Nocardia infections among immunomodulated inflammatory bowel disease patients: A review

Table 1 Usual susceptibility patterns of common Nocardia species in human diseases

Nocardia species	Susceptibility	Resistance	Ref.
N. asteroids sensu stricto	TMP-SMX, TGC, Amikacin	TGC	Lerner et al[2]
	Imipenem (64%-98%)		Sorrel et al[43]
N. farcinica	Amikacin	Tobramycin	Wallace et al[21]
	TMP-SMX, Minocycline	TMP-SMX (80%), TGC	Lerner et al[2]
			Uhde et al[44]
N. nova	TMP-SMX, TGC, Imipenem, Amikacin	TMP-SMX, TGC (53%)	Uhde et al[44]
	Clarithromycin (96%)		Wallace et al[21]
			Larruskain et al[46]
N. brasiliensis	TMP-SMX, Amikacin	Ceftriaxone (81%)	Uhde et al[44]
	TGC (88%-100%), Imipenem (20%-30%)		Sorrel et al[43]
N. transvalensis	TMP-SMX (88%), Imipenem (90%), TGC (50%)	Amikacin	Sorrel et al[43]
			McNeil et al[47]
N. otitidiscaviarum	Amikacin, Minocycline	TMP-SMX	Lerner et al[2]

TMP-SMX: Trimethropim-sulfamethoxazol; TGC: Third generation cephalosporins.

Table 2 Clinical forms of Nocardiosis related to anti-TNF therapy in inflammatory bowel disease, rheumatic and psoriatic patients

Clinical form	Anti-TNF
	IFXor ADA duration of therapy	Age	Associated treatment	Nocardia isolation	Outcome	Ref.
Cutaneous
IBD-P	IFX -3 infusions	45	No	Nocardia spp.	Favourable	Singh et al[30]
	IFX- 1,5 yr	61	No	Nocardia spp.	Favourable	Ali et al[31]
R-P	IFX -3 yr	70	Metothrexate + steroids	N. otitidiscaviarum	Favourable	Fabre et al[32]
Pulmonary
IBD-P	IFX - 8 mo -6 infusions	77	Steroids	N. asteroids	Favourable	Stratakos et al[33]
	IFX - 3 infusions	53	Azathioprine + steroids	N.cyriacigeorgica	Favourable	Parra et al[34]
	IFX - 6 mo	81	6-mercapto-purine	Nocardia spp	Favourable	Saleemuddin et al[35]
R-P	ADA - 4 mo	63	Steroids (DPOC)	N. asteroids	Favourable	Doraiswamy et al[48]
Disseminated
R-P	ADA1- 4 mo	63	Metotrexate	N. farcinica	Favourable	Wendling et al[38]
P-P	IFX2- 2 mo	66	Alefacet 6 mo before	N. farcinica	death	Al-Tawfiq et al[37]
IBD-P	IFX - 5 infusions	73	Prednisolone methrotexate	N. asteroids	Favourable with sequelae	Sidney et al[49]
Hepatic
IBD-P	IFX ≤ 1 mo	23	Steroids	N. farcinica	Favourable	Nakahara et al[36]

¹Previously was treated with 3 mo of etanercept;

²Diabetic patient. IBD-P: IBD-patients; R-P: Rheumatologic patients; P-P: Psoriatic patients.

Table 3 Clinical cases of nocardia disease in inflammatory bowel disease patients: Literature review

Ref.	IBD	Age (yr)	Sex	Medication	N. species	Clinical form	Treatment(duration)	Evolution
Vohra et al[40]	CD	16	F	6-Mercaptopurine 6 wk steroids	N. asteroids	Brain abcess; calf abscess	TMP-SMX + ceftriaxon: not established	Favourable
Stack et al[41]	UC	68	M	Cyclosporine, steroids	N. asteroids	Pulmonary (abcess)	Amikacin + cefotaxime-3 wk followed by cefuroxime 3 mo	Favourable
Singh et al[30]	CD	45	M	Infliximab 6 wk	N. spp. (polymerase chain reaction)	Cutaneous	TMP-SMX, 3 yr	Favourable
Stratakos et al[33]	CD (DM)	77	F	Infliximab 8 mo, steroids	N asteroids (+Pneumocystis jiroveci)	Pulmonary	TMP-SMX, 6 mo	Favourable
Parra et al[34]	CD	53	F	Infliximab, azathioprine, steroids	N. cyriacigeorgica	Pulmonary	TMP-SMX + amikacin + imipnem - 6 wk followed by TMP-SMX, 7.5 mo	Favourable
Arora et al[42]	UC	61	F	Azathioprine, steroids	N. nova	Cutaneous, abscess: brain lung, renal, pancreatic	TMP-SMX, 1 yr	Favourable, remission 2 yr after treatment
Nakahara et al[36]	CD	23	M	Infliximab, < 3 wk, steroids	N. farcinia	Liver nocardiosis	TMP-SMX for? not known	Favourable
Ali et al[31]	CD	61	M	Infliximab > 1 yr	N. spp.	Cutaneous	TMP-SMX for 6 mo	Favourable, restarted anti-TNF after therapy
Saleemuddin et al[35]	CD	81	M	Infliximab (3 mo) 6-mercapto-purine	Nocardia spp.	Pulmonary	TMP-SMX for? not known	Favourable; 5 mo after restarted anti-TNF under TMP-SMX; ok 1 yr after diagnosis
Sidney et al[49]	CD	73	F	Infliximab (5 infusions) Prednisolone methotrexate	Nocardia asteroids	Disseminated: Pulmonary cerebral	TMP-SMX for? not known	Favourable with sequelae

TMP-SMX: Trimethoprim- sulfamethoxazole; DM: Diabetes mellitus; CD: Crohn's disease; UC: Ulcerative colitis.