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Babar S, Liu E, Kaur S, Hussain J, Danaher PJ, Anstead GM. Pseudopropionibacterium propionicum as a Cause of Empyema; A Diagnosis with Next-Generation Sequencing. Pathogens 2024; 13:165. [PMID: 38392903 PMCID: PMC10893085 DOI: 10.3390/pathogens13020165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
Pseudopropionibacterium propionicum (P.p.) is an anaerobic, Gram-positive, branching beaded rod that is a component of the human microbiome. An infection of the thoracic cavity with P.p. can mimic tuberculosis (TB), nocardiosis, and malignancy. We present a case of a 77-year-old male who presented with dyspnea and a productive cough who was initially misdiagnosed with TB based on positive acid-fast staining of a pleural biopsy specimen and an elevated adenosine deaminase level of the pleural fluid. He was then diagnosed with nocardiosis based on the Gram stain of his pleural fluid that showed a Gram-positive beaded and branching rod. The pleural fluid specimen was culture-negative, but the diagnosis of thoracic P.p. infection was determined with next-generation sequencing (NGS). The patient was initially treated with imipenem and minocycline, then ceftriaxone and minocycline, and later changed to minocycline only. This report shows the utility of NGS in making a microbiological diagnosis when other techniques either failed to provide a result (culture) or gave misleading information (histopathologic exam, pleural fluid adenosine deaminase determination, and organism morphology on Gram stain).
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Affiliation(s)
- Sumbal Babar
- Division of Infectious Diseases, Department of Medicine, Carilion Clinic, 2001 Crystal Spring Ave, Suite 301, Roanoke, VA 24014, USA;
| | - Emily Liu
- Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (E.L.); (S.K.)
| | - Savreet Kaur
- Long School of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA; (E.L.); (S.K.)
| | - Juzar Hussain
- Internal Medicine Residency Program, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA;
| | - Patrick J. Danaher
- Division of Infectious Diseases, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA;
- Division of Infectious Diseases, Medical Service, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
| | - Gregory M. Anstead
- Division of Infectious Diseases, Department of Medicine, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX 78229, USA;
- Division of Infectious Diseases, Medical Service, South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX 78229, USA
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Pender M, Mehta N, Hamilton BD, Swaminathan S. Nocardia beijingensis isolated from an adrenal abscess in a diabetic host. Open Forum Infect Dis 2022; 9:ofac328. [PMID: 35899284 PMCID: PMC9310264 DOI: 10.1093/ofid/ofac328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/30/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
We describe the case of a 57-year-old man with poorly controlled type 2 diabetes mellitus who presented with 30 days of left-sided abdominal pain. He was found to have a left adrenal abscess and underwent adrenalectomy. Intraoperative cultures grew Nocardia beijingensis, which is an uncommonly identified Nocardia species rarely affecting immunocompetent patients. We review the published literature on cases of N. beijingensis among immunocompetent patients. This is the first report summarizing the diagnosis and management of N. beijingensis isolated from an adrenal abscess.
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Affiliation(s)
- Melissa Pender
- Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine , Salt Lake City, UT , USA
| | - Ninad Mehta
- Department of Pathology, University of Utah School of Medicine , Salt Lake City, Utah , USA
- Department of Pathology and Laboratory Medicine, University of Saskatchewan , Saskatoon, SK , Canada
| | - Blake D Hamilton
- Division of Urology, Department of Surgery, University of Utah School of Medicine , Salt Lake 17 City, Utah , USA
| | - Sankar Swaminathan
- Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine , Salt Lake City, UT , USA
- Department of Medicine, George E. Wahlen Veterans Affairs Medical Center , Salt Lake City, UT , USA
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Leon-Tavares DM, Hernández-Silva G, Diaz-Lomeli P, Martínez-Gamboa A, Lopez-Luis BA. Multiple Brain Abscesses Caused by Nocardia Beijingensis in a Patient With HIV Infection. Cureus 2022; 14:e25754. [PMID: 35812577 PMCID: PMC9270086 DOI: 10.7759/cureus.25754] [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] [Accepted: 06/08/2022] [Indexed: 11/05/2022] Open
Abstract
The etiologic agents of central nervous system infections in HIV-infected patients comprise a broad range of opportunistic pathogens. We presented a 49-year-old male patient with HIV infection and low adherence to antiretroviral therapy. He presented with multiple cerebral abscesses, and his microbiological diagnosis approach resulted in the isolation of Nocardia beijingensis, a species rarely reported in America. Central nervous system nocardial infection in HIV-infected patients should be considered, and a diagnosis at species level is mandatory because the antibiotic susceptibility profile varies among species.
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Luu T, Khalid R, Rehman T, Clark NM. Disseminated Nocardia paucivorans Infection Resembling Metastatic Disease in a Kidney Transplant Recipient. Cureus 2022; 14:e25365. [PMID: 35765399 PMCID: PMC9233555 DOI: 10.7759/cureus.25365] [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] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
Recipients of solid-organ transplants (SOT) or hematopoietic stem-cell transplants are prone to various complications, including serious infections. Nocardiosis is an opportunistic bacterial infection that primarily affects the lung. It may also cause skin and soft-tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. We present a case of an immunocompromised kidney transplant recipient who experienced a prolonged history of unexplained indolent constitutional symptoms without a fever. Initial radiographic findings were suggestive of metastatic disease at multiple sites. However, metagenomic next-generation sequencing of microbial cell-free DNA in blood revealed disseminated Nocardia paucivorans infection, and organisms consistent with Nocardia were identified on histopathology of a lung biopsy. It is crucial for healthcare providers to be aware of unusual opportunistic infections to provide appropriate workups and interventions for immunocompromised SOT recipients.
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Knoetzen M, Robbertse PPS, Parker A. Spinal nocardiosis: A rare tuberculosis mimic in an HIV infected patient. IDCases 2022; 27:e01444. [PMID: 35198387 PMCID: PMC8844763 DOI: 10.1016/j.idcr.2022.e01444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 11/28/2022] Open
Abstract
Early microbiological sampling is crucial when spinal tuberculosis is suspected. Awareness of nocardiosis in the immune compromised patient is important. Tuberculosis and nocardiosis may be similar in their non-specific presentation. Nocardia’s presentation is variable and depends on its clinical form and severity. To date, few cases of spinal infection with N. beijingensis have been described.
Despite advances in treatment, human immunodeficiency virus/tuberculosis (HIV/TB) coinfection remains highly prevalent in selected low- and middle income countries. The diagnosis of tuberculosis frequently proves challenging in the setting of advanced HIV, as patients may present with atypical features. A high index of suspicion must be maintained for TB in this setting, but it is critical that alternative diagnoses are considered. A myriad of opportunistic infections may mimic TB and a definitive microbiological diagnosis prior to TB treatment should always be sought. We report on a case of a young, HIV positive male who presented with a delayed diagnosis of nocardiosis that was thought to be TB of the spine. Despite extensive laboratory and radiological investigations, the diagnosis was only made after tissue was cultured. Earlier diagnosis of this mimic would have led to appropriate therapy and may have improved the outcome for this patient.
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Affiliation(s)
- Monique Knoetzen
- Department of Internal Medicine, Karl Bremer Hospital, Cape Town 7530, South Africa
- Corresponding author.
| | - Pieter-Paul Straus Robbertse
- Division of Cardiology, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
| | - Arifa Parker
- Division of General Internal Medicine and Infectious Diseases, Department of Medicine, Stellenbosch University and Tygerberg Hospital, Cape Town 7505, South Africa
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Abstract
PURPOSE OF REVIEW Brain nocardiosis is a rare but severe infection mostly occurring among immunocompromised patients. In this review, we present recent data on this infection and address some of the common clinical dilemmas encountered in patients with brain nocardiosis. RECENT FINDINGS Strategies used to approach a patient with suspected brain nocardiosis include the 'conservative strategy' (without early neurosurgery) and the 'neurosurgical strategy' (with early aspiration or excision of brain abscess[es]). The advantages and disadvantages of both strategies are summarised. Our opinion is that the use of the 'conservative strategy' should be limited to well-selected patients presenting with an easily accessible extra-neurological lesion(s) and have brain abscesses at low risk of treatment failure. In terms of antimicrobial therapy, we summarise the data supporting the use of a multidrug regimen in patients with brain nocardiosis.Last, we list possible reasons for treatment failure in patients with brain nocardiosis and suggest interventions to overcome them. SUMMARY Literature is scarce regarding brain nocardiosis, as a consequence of the rarity of this disease. A multidisciplinary and individualised management is required to optimise the outcome of patients with brain nocardiosis.
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Diioia A, Kalra L, Krop LC. Stroke like presentation of disseminated CNS Nocardia beijingensis infection in an immunocompetent patient: Case report and review of the literature. IDCases 2021; 25:e01223. [PMID: 34307047 PMCID: PMC8287212 DOI: 10.1016/j.idcr.2021.e01223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 10/25/2022] Open
Abstract
We describe a rare case of pulmonary and central nervous system (CNS) Nocardia beijingensis infection in an immunocompetent patient presenting with stroke like symptoms and newly discovered pulmonary and brain mass. Initial work up suggested lung cancer with metastasis to the brain. However, further evaluation revealed disseminated N. beijingensis. A literature review of N. beijingensis infections in immunocompetent host is also presented.
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Affiliation(s)
- Alessandra Diioia
- Morton Plant Hospital, BayCare Health System, Clearwater, FL, USA.,University of Florida College of Pharmacy, Gainesville, FL, USA
| | - Lalit Kalra
- Morton Plant Hospital, BayCare Health System, Clearwater, FL, USA.,Morton Plant Mease Health Care, Consultants in Infectious Diseases, Inc., Clearwater, FL, USA
| | - Lynne C Krop
- Morton Plant Hospital, BayCare Health System, Clearwater, FL, USA
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Margalit I, Lebeaux D, Tishler O, Goldberg E, Bishara J, Yahav D, Coussement J. How do I manage nocardiosis? Clin Microbiol Infect 2021; 27:550-558. [PMID: 33418019 DOI: 10.1016/j.cmi.2020.12.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Nocardiosis is a rare infection that is often difficult to treat and may be life-threatening. There is no consensus on its management. OBJECTIVES Our aim was to provide the current evidence for the diagnosis and management of individuals with nocardiosis, and to propose a management approach for this uncommon infection. SOURCES We systematically searched the medical literature on nocardiosis for studies published between 2010 and 2020 and describing ten or more individuals. CONTENT Nocardiosis, a primarily opportunistic infection which may occur in immunocompetent persons, most commonly involves the lungs and frequently disseminates to other sites including the central nervous system. The reference standard for Nocardia species identification is molecular biology, and the preferred method for antibiotic susceptibility testing (AST) is broth microdilution. Monotherapy seems appropriate for patients with primary skin nocardiosis or non-severe pulmonary disease; we reserve a multidrug regimen for more severe infections. Species identification and AST results are often missing at initiation of antibiotics. Trimethoprim-sulfamethoxazole is the preferred agent for initial therapy, because Nocardia is very often susceptible to this agent, and because it has been the keystone of nocardiosis treatment for years. Linezolid, to which Nocardia is almost always susceptible, may be an alternative. When combination therapy is required, the repertoire of companion drugs includes third-generation cephalosporins, amikacin and imipenem. Therapeutic modifications should take into account clinical response to initial therapy and AST results. Treatment duration of 6 months is appropriate for most situations, but longer durations are preferred for disseminated nocardiosis and shorter durations are reasonable in low-risk situations. Secondary prophylaxis may be considered in selected individuals with permanent immunosuppression. IMPLICATIONS We hereby provide the clinician with an easy-to-use algorithm for the management of individuals with nocardiosis. We also illuminate gaps in evidence and suggest future research directions.
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Affiliation(s)
- Ili Margalit
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - David Lebeaux
- Université de Paris, Paris, France; Service de Microbiologie, Unité Mobile d'Infectiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Ori Tishler
- Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Elad Goldberg
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel; Department of Internal Medicine F-Recanati, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Jihad Bishara
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Dafna Yahav
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Julien Coussement
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia; National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia
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