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Liang GF, Chao S, Sun Z, Zhu KJ, Chen Q, Jia L, Niu YL. Pleural empyema with endobronchial mass due to Rhodococcus equi infection after renal transplantation: A case report and review of literature. World J Clin Cases 2024; 12:224-231. [PMID: 38292625 PMCID: PMC10824171 DOI: 10.12998/wjcc.v12.i1.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/30/2023] [Accepted: 12/20/2023] [Indexed: 01/02/2024] Open
Abstract
BACKGROUND Kidney transplantation is the best option for patients with end-stage renal disease. However, the need for lifelong immunosuppression results in renal transplant recipients being susceptible to various infections. Rhodococcus equi (R. equi) is a rare opportunistic pathogen in humans, and there are limited reports of infection with R. equi in post-renal transplant recipients and no uniform standard of treatment. This article reports on the diagnosis and treatment of a renal transplant recipient infected with R. equi 21 mo postoperatively and summarizes the characteristics of infection with R. equi after renal transplantation, along with a detailed review of the literature. CASE SUMMARY Here, we present the case of a 25-year-old man who was infected with R. equi 21 mo after renal transplantation. Although the clinical features at the time of presentation were not specific, chest computed tomography (CT) showed a large volume of pus in the right thoracic cavity and right middle lung atelectasis, and fiberoptic bronchoscopy showed an endobronchial mass in the right middle and lower lobe orifices. Bacterial culture and metagenomic next-generation sequencing sequencing of the pus were suggestive of R. equi infection. The immunosuppressive drugs were immediately suspended and intravenous vancomycin and azithromycin were administered, along with adequate drainage of the abscess. The endobronchial mass was then resected. After the patient's clinical symptoms and chest CT presentation resolved, he was switched to intravenous ciprofloxacin and azithromycin, followed by oral ciprofloxacin and azithromycin. The patient was re-hospitalized 2 wk after discharge for recurrence of R. equi infection. He recovered after another round of adequate abscess drainage and intravenous ciprofloxacin and azithromycin. CONCLUSION Infection with R. equi in renal transplant recipients is rare and complex, and the clinical presentation lacks specificity. Elaborate antibiotic therapy is required, and adequate abscess drainage and surgical excision are necessary. Given the recurrent nature of R. equi, patients need to be followed-up closely.
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Affiliation(s)
- Guo-Fu Liang
- Department of Organ Transplantation, School of Clinical Medicine, Guizhou Medical University, Guiyang 550025, Guizhou Province, China
| | - Sheng Chao
- Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Zhou Sun
- Department of Organ Transplantation, School of Clinical Medicine, Guizhou Medical University, Guiyang 550025, Guizhou Province, China
| | - Ke-Jing Zhu
- Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Qian Chen
- Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Lei Jia
- Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
| | - Yu-Lin Niu
- Department of Organ Transplantation, The Affiliated Hospital of Guizhou Medical University, Guiyang 550000, Guizhou Province, China
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Ursales A, Klein JA, Beal SG, Koch M, Clement-Kruzel S, Melton LB, Spak CW. Antibiotic failure in a renal transplant patient with Rhodococcus equi infection: an indication for surgical lobectomy. Transpl Infect Dis 2014; 16:1019-23. [PMID: 25412764 DOI: 10.1111/tid.12314] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/03/2014] [Accepted: 09/11/2014] [Indexed: 12/18/2022]
Abstract
Rhodococcus equi is an animal pathogen that causes infrequent but challenging infections in immunocompromised individuals, few of which have been described in solid organ transplant recipients. Common clinical presentations include indolent cough, fever, and dyspnea, with necrotizing pneumonia and cavitation. We report a case of a dense right upper lung pneumonia with resultant R. equi bacteremia in a renal transplant recipient. Our patient initially responded to antibiotic treatment with resolution of bacteremia and clinical recovery, followed by interval progression in her right upper lobe consolidation on follow-up computed tomography scans. She underwent lobectomy for definitive therapy with resolution of symptoms. Lobectomy can be utilized in isolated infection after antibiotic failure with excellent clinical outcomes.
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Affiliation(s)
- A Ursales
- Department of Medicine, Division of Infectious Diseases, Baylor University Medical Center, Dallas, Texas, USA
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3
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Menon V, Gottlieb T, Gallagher M, Cheong EL. Persistent Rhodococcus equi infection in a renal transplant patient: case report and review of the literature. Transpl Infect Dis 2012; 14:E126-33. [PMID: 23013470 DOI: 10.1111/tid.12008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 04/18/2012] [Accepted: 06/06/2012] [Indexed: 12/14/2022]
Abstract
Rhodococcus equi is a pathogen that mainly causes infection in immunocompromised hosts. We report a case of relapsing R. equi pulmonary infection in a 57-year-old male renal transplant recipient who was treated with 12 months of antibiotics, adjunctive surgery, and a reduction in his immunosuppression. He suffered from relapsing disease, treatment-related complications, and ultimately died of Pneumocystis pneumonia. Case reports in the literature portray a good cure rate for transplant-related R. equi infections, with shorter durations of antibiotics. The case illustrates the difficulties in the management of R. equi infections. Forty cases from the literature were reviewed and compared in terms of epidemiology, location of infection, transplant type, immunosuppression used, treatment used, outcomes, and possible exposures.
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Affiliation(s)
- V Menon
- Department of Microbiology and Infectious Diseases, Concord Hospital, Concord, New South Wales, Australia
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Wong KW, Thevarajah B. Rhodococcal lung abscess in a renal transplant recipient. Am J Case Rep 2012; 13:191-4. [PMID: 23569526 PMCID: PMC3615939 DOI: 10.12659/ajcr.883327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 05/10/2012] [Indexed: 11/11/2022] Open
Abstract
Background: Rhodococcus species are relatively rare human pathogens, but are being increasingly recognized as causes of infection especially in immunosuppressed patients. Case Report: We present a case of Rhodococcus lung abscess in a patient 10 months post-cadaveric renal transplant, successfully treated with a combination of antibiotics. She required a prolonged course of oral antibiotics for 6 months. She did not require surgical intervention. Chest X-rays and CT thorax showed complete resolution of the initial lesion. We also review the medical literature related to Rhodococcus infection in patients with renal transplantation. Rhodococcus infection should be considered as in the differential diagnosis of immunosuppressed patients who present with lung abscess/mass. Conclusions: A literature review indicates this is a potentially fatal condition with disseminated sepsis/abscesses.
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Affiliation(s)
- Koh-Wei Wong
- Nephrology Unit, Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
| | - Bharathan Thevarajah
- Nephrology Unit, Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Malaysia
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5
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Yamshchikov AV, Schuetz A, Lyon GM. Rhodococcus equi infection. THE LANCET. INFECTIOUS DISEASES 2010; 10:350-9. [DOI: 10.1016/s1473-3099(10)70068-2] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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6
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A pulmonary mass caused by Rhodococcus equi infection in a renal transplant recipient. ACTA ACUST UNITED AC 2008; 4:398-403. [DOI: 10.1038/ncpneph0833] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 04/04/2008] [Indexed: 11/08/2022]
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7
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Tse KC, Tang SCW, Chan TM, Lai KN. Rhodococcus lung abscess complicating kidney transplantation: successful management by combination antibiotic therapy. Transpl Infect Dis 2008; 10:44-7. [PMID: 17428277 DOI: 10.1111/j.1399-3062.2007.00231.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this report, a renal transplant recipient with Rhodococcus lung abscess is described. A high clinical suspicion and appropriate combination antibiotic therapy obviated the need for surgical intervention and was associated with a good clinical outcome. The optimal regimen of combination antibiotic therapy is discussed.
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Affiliation(s)
- K C Tse
- Department of Medicine, Nephrology Division, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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8
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Mikić D. [Rhodococcus equi infection]. VOJNOSANIT PREGL 2006; 63:957-62. [PMID: 17144431 DOI: 10.2298/vsp0611957m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
<zakljucak> Humana R. equi infekcija jos uvek je retko oboljenje koje se javlja uglavnom kod osoba sa teskim stepenom imunodeficijencije. Najcesce se ispoljava u vidu subakutne bakterijske pneumonije sa kavitacijama, a karakterise se cestim recidivima, bakterijemijama i visokom stopom mortaliteta. Terapija R. equi infekcije bazira se na kombinaciji baktericidnih i antibiotika sa dobrom intracelijskom penetracijom koji se primenjuju u duzem periodu, dok su drenaza apscesnih kolekcija i/ili operativni zahvati indikovani samo u slucajevima izostanka adekvatnog odgovora na antibiotsku terapiju. Uzimajuci u obzir cinjenicu da je R. equi infekciju veoma tesko eradikovati, a u cilju sto ranijeg postavljanja prave dijagnoze i blagovremenog pocetka adekvatne terapije, od velikog znacaja je poznanje najvaznijih karakteristika ove bolesti.
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Affiliation(s)
- Dragan Mikić
- Klinika za infektivne i tropske bolesti, Vojnomedicinska akademija, Crnotravska 17, 11 040 Beograd, Srbija
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Secchi C, Pereira F, Perez LRR, d'Azevedo PA, da Silva Rios S. Bacteremia por Rhodococcus equi em paciente com síndrome da imunodeficiência adquirida: relato de caso. Rev Soc Bras Med Trop 2006; 39:570-2. [PMID: 17308706 DOI: 10.1590/s0037-86822006000600013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2006] [Accepted: 12/04/2006] [Indexed: 11/21/2022] Open
Abstract
Rhodococcus equi é um importante agente de infecções zoonóticas, podendo causar sérias infecções em humanos, principalmente em pacientes imunocomprometidos. Neste estudo, nós relatamos o caso de uma bacteremia fatal devido a Rhodococcus equi em paciente com síndrome da imunodeficiência adquirida (HIV positivo).
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Arya B, Hussian S, Hariharan S. Rhodococcus equi pneumonia in a renal transplant patient: a case report and review of literature. Clin Transplant 2004; 18:748-52. [PMID: 15516256 DOI: 10.1111/j.1399-0012.2004.00276.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immunocompromised patients are susceptible to many pathogens, including those that are predominantly problems in veterinary medicine. We report a case of a 42-yr-old white male who presented 19 months post-cadaveric renal transplant (for IgA nephropathy) with a 5 d history of nausea, vomiting, abdominal cramping and diarrhea. Admission chest X-ray revealed a suspicious mass lesion in the left lower lobe. Computed tomography (CT) guided biopsy of the lesion showed a large zone of CD68 +ve histiocytes in a non-caseating granuloma. Gram stain revealed multiple gram-positive rods within the histiocytes, which were eventually identified as R. equi. After 4 months of therapy with fluoroquinolones (Avelox) and Azithromycin a repeat CT showed complete resolution of the lesion. We reviewed the literature with special focus on the clinical features, challenges in diagnosis, and treatment of this rare infection (especially in the transplant patients who are also on immunosuppressive therapy).
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Affiliation(s)
- Basant Arya
- Medical College of Wisconsin, West Wisconsin Avenue, Milwaukee, Wisconsin, USA
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11
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Yoo SJ, Sung H, Chae JD, Kim MN, Pai CH, Park J, Kim JJ. Rhodococcus equi pneumonia in a heart transplant recipient in Korea, with emphasis on microbial diagnosis. Clin Microbiol Infect 2003; 9:230-3. [PMID: 12667256 DOI: 10.1046/j.1469-0691.2003.00480.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Rhodococcus equi is an opportunistic pathogen that usually causes infection in immunocompromised hosts. A heart transplant recipient who had been treated with amphotericin B for pulmonary aspergillosis showed newly developed multiple nodules with a central necrotic area in the right lower lobes. Cultures of several blood samples and an aspirate of the lung nodule yielded a Gram-positive coccobacillary bacterium, which was initially reported as a Corynebacterium species, but was later identified as R. equi by API CORYNE (bioMerieux SA, Marcy l'Etoile, France) and by demonstrating the production of 'equi factor'. The identification was subsequently confirmed by an R. equi-specific polymerase chain reaction (PCR). The patient was successfully treated with ciprofloxacin and azithromycin for 14 weeks. This is the first documented case of R. equi infection in Korea. There is a possibility of underestimation of R. equi infections due to the misidentification of the organism as a contaminating diphtheroid. Because R. equi will not respond to the conventional empirical therapy, the microbiology laboratory should identify R. equi in a timely manner. R. equi-specific PCR will be a useful confirmatory test in human infection.
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Affiliation(s)
- S J Yoo
- Department of Clinical Pathology, University of Ulsan College of Medicine, and Asan Medical Center, Seoul, Korea
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12
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Pardo Mateu L, Faubel Serra M, Llavero Segovia MT, Cano Cuenca B, Pérez Climent F, Giménez Vaillo F, Grau Alario E, Lazaro Santander R. [Laryngeal infection by Rhodococcus equi in patient with AIDS]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2002; 53:783-8. [PMID: 12658846 DOI: 10.1016/s0001-6519(02)78376-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The Rhodococcus equi is an aerobic gram positive pleomorphic bacillus, that was isolated for the first time like a producer of bronchopneumonia in young horses. Every time more often, it is being recognized as a pathogen in humans, mainly in the immunodepressed population. We described a case, until now exceptional, of laryngeal infection by Rhodococcus equi in a patient with positive serology for the virus of the human immunodeficiency (HIV), and we reviewed some clinical and epidemiological characteristics of the infections by this germ. The treatment is riphampicine and/or erythromycin, being the prognosis bad, because usually they are immunodepressed patients.
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Affiliation(s)
- L Pardo Mateu
- Sección de Otorrinolaringología, Hospital de la plana, Villarreal, Castellón
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Lo A, Stratta RJ, Trofe J, Norwood J, Egidi MF, Shokouh-Amiri MH, Grewal HP, Allway RR, Gaber AO. Rhodococcus equi pulmonary infection in a pancreas-alone transplant recipient: consequence of intense immunosuppression. Transpl Infect Dis 2002; 4:46-51. [PMID: 12123426 DOI: 10.1034/j.1399-3062.2002.00008.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We report the case of a pancreas-alone transplant recipient who developed Rhodococcus equi pneumonia after receiving multiple courses of antilymphocyte therapy for the treatment of recurrent acute pancreas allograft rejection. We also review and discuss the diagnosis, clinical course, and treatment of 18 cases of R. equi infection reported in solid organ transplant recipients. The lung is the most common primary site of infection, but R. equi infection is difficult to diagnose because of the pleomorphic, gram-positive, and partially acid-fast nature of the organism. Treatment usually involves a combination of antibiotics including rifampin, macrolides, vancomycin, and ciprofloxacin. The optimal duration of therapy is unknown, but relapse is common if the duration of treatment is less than 14 days. The duration of therapy should be guided by clinical recovery, culture results, and radiographic findings. Monitoring levels of immunosuppressive agents-such as tacrolimus and cyclosporine-is needed in order to avoid clinically significant drug interactions with rifampin or the macrolides when these agents are used in order to treat R. equi infection in the transplant population.
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Affiliation(s)
- A Lo
- Department of Pharmacy, University of Tennessee-Memphis, Memphis, Tennessee 38163, USA
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González-Roncero FM, Gentil MA, Rodriguez-Algarra G, Pereira P, Cisneros JM, Castilla JJ, Rocha JL, Mateos J. Medical management of pneumonia caused by Rhodococcus equi in a renal transplant recipient. Am J Kidney Dis 2002; 39:E7. [PMID: 11840398 DOI: 10.1053/ajkd.2002.30574] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Rhodococcus equi is an animal pathogen that occasionally causes opportunistic infections in immunocompromised patients. The most common clinical picture is one of necrotizing pneumonia with a tendency toward cavitation and the formation of abscesses. We report a case of pneumonia caused by R equi in a renal transplant patient. An excellent response was shown to antibiotic treatment. Symptoms regressed, and the progressive disappearance of the lesion was confirmed on follow-up computed tomography scans. Surgical intervention or other invasive procedures were not required. To our knowledge, 14 cases of infection by R equi in solid-organ transplant patients have been described to date. Nine were recipients of a renal allograft. Surgery was required in many of these patients, and all the renal transplant recipients required the use of invasive therapeutic techniques, such as pleural drainage. This is the first case of a renal transplant recipient in whom radiologic presentation was as a solid nodule without ensuing cavitation that resolved exclusively with antibiotic treatment.
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La Rocca E, Gesu G, Caldara R, Maffi P, Del Maschio A, Vanzulli A, Castoldi R, Di Carlo V, Pozza G, Secchi A. Pulmonary infection caused by Rhodococcus equi in a kidney and pancreas transplant recipient: a case report. Transplantation 1998; 65:1524-5. [PMID: 9645819 DOI: 10.1097/00007890-199806150-00025] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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