunocompetent patient with no known risk factors who contracted fatal N. farcinica sepsis. RESULTS Positive pre-mortem and post-mortem cultures from the lung and synovium correlated with acute bronchopneumonia and synovitis at autopsy. Colonies of filamentous bacteria, which were not apparent in conventional hematoxylin and eosin-stained sections, were observed with gram and methenamine silver stains, but acid-fast stains were negative. A literature review revealed that disseminated N. farcinica often is associated with an underlying malignant tumor or autoimmune disease (88% of patients). Chemotherapy or corticosteroid treatments are additional risk factors. CONCLUSIONS Trimethoprim-sulfamethoxazole typically is the first-line therapy for N. farcinica; treatment with amikacin and imipenem-cilastatin is used less often (7% of patients). Despite aggressive therapy, we observed that the death rate (39%) associated with N. farcinica in recent publications was eight percentage points higher than reported in a review from 2000.
Collapse
Affiliation(s)
- Jonathan M Budzik
- Department of Pathology, Pritzker School of Medicine, Chicago, Illinois, USA
| | | | | | | |
Collapse
|
12
|
Abstract
PURPOSE To review the computed tomography (CT) imaging features of pulmonary nocardiosis (PN) at the time of initial presentation. MATERIALS AND METHODS All patients from 1991 to 2008 with PN were identified (n=105). Patients without CT scan available at initial presentation were excluded (n=52). For the remaining 53 patients, standardized radiographic features were recorded. The patients were grouped by predisposing condition. Analysis includes descriptive summary statistics as well as associations among radiographic findings, associated findings, and host characteristics. Parametric and nonparametric statistical methods were used. RESULTS Median age of the patients was 52 years (range, 6 to 82 y). Some form of immunosuppression was present in 83% of the cases. Preexisting structural abnormalities of the lung were uncommon (bronchiectasis, 7; chronic obstructive pulmonary disease, 3). Twenty (38%) patients had interstitial opacities. Airspace disease was seen in 34 (64%) cases. Thirty (57%) cases revealed discrete nodules, 25 patients had 1 to 6 nodules (mean, 2), and 5 patients had fewer than 6 nodules, with the mean size of the largest nodule being 1.67 cm. Masses were seen in 11 patients (21%), 9 of whom had concomitant nodules. Cavitary lesions, including nodules, masses, or airspace disease, occurred in 40% of the cohort. Mediastinal lymphadenopathy was present in 8 (15%) patients. Fifteen patients (28%) had pleural effusions; the effusions were unilateral in 10 patients. Analysis of radiographic associations with patient groups found discrete nodules to be more often associated with immunosuppression compared with the nonimmunosuppressed group (66% vs. 11%; P=0.0067). CONCLUSION The CT presentation of PN is heterogeneous. Airspace disease appeared most frequently (in 64% of the cases), and nodules were present in 57% of the cases. Nocardiosis should be considered in the differential diagnosis of immunosuppressed patients with new nodules or masses.
Collapse
|
13
|
Frank M, Woschnagg H, Mölzer G, Finsterer J. Cerebellar nocardiosis and myopathy from long-term corticosteroids for idiopathic thrombocytopenia. Yonsei Med J 2010; 51:131-7. [PMID: 20046527 PMCID: PMC2799960 DOI: 10.3349/ymj.2010.51.1.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 05/09/2008] [Accepted: 05/14/2008] [Indexed: 11/30/2022] Open
Abstract
Infection of the central nervous system with Nocardia sp. usually manifests as supratentorial abscesses. Supratentorial and cerebellar abscesses from infection with Nocardia sp. following immunosuppression with long-term corticosteroids for idiopathic thrombocytopenia (ITP) have not been reported. An 83 years-old, human immunodeficiency virus (HIV)-negative, polymorbid male with ITP for which he required corticosteroids since age 53 years developed tiredness, dyspnoea, hemoptysis, abdominal pain, and progressive gait disturbance. Imaging studies of the lung revealed an enhancing tumour in the right upper lobe with central and peripheral necrosis, multiple irregularly contoured hyperdensities over both lungs, and right-sided pleural effusions. Sputum culture grew Nocardia sp. Neurological diagnostic work-up revealed dysarthria, dysphagia, ptosis, hypoacusis, tremor, dysdiadochokinesia, proximal weakness of the lower limbs, diffuse wasting, and stocking-type sensory disturbances. The neurological deficits were attributed to an abscess in the upper cerebellar vermis, myopathy from corticosteroids, and polyneuropathy. Meropenem for 37 days and trimethoprime-sulfamethoxazole for 3 months resulted in a reduction of the pulmonary, but not the cerebral lesions. Therefore, sultamicillin was begun, but without success. Long-term therapy with corticosteroids for ITP may induce not only steroid myopathy but also immune-incompetence with the development of pulmonary and cerebral nocardiosis. Cerebral nocardiosis may not sufficiently respond to long-term antibiotic therapy why switching to alternative antibiotics or surgery may be necessary.
Collapse
|
14
|
McPhee L, Stogsdill P, Vella J. Nocardia farcinicapericarditis after kidney transplantation despite prophylaxis. Transpl Infect Dis 2009; 11:448-53. [DOI: 10.1111/j.1399-3062.2009.00413.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
15
|
Iannotti CA, Hall GS, Procop GW, Tuohy MJ, Staugaitis SM, Weil RJ. Solitary Nocardia farcinica brain abscess in an immunocompetent adult mimicking metastatic brain tumor: rapid diagnosis by pyrosequencing and successful treatment. ACTA ACUST UNITED AC 2009; 72:74-9; discussion 79. [DOI: 10.1016/j.surneu.2008.02.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Accepted: 02/04/2008] [Indexed: 10/22/2022]
|
16
|
Kawakami O, Kenmochi J, Sugiura M, Kato H, Takagi S, Ando T. [Case report of nocardia brain abscess that needs to be distinguished from metastatic brain tumor]. Rinsho Shinkeigaku 2008; 48:401-405. [PMID: 18616150 DOI: 10.5692/clinicalneurol.48.401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
We report a 62-year-old woman presenting with nocardia brain abscess that mimics metastatic brain tumor. Six months before admission to our hospital, she presented with persistent hemoptysis, and a friable endobronchial mass was detected at another hospital. However, a definite diagnosis had not been made, and then she presented with hemianopia. Her laboratory analysis results showed that she had no immunological abnormalities. T1-weighted magnetic resonance images of the brain with Gd-DTPA revealed hyperintensive multiple masses with surrounding edema. We suspected this case as metastatic brain tumor of unknown origin, and the patient underwent biopsy of the supraclavicular lymph node. Histopathology results indicated abscess, and gram staining of material obtained from the abscess showed Gram-variable rods, which were determined upon culture as acid-fast Gram-positive branching rods and identified as Nocardia asteroides. Accordingly, we diagnosed the patient as having nocardia brain abscess, and she was treated with an oral antibiotic (TMP-SMX). Four months later, the abscesses disappeared. The patient recovered after prolonged TMP-SMX therapy with no recurrence in over 9 months.
Collapse
|
17
|
Shin N, Sugawara Y, Tsukada K, Tamura S, Akamatsu N, Okugawa S, Koike K, Kikuchi K, Makuuchi M. Successful treatment of disseminated Nocardia farcinica infection in a living-donor liver transplantation recipient. Transpl Infect Dis 2007; 8:222-5. [PMID: 17116136 DOI: 10.1111/j.1399-3062.2006.00141.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Nocardiosis is a serious infection with high mortality. We report a case of subcutaneous and neural lesions due to Nocardia farcinica infection after living-donor liver transplantation. The neural lesion was cured with antibiotics without drainage.
Collapse
Affiliation(s)
- N Shin
- Artificial Organ and Transplantation Division, Department of Surgery, University of Tokyo, Tokyo, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Everett CM, Dhillon H, Samarasinghe D, Berry L, Warwick S, Turner B. A case of cerebral nocardiosis following brief immunosuppression. Eur J Neurol 2006; 13:431-2. [PMID: 16643331 DOI: 10.1111/j.1468-1331.2006.01186.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Severo CB, Oliveira FDM, Cunha L, Cantarelli V, Severo LC. Disseminated nocardiosis due to Nocardia farcinica: diagnosis by thyroid abscess culture. Rev Inst Med Trop Sao Paulo 2006; 47:355-8. [PMID: 16553327 DOI: 10.1590/s0036-46652005000600009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A previously healthy 75-year-old white male dentist presented with a 6-month history of low-back pain treated with chronic steroid therapy had a Nocardia farcinica infection diagnosed by aspirate of thyroid abscess and six blood cultures. Despite the treatment with parenteral combination of trimethoprim/sulfamethoxazole, the patient failed to respond and died after two days of therapy. Autopsy revealed disseminated nocardiosis, involving lungs with pleural purulent exudate in both sides, heart, thyroid, kidneys, brain, bones, and lumbosacral soft tissue with destruction of L2-L4.
Collapse
Affiliation(s)
- Cecília Bittencourt Severo
- Laboratório de Micologia, Hospital Santa Rita, Santa Casa Complexo-Hospitalar, Porto Alegre, RS, Brasil.
| | | | | | | | | |
Collapse
|
20
|
Yamada SM, Nakai E, Toyonaga S, Nakabayashi H, Park KC, Shimizu K. A rapidly enlarging nocardial brain abscess mimicking malignant glioma. J NIPPON MED SCH 2005; 72:308-11. [PMID: 16247233 DOI: 10.1272/jnms.72.308] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Nocardial brain abscesses are uncommon and are not preceded by clear infectious symptoms in most cases. Delayed identification of the bacteria is responsible for a high mortality rate. A 58-year-old afebrile woman was admitted to our hospital because of progressive right hemiparesis and aphasia. Magnetic resonance imaging (MRI) showed a single ring-enhanced lesion in the left frontal lobe. It was extremely difficult to establish the diagnosis of brain abscess, because the laboratory data provided little evidence of bacterial infection, (201)TlCl-scintigraphy revealed definite accumulation of thallium in the lesion, and follow-up MRI demonstrated rapid enlargement of the lesion. Total resection was performed because of the possibility of a malignant brain tumor, but brain abscess was finally diagnosed with histological examination. A nocardial species was detected through microscopic examination of the pus obtained at surgery, and this precise diagnosis of nocardial brain abscess in the early stage enabled the administration of appropriate antibiotics and the patient's quick recovery. Nocardial brain abscesses are often misdiagnosed as malignant brain tumors, and a definitive diagnosis may not be possible without detecting bacteria from the lesion. Total excision of the abscess can produce good results when the abscess is large and located superficially, but incomplete aspiration and drainage of a lesion is associated with a high chance of relapse.
Collapse
Affiliation(s)
- Shoko M Yamada
- Department of Neurosurgery, Kochi University Medical School, Kohasu, Okoh-cho, Nankoku, Kochi 783-8505, Japan.
| | | | | | | | | | | |
Collapse
|
21
|
Lai CC, Lee LN, Teng LJ, Wu MS, Tsai JC, Hsueh PR. Disseminated Nocardia farcinica infection in a uraemia patient with idiopathic thrombocytopenia purpura receiving steroid therapy. J Med Microbiol 2005; 54:1107-1110. [PMID: 16192444 DOI: 10.1099/jmm.0.46084-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Nocardia farcinica has been reported as an increasingly frequent cause of localized and disseminated infections in immunocompromised patients in recent years, but N. farcinica bacteraemia remains a rare finding. Here, the case is described of a 68-year-old man with end-stage renal disease and idiopathic thrombocytopenia purpura treated with steroid therapy who developed disseminated infection (bacteraemia, multilobar pneumonia and brain abscesses) due to N. farcinica. The isolate was confirmed by partial sequencing analysis of the 16S rRNA gene. The patient recovered after prolonged trimethoprim-sulfamethoxazole therapy with no recurrence in over 1 year.
Collapse
MESH Headings
- Aged
- Bacteremia/microbiology
- Brain Abscess/microbiology
- Brain Abscess/pathology
- DNA, Bacterial/genetics
- DNA, Ribosomal/chemistry
- DNA, Ribosomal/genetics
- Humans
- Male
- Nocardia/classification
- Nocardia/isolation & purification
- Nocardia Infections/drug therapy
- Nocardia Infections/microbiology
- Nocardia Infections/pathology
- Pneumonia/microbiology
- Pneumonia/pathology
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/drug therapy
- RNA, Ribosomal, 16S/genetics
- Sequence Analysis, DNA
- Steroids/therapeutic use
- Trimethoprim, Sulfamethoxazole Drug Combination/administration & dosage
- Uremia/complications
Collapse
Affiliation(s)
- Chih-Cheng Lai
- Department of Internal Medicine1 and Department of Laboratory Medicine2, National University Hospital, Taipei, Taiwan 3,4School of Medical Technology3 and Center for Optoelectronic Biomedicine4, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Li-Na Lee
- Department of Internal Medicine1 and Department of Laboratory Medicine2, National University Hospital, Taipei, Taiwan 3,4School of Medical Technology3 and Center for Optoelectronic Biomedicine4, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Lee-Jene Teng
- Department of Internal Medicine1 and Department of Laboratory Medicine2, National University Hospital, Taipei, Taiwan 3,4School of Medical Technology3 and Center for Optoelectronic Biomedicine4, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming Shiou Wu
- Department of Internal Medicine1 and Department of Laboratory Medicine2, National University Hospital, Taipei, Taiwan 3,4School of Medical Technology3 and Center for Optoelectronic Biomedicine4, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jui-Chang Tsai
- Department of Internal Medicine1 and Department of Laboratory Medicine2, National University Hospital, Taipei, Taiwan 3,4School of Medical Technology3 and Center for Optoelectronic Biomedicine4, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Ren Hsueh
- Department of Internal Medicine1 and Department of Laboratory Medicine2, National University Hospital, Taipei, Taiwan 3,4School of Medical Technology3 and Center for Optoelectronic Biomedicine4, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
22
|
Viganò SM, Edefonti A, Ferraresso M, Ranzi ML, Grossi P, Righini A, Rusconi R, Santambrogio L, Ghio L. Successful medical treatment of multiple brain abscesses due to Nocardia farcinica in a paediatric renal transplant recipient. Pediatr Nephrol 2005; 20:1186-8. [PMID: 15947983 DOI: 10.1007/s00467-005-1978-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2005] [Revised: 04/01/2005] [Accepted: 04/04/2005] [Indexed: 10/25/2022]
Abstract
Brain abscesses caused by Nocardia are rare, but it is very important to detect and treat them early because the associated mortality is 3 times higher than that associated with other bacterial brain abscesses. This infection is prevalent among adults on long-term immunosuppressive therapy; we report the case of a male kidney transplant recipient aged 12.7 years who developed early multiple Nocardia-induced brain abscesses that were successfully treated with linezolid, a novel antibiotic therapy.
Collapse
Affiliation(s)
- Sara Maria Viganò
- ICP Pediatric Nephrology, Dialysis and Transplantation Unit, Milan, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Djennane S, Zecknini K, Billy C, Kamga I, Perronne V, Granier F. [Nocardia farcinica brain abscess associated with a pulmonary embolism in an immunocompetent patient]. Presse Med 2005; 34:522-4. [PMID: 15903008 DOI: 10.1016/s0755-4982(05)83964-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Nocardiosis is a rare, generally systemic infection that occurs in immunocompromised patients. We report a case of Nocardia farcinica primary brain abscess in an immunocompetent patient, unusually associated with a pulmonary embolism. OBSERVATION A 62 year-old woman without medical past was hospitalised because of a Bravais-Jacksonian type of seizure. The clinical and radiological profile was unspecific. The diagnosis was made on identification of the microorganism. The patient improved after craniotomy with excision of the abscess and appropriate antibiotic therapy for four months. DISCUSSION The N. farcinica species is distinct from others by its high degree of antibiotic resistance its virulence. We insist on the need to identify not only the microorganism but also the species concerned because this may influence the treatment strategy.
Collapse
Affiliation(s)
- Sabria Djennane
- Service de médecine interne-maladies infectieuses et tropicales, CHF Quesnay, Mantes la Jolie
| | | | | | | | | | | |
Collapse
|
24
|
Hitti W, Wolff M. Two cases of multidrug-resistant Nocardia farcinica infection in immunosuppressed patients and implications for empiric therapy. Eur J Clin Microbiol Infect Dis 2005; 24:142-4. [PMID: 15692815 DOI: 10.1007/s10096-005-1285-y] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Presented here are two cases of multidrug-resistant Nocardia farcinica infection that occurred in immunocompromised patients. One of the patients developed the infection despite being on trimethoprim/sulfamethoxazole prophylaxis for Pneumocystis jiroveci. These cases demonstrate the propensity of Nocardia spp. to cause disseminated disease and to develop resistance to multiple antimicrobial agents used in the initial treatment of serious Nocardia infection. These factors lead to the conclusion that empiric monotherapy with trimethoprim/sulfamethoxazole may not be sufficient. Treatment with a combination regimen of imipenem and amikacin may be a more promising initial therapy.
Collapse
Affiliation(s)
- W Hitti
- Department of Internal Medicine, Franklin Square Hospital Center, 9000 Franklin Square Drive, Baltimore, MD 21237, USA.
| | | |
Collapse
|
25
|
Christidou A, Maraki S, Scoulica E, Mantadakis E, Agelaki S, Samonis G. Fatal Nocardia farcinica bacteremia in a patient with lung cancer. Diagn Microbiol Infect Dis 2005; 50:135-9. [PMID: 15474324 DOI: 10.1016/j.diagmicrobio.2004.06.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2004] [Accepted: 06/18/2004] [Indexed: 11/18/2022]
Abstract
Nocardia farcinica is an emerging pathogen in immunocompromised patients, accounting for approximately 20% of Nocardia clinical isolates in various countries. A case of fatal N. farcinica bacteremia in a 52-year-old man with lung cancer is described. He was admitted with severe respiratory distress, and despite the early onset of empirical antibiotic treatment, he failed to respond and died of septic shock 24 hours later. N. farcinica was isolated from blood cultures obtained at hospital admission and was identified by conventional methods. Strain identification was confirmed by nucleotide sequencing of the 16S rRNA gene. N. farcinica bacteremia is a life-threatening infection. Because of the actinomycete's highly-resistant antibiotic profile, early identification and antibiotic susceptibility testing are necessary to improve the chances of survival.
Collapse
Affiliation(s)
- Athanassia Christidou
- Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
Nocardia species are ubiquitous soil organisms that often infect patients with underlying immune compromise, pulmonary disease, or a history of surgery or trauma. We report 5 cases of nocardiosis representing various aspects of this "great imitator": 1) pneumonia in the setting of underlying malignancy, 2) chronic pneumonia with drug-resistant organism, 3) bacteremia and empyema with chronic hematologic malignancy, 4) primary cutaneous disease, and 5) sternal wound infection. We present a summary of the English literature from 1966 to 2003 with a focus on the teaching points of each of our 5 cases as well as the background epidemiology and microbiology of the Nocardia genus. Isolation of the organism may be achieved with routine media but longer incubation times may be necessary, delaying diagnosis and appropriate therapy. Treatment with a sulfa-containing regimen is standard of care, but resistance testing is warranted given emerging drug resistance, high rates of discontinuation due to adverse reactions, and the potential for nephrotoxicity in transplant recipients on cyclosporine.
Collapse
Affiliation(s)
- Edith R Lederman
- From United States Naval Medical Research Unit 2 (ERL), Jakarta, Indonesia; and Infectious Diseases Division (NFC), Naval Medical Center San Diego, San Diego, California
| | | |
Collapse
|
27
|
Lewis KE, Ebden P, Wooster SL, Rees J, Harrison GAJ. Multi-system Infection with Nocardia farcinica-therapy with linezolid and minocycline. J Infect 2003; 46:199-202. [PMID: 12643874 DOI: 10.1053/jinf.2002.1122] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We describe a case of disseminated infection with a multiple-resistant strain of Nocardia farcinica, probably resulting from direct inoculation during a road traffic accident. Initial presentation was with pulmonary symptoms, with subsequent development of cutaneous, renal, soft tissue and cerebral involvement. Precise microbiological diagnosis was delayed. Once sensitivity test results were available, the patient was stabilised on linezolid and minocycline. Premature withdrawal of therapy at one month resulted in recrudescence of infection, requiring re-institution of treatment. Linezolid was discontinued after a total of 4 months, because of evidence of myelosuppression and visual impairment, which subsequently improved. Monotherapy with minocycline was continued for a total of 12 months. The patient now remains well.
Collapse
Affiliation(s)
- K E Lewis
- Respiratory Unit, Llandough Hospital, Penlan Road, Cardiff, UK
| | | | | | | | | |
Collapse
|
28
|
Abstract
Five cases of systemic Nocardia infection were diagnosed among 301 allogeneic bone marrow transplant recipients. A sixth case included in this report received her transplant at another institution. The cumulative annual incidence rate of this infection was 1.75%. All patients had been treated previously for acute graft-versus-host disease (GVHD). At the time of diagnosis of systemic Nocardia infection, a median of 198 (range 148-1121) days after transplantation, all patients had extensive chronic GVHD and were taking 2 to 3 immunosuppressive medications. Prior to diagnosis of Nocardia infection patients had experienced multiple opportunistic infections, including infections with Mycobacterium avium-intracellulare, Pneumocystis carinii, and cytomegalovirus antigenemia. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX), ceftriaxone, or carbapenem antibiotics resulted in a median survival of 219 days from the time of diagnosis and an actuarial 1-year survival of 40%. All patients who received more than 2 weeks of therapy were cured of their infections. Notably, 5/6 patients in this cohort were unable to take TMP-SMX because of myelosuppression. In comparison with randomly selected control patients, the use of pentamidine for prevention of P. carinii infection was associated with a marginal increase in the risk of Nocardia infection. We postulate that the use of TMP-SMX may be of benefit in the prophylaxis of infections other than P. carinii in patients with chronic GVHD.
Collapse
Affiliation(s)
- A S Daly
- Allogeneic Bone Marrow Transplant Service, Department of Medical Oncology and Hematology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario, Canada.
| | | | | |
Collapse
|
29
|
Yorke RF, Rouah E. Nocardiosis with brain abscess due to an unusual species, Nocardia transvalensis. Arch Pathol Lab Med 2003; 127:224-6. [PMID: 12562241 DOI: 10.5858/2003-127-224-nwbadt] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The identification of Nocardia transvalensis, an unusual and probably underrecognized cause of nocardial infection, is clinically significant because of this species' resistance to aminoglycosides, a standard antinocardial therapy. Diagnosis requires analytic methods available predominately in reference laboratories. We report a case of disseminated infection with N transvalensis with primary pulmonary involvement and subsequent development of brain abscesses, and review the literature to date. Familiarity with the epidemiology, pathologic findings, and clinical significance of this and other unusual Nocardia species may increase early identification and antibiotic susceptibility testing in cases of nocardial infection.
Collapse
Affiliation(s)
- Rebecca F Yorke
- Department of Pathology, Baylor College of Medicine, Houston, TX 77030, USA
| | | |
Collapse
|
30
|
Abstract
We present the case of a non-immunocompromised man with right-sided hemiparesis and aphasia thought to be caused by cerebral infarction, but which in the later clinical course evolved to be a nocardia brain abscess that needed surgical intervention. Misinterpretation of imaging combined with the absence of clinical signs of infection led to inadequate primary treatment
Collapse
Affiliation(s)
- W Börm
- Neurosurgical Department, Klinikum, Aschaffenburg, Germany.
| | | |
Collapse
|
31
|
Pamuk GE, Pamuk ON, Tabak F, Mert A, Oztürk R, Aktuğlu Y. Systemic Nocardia infection in a patient with Behçet's disease. Rheumatology (Oxford) 2001; 40:597-9. [PMID: 11371678 DOI: 10.1093/rheumatology/40.5.597] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
32
|
Abstract
Infection with Nocardia poses a diagnostic challenge in patients with chronic granulomatous disease (CGD) because the signs and symptoms are often nonspecific, delay in diagnosis is common, and invasive procedures are frequently required to obtain appropriate tissue specimens. We present the first reported case of N farcinica pneumonia in an adolescent with X-linked CGD. Differentiation of N farcinica from other members of N asteroides complex is important because of its propensity for causing disseminated infection and antimicrobial resistance. Physicians caring for patients with CGD should maintain a high index of suspicion for nocardiosis, especially in those receiving chronic steroid therapy. Early diagnosis remains critical for decreased morbidity and occasional mortality.
Collapse
Affiliation(s)
- A K Shetty
- Department of Pediatrics, Stanford University School of Medicine and Lucile Salter Packard Children's Hospital at Stanford, CA 94040, USA
| | | | | |
Collapse
|
33
|
Abstract
Bacteremic nocardiosis is reported rarely. We discuss 4 recent cases seen at our institution and 32 other cases described in the English literature. We found that patients with bacteremic nocardiosis were similar in presentation, risk factors, course, and therapeutic outcome to nonbacteremic patients with nocardiosis. The presence of endovascular foreign bodies appeared to be the only unique risk factor associated with bacteremic illness. Seeding of the central nervous system appeared to be relatively uncommon. Thirty percent of patients with nocardemia had concomitant bacteremia with other pathogens, mostly Gram-negative organisms. Nocardia grew in a variety of growth media, and the median incubation time to detection was 4 days. Fifty percent of patients with Nocardia bacteremia died. Positive blood cultures were a preterminal finding in the fatal, acute cases and occurred relatively early in the subacute, nonfatal cases. Poor outcome seemed to correlate with acute onset of nocardiosis (duration less than 1 month), late identification of nocardemia, involvement of more than 2 sites, and the lack of treatment with a sulfonamide-containing regimen.
Collapse
Affiliation(s)
- D P Kontoyiannis
- Infectious Disease Division, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | | |
Collapse
|
34
|
|
35
|
Mohammedi I, Vedrinne JM, Floccard B, Reverdy ME, Duperret S, Motin J. Disseminated Rhodococcus equi and Nocardia farcinica infection in a patient with sarcoidosis. J Infect 1998; 36:134-5. [PMID: 9515692 DOI: 10.1016/s0163-4453(98)93954-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
36
|
Abstract
Keratitis due to Nocardia farcinica occurred in a 49-year-old female after inappropriate cleaning of her semipermeable rigid contact lenses with basin-stored water during a holiday in France. N. farcinica was differentiated from Nocardia asteroides by its growth at 45 degrees C, acid production from rhamnose, its opacification of Middlebrook 7H10 agar, and its marked degree of resistance to all cephalosporins, aminoglycosides, tetracyclins, macrolides, and trimethoprim-sulfamethoxazole. To the best of our knowledge, this is the first reported case of human N. farcinica keratitis, confirming that this microorganism can be responsible for serious human disease.
Collapse
Affiliation(s)
- C A Eggink
- Department of Ophthalmology, University Hospital Nijmegen, The Netherlands
| | | | | | | |
Collapse
|