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He J, Tan S, Lv J. Successful Treatment of HIV-Combined CNS Nocardia Terpenica Infection with Cotrimoxazole as a Single Agent During the Maintenance Phase: A Case Report and Review of the Literature. Infect Drug Resist 2025; 18:2461-2467. [PMID: 40384798 PMCID: PMC12083499 DOI: 10.2147/idr.s520976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2025] [Accepted: 04/16/2025] [Indexed: 05/20/2025] Open
Abstract
The Nocardia infection of the central nervous system (CNS) in HIV-positive individuals is difficult to diagnose and treat, often requiring a combination of at least two drugs during the maintenance phase. In this article, we report a case of CNS Nocardia terpenic infection in an AIDS patient diagnosed by cerebrospinal fluid targeted next-generation sequencing (tNGS), which was ultimately treated successfully with sulfamethoxazole monotherapy due to adverse drug reactions. Additionally, we reviewed the relevant literature to explore individualized treatment options for CNS Nocardia infections in patients with AIDS and to provide clinicians with evidence-based treatment recommendations.
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Affiliation(s)
- Jingjing He
- Department of Infection, Baise People’s Hospital, Baise, 533000, People’s Republic of China
| | - Shengkui Tan
- Guangxi Clinical Medical Research Center for Hepatobiliary Diseases, Youjiang Medical University for Nationalities, Baise, 533000, People’s Republic of China
| | - Jiannan Lv
- Guangxi Clinical Medical Research Center for Hepatobiliary Diseases, Department of Infection, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, 533000, People’s Republic of China
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de Escalante Yangüela B, Ligero López J, Venegas Robles A, Urdaniz Borque R, Vallejo Grijalba J, Bandrés Nivela O, Juan Bañón JL, Beltrán Rosel A. Successful maintenance therapy with moxifloxacin for disseminated nocardiosis caused by Nocardia farcinica in a patient with Cushing's syndrome. Diagn Microbiol Infect Dis 2025; 111:116718. [PMID: 39904147 DOI: 10.1016/j.diagmicrobio.2025.116718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2024] [Revised: 01/20/2025] [Accepted: 01/27/2025] [Indexed: 02/06/2025]
Abstract
Nocardia species are aerobic, Gram-positive actinomycetes often causing opportunistic infections, particularly in immunocompromised hosts. Nocardia farcinica is notable for disseminated nocardiosis (DN), frequently involving the lungs and central nervous system (CNS). Cushing's syndrome (CS), characterized by hypercortisolemia, further predisposes patients to severe infections. We report a 73-year-old woman with ACTH-dependent CS due to a pituitary adenoma who developed DN with pleuropulmonary, CNS, and gluteal abscesses. Diagnosis was confirmed through cultures and MALDI-TOF MS, identifying N. farcinica. Resistance to standard antibiotics required a tailored regimen, including imipenem, amikacin, and moxifloxacin, alongside surgical management of abscesses and the adenoma. This case emphasizes the importance of rapid diagnostic methods and individualized therapies in managing DN with CS, a rare but severe combination. It highlights the need for vigilance in high-risk patients and contributes valuable insights for optimizing outcomes in such complex cases.
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Affiliation(s)
| | - Jorge Ligero López
- Clinical Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Department of Microbiology, Pediatrics, Radiology and Public Health, Faculty of Medicine, Universidad de Zaragoza, Zaragoza, Spain.
| | | | - Rosana Urdaniz Borque
- Endocrinology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Juan Vallejo Grijalba
- Internal Medicine Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Orosia Bandrés Nivela
- Endocrinology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | - Antonio Beltrán Rosel
- Clinical Microbiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain; Department of Microbiology, Pediatrics, Radiology and Public Health, Faculty of Medicine, Universidad de Zaragoza, Zaragoza, Spain; Group of Water and Environmental Health, Institute of Environmental Sciences (IUCA), Spain
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Gu Q, Zhou L, Shen X, Xu L, Wu G, Pan W, Lin W, Lv D, Lin L, Yan S. Fatal Empyema Thoracis Caused by Nocardia otitidiscaviarum. Infect Drug Resist 2025; 18:669-678. [PMID: 39926171 PMCID: PMC11806675 DOI: 10.2147/idr.s501622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Accepted: 01/15/2025] [Indexed: 02/11/2025] Open
Abstract
Nocardiosis caused by Nocardia otitidiscaviarum is exceptionally rare and characterized by a high mortality rate. It typically affects immunocompromised patients, resulting in severe pulmonary or disseminated infections, and is notorious for abscess formation. Empyema resulting from nocardiosis is even less common. Early clinical signs and imaging findings lack specificity, culture growth is sluggish, and the absence of an effective serological detection method can delay treatment. We report an 81-year-old patient with chronic obstructive pulmonary disease treated by long-term inhalation of high-dose salmeterol fluticasone. The initial empirical anti-infection treatment proved ineffective, resulting in rapid disease progression before the confirmation of nocardiosis with empyema through cultures of pleural fluid and sputum. Despite active treatment measures, the patient succumbed to severe pulmonary infection, sepsis, and multiple organ failure. A review of the literature, together with clinical experience, indicates that conventional empirical treatment for Nocardia otitidiscaviarum infection may not always be effective due to the escalating rate of drug resistance. Therefore, the primary step in the management of the infection is timely diagnosis using different methods. Furthermore, the identification of the responsible strain followed by conducting drug sensitivity tests is paramount for the successful treatment of this disease.
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Affiliation(s)
- Qianqian Gu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, People’s Republic of China
| | - Lingren Zhou
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, People’s Republic of China
| | - Xiaofei Shen
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, People’s Republic of China
| | - Le Xu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, People’s Republic of China
| | - Guixian Wu
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, People’s Republic of China
| | - Weijia Pan
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, People’s Republic of China
| | - Wenxia Lin
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, People’s Republic of China
| | - Dongqing Lv
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, People’s Republic of China
| | - Ling Lin
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, People’s Republic of China
| | - Shuangquan Yan
- Department of Respiratory Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, 317000, People’s Republic of China
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Hasegawa A, Tone K, Baba Y, Saito Z, Akutsu T, Kitayama T, Inaki S, Gochi M, Yaguchi T, Makimura K, Takagi M, Araya J. Nodular-bronchiectatic pattern in pulmonary nocardiosis: Immune status and treatment outcomes in a multicenter retrospective study. Respir Med 2025; 237:107922. [PMID: 39722283 DOI: 10.1016/j.rmed.2024.107922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Revised: 12/20/2024] [Accepted: 12/21/2024] [Indexed: 12/28/2024]
Abstract
BACKGROUND Pulmonary nocardiosis is a rare opportunistic infection, with approximately 15 % of patients being immunocompetent. The isolation rate of Nocardia spp. has recently increased, indicating rising clinical concern. This study aimed to summarize computed tomography (CT) findings, evaluate treatment outcomes, and improve disease recognition. METHODS We retrospectively analyzed 12 pulmonary nocardiosis cases recorded over 10 years in three hospitals, excluding two unclear cases. All pathogens were detected on smears and isolated from respiratory specimens. RESULTS The mean age was 73.0 ± 12.9 years, with 9 men and 6 smokers. Among the included patients, 8 had underlying pulmonary diseases, 4 had non-pulmonary diseases, and 3 were on steroids. The most common species were N. cyriacigeorgica and N. nova. CT findings included cavitary, consolidation/infiltrative, and nodular-bronchiectatic (NB) patterns. The NB pattern, particularly common in immunocompetent patients, was associated with significantly better treatment outcomes than non-NB patterns (Fisher's exact test, p = 0.0476). All isolates were susceptible to trimethoprim/sulfamethoxazole. Eight patients recovered with appropriate antimicrobial therapy, while two patients died. CONCLUSIONS Pulmonary nocardiosis presented three CT patterns, with the NB pattern being the most frequent and showing favorable treatment outcomes, especially in immunocompetent patients. While Nocardia spp. can develop in patients with preexisting bronchiectasis, it may also independently cause bronchiectasis. Nocardia infection should be considered as a differential diagnosis in patients exhibiting the NB pattern, resembling that of nontuberculous mycobacterial pulmonary diseases.
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Affiliation(s)
- Airi Hasegawa
- Department of Respiratory Medicine, The Jikei University School of Medicine Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
| | - Kazuya Tone
- Department of Respiratory Medicine, The Jikei University School of Medicine Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
| | - Yuri Baba
- Department of Respiratory Medicine, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo, 125-8506, Japan.
| | - Zenya Saito
- Department of Respirology, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi, Kanagawa, 243-8588, Japan.
| | - Takuya Akutsu
- Department of Respiratory Medicine, The Jikei University School of Medicine Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
| | - Takaaki Kitayama
- Department of Respiratory Medicine, The Jikei University School of Medicine Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan; Department of Respirology, Atsugi City Hospital, 1-16-36 Mizuhiki, Atsugi, Kanagawa, 243-8588, Japan.
| | - Shunsuke Inaki
- Department of Respiratory Medicine, The Jikei University School of Medicine Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
| | - Mina Gochi
- Department of Respiratory Medicine, The Jikei University School of Medicine Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
| | - Takashi Yaguchi
- Medical Mycology Research Center, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8673, Japan.
| | - Koichi Makimura
- Teikyo University Institute of Medical Mycology, 359 Otsuka, Hachioji, Tokyo, 192-0395, Japan.
| | - Masamichi Takagi
- Department of Respiratory Medicine, The Jikei University School of Medicine Kashiwa Hospital, 163-1 Kashiwashita, Kashiwa, Chiba, 277-8567, Japan.
| | - Jun Araya
- Division of Respiratory Diseases, Department of Internal Medicine, The Jikei University School of Medicine, 3-25-8 Nishi-shimbashi, Minato-ku, Tokyo, 105-8471, Japan.
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Li X, Zhou W, Zhao K, Li Y. A case of disseminated nocardia infection with initial symptoms manifesting as cognitive impairment: Case report and literature review. Medicine (Baltimore) 2024; 103:e39535. [PMID: 39654166 PMCID: PMC11630925 DOI: 10.1097/md.0000000000039535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 12/12/2024] Open
Abstract
RATIONALE Nocardia infections, although rare, pose significant challenges in diagnosis and treatment, especially when involving the central nervous system (CNS). Mortality rates in such cases can be high, highlighting the need for early recognition and tailored antimicrobial therapy. PATIENT CONCERNS A 58-year-old male with a history of chronic obstructive pulmonary disease, antineutrophil cytoplasmic antibody-associated glomerulonephritis, and steroid-induced diabetes mellitus presented with disorganized speech, fever, cough, dyspnea, and psychiatric symptoms. DIAGNOSES The patient was diagnosed with severe pneumonia, left pneumothorax, bilateral pulmonary bullae, and CNS involvement. Next-generation sequencing (NGS) identified Nocardia farcinica as the causative agent. INTERVENTIONS Initial treatment with ceftriaxone was ineffective. Upon identification of N. farcinica via NGS, the patient was started on a tailored antimicrobial regimen consisting of sulfamethoxazole, linezolid, and meropenem. OUTCOMES Despite initial clinical improvement, the patient was discharged early due to financial constraints. Unfortunately, he later succumbed to the infection. LESSONS This case underscores the difficulty of diagnosing Nocardia infections, particularly when they involve the CNS. The use of advanced diagnostic tools such as NGS, along with early and appropriate antimicrobial therapy, is crucial for improving patient outcomes. Financial and healthcare access challenges may impact the success of treatment, emphasizing the importance of comprehensive follow-up and patient support.
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Affiliation(s)
- Xiayahu Li
- Department of Critical Care Medicine, Chengdu Second People’s Hospital, Chengdu, China
| | - Weiguo Zhou
- Department of Critical Care Medicine, The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Kai Zhao
- Department of Critical Care Medicine, The Fourth People’s Hospital of Chengdu, Chengdu, China
| | - Yaolin Li
- Department of Pulmonary and Critical Care Medicine, The Third People’s Hospital of Chengdu, Chengdu, China
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Hayashi M, Takaoka C, Higashi K, Kurokawa K, Margolin W, Oshima T, Shiomi D. Septal wall synthesis is sufficient to change ameba-like cells into uniform oval-shaped cells in Escherichia coli L-forms. Commun Biol 2024; 7:1569. [PMID: 39587276 PMCID: PMC11589767 DOI: 10.1038/s42003-024-07279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/15/2024] [Indexed: 11/27/2024] Open
Abstract
A cell wall is required to control cell shape and size to maintain growth and division. However, some bacterial species maintain their morphology and size without a cell wall, calling into question the importance of the cell wall to maintain shape and size. It has been very difficult to examine the dispensability of cell wall synthesis in rod-shaped bacteria such as Escherichia coli for maintenance of their shape and size because they lyse without cell walls under normal culture conditions. Here, we show that wall-less E. coli L-form cells, which have a heterogeneous cell morphology, can be converted to a mostly uniform oval shape solely by FtsZ-dependent division, even in the absence of cylindrical cell wall synthesis. This FtsZ-dependent control of cell shape and size in the absence of a cell wall requires at least either the Min or nucleoid occlusion systems for positioning FtsZ at mid cell division sites.
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Affiliation(s)
- Masafumi Hayashi
- Rikkyo University, Tokyo, Japan
- Gakushuin University, Tokyo, Japan
| | | | | | | | | | - Taku Oshima
- Toyama Prefectural University, Toyama, Japan.
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Huang L, Jia L. Disseminated nocardiosis caused by Nocardia otitidiscaviarum-A case report. Diagn Microbiol Infect Dis 2024; 110:116347. [PMID: 38878341 DOI: 10.1016/j.diagmicrobio.2024.116347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/19/2024] [Accepted: 05/09/2024] [Indexed: 07/30/2024]
Abstract
In this article we report a case of disseminated nocardiosis caused by Nocardia otitidiscaviarum in an immunocompetent patient with chronic obstructive pulmonary disease (COPD) who complained of a cough, followed by skin and intracranial lesions. On metagenomic next-generation sequencing (mNGS) technology of respiratory samples (bronchoalveolar lavage fluid, BALF) Nocardia otitidiscaviarum was identified. The patient was treated with therapy combined with a low dose of TMP-SMX and imipenem cilastatin sodium and had a favorable outcome. The timely diagnosis of Nocardia with the help of mNGS technology and early rational treatment of TMP-SMX can help improve the prognosis.
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Affiliation(s)
- Linyue Huang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu Sichuan 610041, PR China
| | - Lian Jia
- Pulmonary and Critical Care Medicine, West China Hospital of Sichuan University, Chengdu Sichuan 610041, PR China; State Key Laboratory of Respiratory Health and Multimorbidity, Chengdu Sichuan 610041, PR China.
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8
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Nallamotu S, Reddy MS. Exposing the Masquerade of Nocardia otitidiscaviarum Pneumonia: A Case Report. Cureus 2024; 16:e67849. [PMID: 39323673 PMCID: PMC11424122 DOI: 10.7759/cureus.67849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2024] [Indexed: 09/27/2024] Open
Abstract
We present a rare case of an immunocompetent 49-year-old male agriculturalist from India diagnosed with Nocardia otitidiscaviarum pneumonia. Nocardia species are ubiquitous gram-positive, partially acid-fast bacilli that predominantly infect immunocompromised individuals. Only 0.3% to 2.9% of all nocardiosis cases are attributed to N. otitidiscaviarum. The patient presented with a 25-day history of wet cough and high-grade fever, with bilateral bronchial breath sounds on chest auscultation and findings consistent with pneumonia on chest X-ray. During hospitalization, multiple treatment revisions were made. On admission, empiric antibiotic therapy against community-acquired pneumonia was initiated. Later, GeneXpert sputum testing for Mycobacterium tuberculosis complex (MTBC) was positive for MTBC DNA. Suspected tuberculosis with a secondary infection prompted a treatment switch to antitubercular therapy (ATT) along with meropenem. Despite changes to treatment, the patient continued to deteriorate with no signs of clinical improvement. ATT with meropenem was discontinued when a repeat GeneXpert for MTBC was negative, ruling out tuberculosis. Slow-growing bronchial wash culture identified the rare pathogen N. otitidiscaviarum, prompting an urgent referral to a specialized Infectious Diseases team. Treatment was then tailored according to antibiotic resistance-sensitivity testing. Targeted multidrug antibiotic therapy with trimethoprim-sulfamethoxazole and amikacin against N. otitidiscaviarum facilitated gradual clinical improvement. This case underscores the importance of considering uncommon pathogens in differential diagnosis and highlights the critical role of microbiological diagnostics in guiding effective treatment. Drug resistance and changing bacterial pathogenicity trends must not be overlooked. The round-about antibiotic treatment changes in this case point to the necessity for faster diagnostic methods in identifying Nocardia species. Further research into rapid diagnostic methods and up-to-date treatment guidelines are warranted to optimize outcomes in nocardiosis management.
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Affiliation(s)
- Sandhya Nallamotu
- Department of Medicine, Kasturba Medical College, Manipal, Manipal, IND
| | - Mahith S Reddy
- Department of Medicine, Kasturba Medical College, Manipal, Manipal, IND
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Schmid A, Ahmad N, Haubitz S, Speth MM. Disseminated nocardiosis presenting as a superinfected thyroglossal duct cyst in a patient with diabetes. BMJ Case Rep 2024; 17:e259725. [PMID: 38890116 PMCID: PMC11191010 DOI: 10.1136/bcr-2024-259725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/20/2024] Open
Abstract
We introduce the case of a male patient in his 60s who was admitted to our emergency department with a persisting sore throat for the last 3 weeks and dysphagia. Fibre-endoscopic evaluation revealed an asymmetry at the base of the tongue. In combination with elevated white cell count and C reactive protein, a computerized tomography showed a superinfected thyroglossal duct cyst. Intravenous antibiotics were initiated, and the patient was taken to the operating room for cervicotomy. The microbiological swab taken intraoperatively detected Nocardia paucivorans Additional imaging revealed disseminated nocardiosis with cerebral and pulmonary manifestations.The patient was treated with oral trimethoprim/sulfamethoxazole and, over time, showed complete remission of central nervous system lesions and improvement of pulmonary involvement. Following this, the treatment was stopped 8 months after the initial diagnosis. In this report, we discuss treatment standards and outcomes of nocardiosis based on our management strategies of our patient.
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Affiliation(s)
| | - Nader Ahmad
- HNO, Kantonsspital Aarau AG, Aarau, Switzerland
| | | | - Marlene Maria Speth
- University Hospital Basel, Basel, Switzerland
- Kantonsspital Aarau AG, Aarau, Switzerland
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10
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Zhang LY, Wang L, Umar Z, Huang YH, Gu B. Weathering the storm: diagnosis and treatment of a life-threatening disseminated Nocardia otitidiscaviarum infection. Front Cell Infect Microbiol 2024; 14:1397847. [PMID: 38881735 PMCID: PMC11179430 DOI: 10.3389/fcimb.2024.1397847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 05/16/2024] [Indexed: 06/18/2024] Open
Abstract
Nocardiosis demonstrates a temporal categorization that includes acute, subacute, and chronic stages alongside distinct typical localizations such as pulmonary, cutaneous, and disseminated forms. Disseminated nocardiosis, commonly caused by Nocardia asteroides, N. brasiliensis, and N. farcinica, continues to result in substantial morbidity and mortality. Herein, we report a life-threatening disseminated nocardiosis caused by Nocardia otitidiscaviarum in a patient with minimal change disease. This study emphasizes the difficulty in the diagnosis and treatment of unknown infections in clinical settings and highlights the important role played by laboratories in solving infectious diseases caused by rare pathogens.
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Affiliation(s)
- Li-Yan Zhang
- Laboratory Medicine, Ganzhou Municipal Hospital, Guangdong Provincial People’s Hospital Ganzhou Hospital, Ganzhou, Guangdong, China
- Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Liang Wang
- Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
- Centre for Precision Health, School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia
| | - Zeeshan Umar
- Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
| | - Yuan-Hong Huang
- Laboratory Medicine, Ganzhou Municipal Hospital, Guangdong Provincial People’s Hospital Ganzhou Hospital, Ganzhou, Guangdong, China
| | - Bing Gu
- Laboratory Medicine, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China
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11
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Huang HY, Bu KP, Liu JW, Wei J. Overlapping infections of Mycobacterium canariasense and Nocardia farcinica in an immunocompetent patient: A case report. World J Clin Cases 2024; 12:2079-2085. [PMID: 38680269 PMCID: PMC11045514 DOI: 10.12998/wjcc.v12.i12.2079] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 02/26/2024] [Accepted: 04/02/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Infections by non-tuberculous mycobacteria (NTM) have become more common in recent years. Mycobacterium canariasense (M. canariasense) was first reported as an opportunistic pathogen in 2004, but there have been very few case reports since then. Nocardia is a genus of aerobic and Gram-positive bacilli, and these species are also opportunistic pathogens and in the Mycobacteriales order. Conventional methods for diagnosis of NTM are inefficient. Metagenomic next-generation sequencing (mNGS) can rapidly detect many pathogenic microorganisms, even rare species. Most NTM and Nocardia infections occur in immunocompromised patients with atypical clinical symptoms. There are no previous reports of infection by M. canariasense and Nocardia farcinica (N. farcinica), especially in immunocompetent patients. This case report describes an immunocompetent 52-year-old woman who had overlapping infections of M. canariasense, N. farcinica, and Candida parapsilosis (C. parapsilosis) based on mNGS. CASE SUMMARY A 52-year-old woman presented with a productive cough and chest pain for 2 wk, and recurrent episodes of moderate-grade fever for 1 wk. She received antibiotics for 1 wk at a local hospital, and experienced defervescence, but the productive cough and chest pain persisted. We collected samples of a lung lesion and alveolar lavage fluid for mNGS. The lung tissue was positive for M. canariasense, N. farcinica, and C. parapsilosis, and the alveolar lavage fluid was positive for M. canariasense. The diagnosis was pneumonia, and application of appropriate antibiotic therapy cured the patient. CONCLUSION Etiological diagnosis is critical for patients with infectious diseases. mNGS can identify rare and novel pathogens, and does not require a priori knowledge.
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Affiliation(s)
- Hai-Yan Huang
- Department of Comprehensive Internal Medicine, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Kun-Peng Bu
- Department of Comprehensive Internal Medicine, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jin-Wei Liu
- Department of Doppler Ultrasound, The Second Nanning People's Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Jing Wei
- Department of Comprehensive Internal Medicine, The Affiliated Cancer Hospital of Guangxi Medical University, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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12
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Bove A, Abdullah F, Saveeta F, Urena A, Martinez S. Unusual Presentation of Nocardiosis With Pleural Effusion in an Immunocompetent Host. Cureus 2024; 16:e58686. [PMID: 38770507 PMCID: PMC11103114 DOI: 10.7759/cureus.58686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/22/2024] Open
Abstract
Nocardiosis is a disease caused by gram-positive, catalase-positive, rod-shaped bacteria that stain weakly on a Gram stain. It usually affects the lungs and skin but can cause disseminated infections. Nocardia has 85 species, ranging from nonpathogenic to pathogenic. Nocardia is an opportunistic organism that causes infections in the immunocompromised; however, 7% of the immunocompetent population has suffered from Nocardia infection. This case report highlights an unusual occurrence of pulmonary nocardiosis in a 31-year-old woman with a normal immune system. She was initially treated as an outpatient for what appeared to be community-acquired pneumonia. However, her condition deteriorated, ultimately revealing a substantial right pleural effusion with loculation and adjacent compressive atelectasis affecting a significant portion of her right middle and lower lung lobes, as detected by a CT scan followed by pleural fluid analysis which confirmed the infection. By sharing this experience, we aim to contribute to the collective knowledge of medical professionals and improve the accuracy of diagnosis and treatment.
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Affiliation(s)
- Ana Bove
- Medicine, Universidad Iberoamericana (UNIBE), Santo Domingo, DOM
| | - Fnu Abdullah
- Internal Medicine, Combined Military Hospital, Quetta, PAK
| | - Fnu Saveeta
- Internal Medicine, People's University of Medical and Health Sciences, Nawabshah, PAK
| | - Alexander Urena
- Medicine, Universidad Tecnológica de Santiago, Santiago de los Caballeros, DOM
| | - Sergio Martinez
- Pulmonology, Long Island Jewish Forest Hills, Northwell Health, New York, USA
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13
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Timothy LD, Healy CM, Quintanilla NM, Montgomery N, Okcu MF. Nocardiosis in an infant with spindle cell rhabdomyosarcoma treated with mild immunosuppressive chemotherapy. Pediatr Blood Cancer 2024; 71:e30873. [PMID: 38259045 DOI: 10.1002/pbc.30873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Leander D Timothy
- Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas, USA
| | - C Mary Healy
- Department of Infectious Diseases, Texas Children's Hospital, Houston, Texas, USA
| | - Norma M Quintanilla
- Department of Pathology and Immunology, Texas Children's Hospital, Houston, Texas, USA
| | - Nicole Montgomery
- Department of Orthopedics, Texas Children's Hospital, Houston, Texas, USA
| | - M Fatih Okcu
- Cancer and Hematology Center, Texas Children's Hospital, Houston, Texas, USA
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14
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Gupta S, Grant LM, Powers HR, Kimes KE, Hamdi A, Butterfield RJ, Gea-Banacloche J, Vijayvargiya P, Hata DJ, Meza Villegas DM, Dumitrascu AC, Harris DM, Chirila RM, Zhang N, Razonable RR, Kusne S, Alvarez S, Vikram HR. Invasive Nocardia Infections across Distinct Geographic Regions, United States. Emerg Infect Dis 2023; 29. [PMID: 37987603 PMCID: PMC10683819 DOI: 10.3201/eid2912.230673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
We reviewed invasive Nocardia infections in 3 noncontiguous geographic areas in the United States during 2011–2018. Among 268 patients with invasive nocardiosis, 48.2% were from Minnesota, 32.4% from Arizona, and 19.4% from Florida. Predominant species were N. nova complex in Minnesota (33.4%), N. cyriacigeorgica in Arizona (41.4%), and N. brasiliensis in Florida (17.3%). Transplant recipients accounted for 82/268 (30.6%) patients overall: 14 (10.9%) in Minnesota, 35 (40.2%) in Arizona, and 33 (63.5%) in Florida. Manifestations included isolated pulmonary nocardiosis among 73.2% of transplant and 84.4% of non–transplant patients and central nervous system involvement among 12.2% of transplant and 3.2% of non–transplant patients. N. farcinica (20.7%) and N. cyriacigeorgica (19.5%) were the most common isolates among transplant recipients and N. cyriacigeorgica (38.0%), N. nova complex (23.7%), and N. farcinica (16.1%) among non–transplant patients. Overall antimicrobial susceptibilities were similar across the 3 study sites.
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15
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Silwal S, Mir M, Boike S, Bista K, Yadav SK, Sheehy J, Khan SA, Gomez Urena EO. Disseminated Nocardia Brain Abscess Presenting as Primary Lung Cancer With Brain Metastasis. Cureus 2023; 15:e43631. [PMID: 37719483 PMCID: PMC10504867 DOI: 10.7759/cureus.43631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
We present a challenging case of disseminated Nocardia brasiliensis infection manifesting as brain and skin abscesses. Nocardia is an important potential pathogen to consider in patients with a relevant travel history to endemic regions or atypical presentations, such as brain and skin abscesses. About one-third of patients with Nocardia infections are immunocompetent, and their symptoms are nonspecific. This case shows the limitations of imaging studies in diagnosing Nocardia brain abscesses, as the patient's non-magnetic resonance (MR) conditional pacemaker precluded MRI evaluation and led to a diagnostic challenge. Therefore, the patient's initial evaluation was presumed to be primary lung cancer with brain metastasis. High clinical suspicion, imaging studies (especially MRI), and tissue biopsy are needed to diagnose this type of brain abscess in a timely manner to prevent further complications.
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Affiliation(s)
- Swechchha Silwal
- Internal Medicine, Trinity Health Oakland/Wayne State University, Pontiac, USA
| | - Mikael Mir
- Medicine, University of Minnesota Medical School, Minneapolis, USA
| | - Sydney Boike
- Medicine, University of Minnesota Medical School, Minneapolis, USA
| | - Karuna Bista
- Internal Medicine, Nepal Medical College, Kathmandu, NPL
| | - Sumeet K Yadav
- Internal Medicine, Mayo Clinic Health System, Mankato, USA
| | - Jessica Sheehy
- Infectious Diseases, Mayo Clinic Health System, Mankato, USA
| | - Syed Anjum Khan
- Critical Care Medicine, Mayo Clinic Health System, Mankato, USA
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16
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Diallo A, Dembele Y, Yaya I, Niang M, Benoit-Cattin T, Meliani P, Permal S. Disseminated Nocardia transvalensis complex and farcinica: First case in an immunocompetent. New Microbes New Infect 2023; 53:101148. [PMID: 37305022 PMCID: PMC10248225 DOI: 10.1016/j.nmni.2023.101148] [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] [Received: 01/28/2022] [Revised: 02/17/2023] [Accepted: 05/08/2023] [Indexed: 06/13/2023] Open
Abstract
Background Nocardiae is an opportunistic infection mainly of the immunocompromised patient without sparing the immunocompetent subject or without any identified risk factors. They can be localized or disseminated. The extreme rarity of this infection often results in a deleterious diagnostic delay. Case presentation We report a first case of community acquired pneumonia with asymptomatic disseminated brain abscess due to Nocardia transvalensis/wallacei and farcinica in an immunocompetent man. The patient fully recovered after receiving optimized antimicrobial therapy. Conclusions This case suggests that health care professionals should always evoke this diagnosis when confronted to atypical community-acquired pneumonia, even in immunocompetent patients.
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Affiliation(s)
- Abdoulahy Diallo
- Unité Maladies Infectieuses et Tropicales, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte
| | - Yacouba Dembele
- Service de Radiologie, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte
| | - Issifou Yaya
- IRD, Inserm, Univ Montpellier, TransVIHMI, Montpellier, France
| | - Mohamadou Niang
- Unité Maladies Infectieuses et Tropicales, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte
| | | | - Pascal Meliani
- Unité Maladies Infectieuses et Tropicales, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte
| | - Sarah Permal
- Unité Maladies Infectieuses et Tropicales, Centre Hospitalier de Mayotte, Mamoudzou, Mayotte
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17
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George E, T CM, Baikunje N, Nair N. Hidden Behind a Veil: A Rare Case of Pulmonary Nocardiosis. Cureus 2023; 15:e38635. [PMID: 37288242 PMCID: PMC10243381 DOI: 10.7759/cureus.38635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2023] [Indexed: 06/09/2023] Open
Abstract
A 48-year-old male, a known case of seizure disorder, presented with complaints of cough for four months, which increased for two weeks, fever for two weeks and weight loss. Computed tomography (CT) scan of the thorax showed multiple heterogeneously enhancing lesions of bilateral lung fields predominantly in peribronchovascular distribution with enlarged, necrosed and conglomerated lymph nodes suggestive of infective etiology. On routine blood investigations, he was found to be reactive for the human immunodeficiency virus. He underwent bronchoscopy and bronchoalveolar lavage culture grew Nocardia. He was prescribed antibiotics based on susceptibility reports and the patient became symptomatically better after one month and was discharged.
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Affiliation(s)
| | | | | | - Nandu Nair
- Pulmonary Medicine, KS Hegde Medical Academy, Mangaluru, IND
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18
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Malaguez Webber F, Nachiappan A, Lau FD, Costello C, Zane S. Nocardia caishijiensis infection: a case report and review of the literature. BMC Infect Dis 2023; 23:218. [PMID: 37024793 PMCID: PMC10080825 DOI: 10.1186/s12879-023-08186-z] [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: 08/12/2022] [Accepted: 03/20/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Nocardia caishijiensis is a rare soil actinomycete first described in Anhui province, China, in 2003. There has been only one reported instance of human infection caused by this species in the current literature. CASE PRESENTATION We present a case of pulmonary nocardiosis caused by Nocardia caishijiensis in a fifty-two-year-old man with human immunodeficiency virus infection and concomitant use of high-dose dexamethasone for cervical myelopathy, treated successfully with amikacin and thrimetroprim-sulfametoxazole, antibiotic resistance pattern was obtained, although interpretation may be limited. CONCLUSION To our knowledge, this is the first reported case of Nocardia caishijiensis infection in humans in North America and the second one in the literature, this pathogen should be recognized as a potentially rising etiology of nocardiosis, especially in solid organ transplant recipients. This has a rising importance as the survival for solid organ recipients continue to rise with advance in transplant medicine leading to increased life expectancy in this particularly susceptible group.
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Affiliation(s)
- Fabricio Malaguez Webber
- Department of Internal Medicine, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA.
| | - Arun Nachiappan
- Department of Internal Medicine, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA.
| | - Freddy Duarte Lau
- Department of Internal Medicine, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Christie Costello
- Department of Pharmacy, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Saul Zane
- Department of Internal Medicine, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
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19
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Traxler RM, Bell ME, Lasker B, Headd B, Shieh WJ, McQuiston JR. Updated Review on Nocardia Species: 2006-2021. Clin Microbiol Rev 2022; 35:e0002721. [PMID: 36314911 PMCID: PMC9769612 DOI: 10.1128/cmr.00027-21] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
This review serves as an update to the previous Nocardia review by Brown-Elliott et al. published in 2006 (B. A. Brown-Elliott, J. M. Brown, P. S. Conville, and R. J. Wallace. Jr., Clin Microbiol Rev 19:259-282, 2006, https://doi.org/10.1128/CMR.19.2.259-282.2006). Included is a discussion on the taxonomic expansion of the genus, current identification methods, and the impact of new technology (including matrix-assisted laser desorption ionization-time of flight [MALDI-TOF] and whole genome sequencing) on diagnosis and treatment. Clinical manifestations, the epidemiology, and geographic distribution are briefly discussed. An additional section on actinomycotic mycetoma is added to address this often-neglected disease.
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Affiliation(s)
- Rita M. Traxler
- Bacterial Special Pathogens Branch (BSPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Melissa E. Bell
- Bacterial Special Pathogens Branch (BSPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Brent Lasker
- Bacterial Special Pathogens Branch (BSPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Brendan Headd
- Bacterial Special Pathogens Branch (BSPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Wun-Ju Shieh
- Infectious Diseases Pathology Branch (IDPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - John R. McQuiston
- Bacterial Special Pathogens Branch (BSPB), Division of High-Consequence Pathogens and Pathology (DHCPP), National Center for Emerging and Zoonotic Infectious Diseases (NCEZID), Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
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20
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Jiao M, Ma X, Li Y, Wang H, Liu Y, Guo W, Lv J. Metagenomic next-generation sequencing provides prognostic warning by identifying mixed infections in nocardiosis. Front Cell Infect Microbiol 2022; 12:894678. [PMID: 36118026 PMCID: PMC9471186 DOI: 10.3389/fcimb.2022.894678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Nocardia is an opportunistic pathogen that mainly involves immunosuppressed patients and causes a high mortality rate. As an emerging approach to detect infectious pathogens, metagenomic next-generation sequencing (mNGS) was reported in the detection of Nocardia. However, there is no evidence demonstrating the effect of mNGS on the prognosis of Nocardia infection. In this retrospective study, we included 18 nocardiosis patients. Nocardia species were detected by mNGS from their clinical samples. All the patients were diagnosed with nocardiosis by clinical experts through a comprehensive evaluation. Of these 18 patients, fever is the most frequent initial symptom. Compared to traditional culture methods, mNGS provides a faster turnaround time (TAT) and higher sensitivity. Pulmonary nocardiosis was the most common clinical presentation in the study. mNGS detected 13 types of Nocardia species, of which Nocardia abscessus and Nocardia cyriacigeorgica were the most common species. The study's most noteworthy discovery is that mNGS outperforms culture at detecting mixed infections (more than one pathogen detected in one clinical specimen, including bacteria, fungi, and excluding virus), and number of infectious species was an independent risk factor for nocardiosis patients' prognostics after adjusting age, ICU days, gender and underlying diseases (adjusted HR = 1.47, 95% CI: 1.09-1.98, p = 0.011). As a result, we believe that by detecting mixed infections (more than one pathogenic species), mNGS can provide a clinical risk warning for the prognosis of nocardiosis.
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Affiliation(s)
- Mengfan Jiao
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Gene Hospital of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoxu Ma
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaoguang Li
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Gene Hospital of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huifen Wang
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Gene Hospital of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Liu
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Gene Hospital of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wenhu Guo
- R&D Center, Agene (Fuzhou) Medical Laboratory Co. Ltd., Fuzhou, China
| | - Jun Lv
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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21
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Serino M, Sousa C, Redondo M, Carvalho T, Ribeiro M, Ramos A, Cruz-Martins N, Amorim A. Nocardia spp. isolation in chronic lung diseases: Are there differences between patients with Pulmonary Nocardiosis and Nocardia colonization? J Appl Microbiol 2022; 133:3239-3249. [PMID: 35957549 DOI: 10.1111/jam.15778] [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: 07/02/2021] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 11/29/2022]
Abstract
AIMS Chronic lung diseases are a recognized risk factor for Nocardia spp. INFECTION Nocardia spp. isolation does not inevitably imply disease, and thus colonization must be considered. Here, we aimed to analyse the differences between pulmonary nocardiosis (PN) and Nocardia spp. colonization in patients with chronic lung diseases. METHODS AND RESULTS A retrospective study of patients with laboratory confirmation of isolation of Nocardia spp. in at least one respiratory sample was performed. Patients with PN and Nocardia spp. colonization were compared. There were 71 patients with Nocardia spp. identification, 64.8% were male, with a mean age of 67.7±11.2 years. All patients had ≥1 pre-existing chronic lung disease and 19.7% patients were immunocompromised. PN and Nocardia spp. colonization were considered in 26.8% and 73.2% of patients, respectively. Symptoms and chest CT findings were significantly more frequent in patients with PN (p<.001). During follow-up time, 12 (16.9%) patients died, 6 in PN group. Immunosuppression, constitutional symptoms, haematological malignancy and PN diagnosis were associated with significantly shorter survival times, despite only immunosuppression (HR 3.399; 95% CI 1.052-10.989) and PN diagnosis (HR 3.568; 95% CI 1.078-11.910) remained associated with a higher death risk in multivariate analysis. CONCLUSIONS PN was linked to clinical worsening, more chest CT findings and worse clinical outcomes. SIGNIFICANCE AND IMPACT OF STUDY Nocardia spp. isolation in chronic lung disease patients is more common than expected and the differentiation between colonization and disease is crucial.
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Affiliation(s)
- Mariana Serino
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Sousa
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Margarida Redondo
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Teresa Carvalho
- Clinical Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Manuela Ribeiro
- Clinical Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Angélica Ramos
- Clinical Pathology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Institute of Public Health of the University of Porto (ISPUP), Portugal
| | - Natália Cruz-Martins
- Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal.,Institute for Research and Innovation in Health (i3S), University of Porto, Porto, Portugal.,Institute of Research and Advanced Training in Health Sciences and Technologies (CESPU), Rua Central de Gandra, 1317, Gandra, PRD, Portugal
| | - Adelina Amorim
- Pulmonology Department, Centro Hospitalar Universitário de São João, Porto, Portugal.,Faculty of Medicine, University of Porto, Alameda Prof. Hernani Monteiro, Porto, Portugal
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22
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Silva Cruz M, Rodrigues Santos L, Vasconcelos G, Couto C, Esteves Rodrigues T, Veiga Ferraz R, Ferraz Moreira V, Lopes Z, Cadarso F. Nocardiosis: When the Side Effects of Therapy Mimic Symptoms. Cureus 2022; 14:e25695. [PMID: 35812553 PMCID: PMC9259186 DOI: 10.7759/cureus.25695] [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: 06/06/2022] [Indexed: 11/30/2022] Open
Abstract
Nocardiosis is a rare infection caused by gram-positive aerobic actinomycetes, which are common in soil. Inoculation occurs by inhaling agent fragments that cause localized or systemic suppurative lesions. The diagnosis is established based on isolation in cultural examinations. Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line treatment, and an antimicrobial susceptibility test is useful in severe cases or when there is no clinical response. The duration of treatment is determined by the affected site. However, the treatment cycles are long, and recurrence is common, which has a negative impact on the prognosis. We describe a case of an immunocompetent male with a recent diagnosis of pulmonary nocardiosis who, after starting therapy, presented with symptoms that could be explained by either disease progression or an adverse pharmacological reaction. Throughout this case, with atypical evolution, the authors review the diagnostic and therapeutic approach to Nocardia infection and alert to the importance of the differential diagnosis and available therapeutic options.
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23
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A Case of Pulmonary Nocardiosis Presenting with Multiple Cavitary Nodules in a Patient with Thrombocytopenia. REPORTS 2022. [DOI: 10.3390/reports5020019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Nocardiosis is an infrequent opportunistic infection that deserves more attention because of its increasing morbidity and high rate of misdiagnosis. Clinical and radiological manifestations as well as antibiograms of pulmonary nocardiosis are diverse. Herein, we report a patient with idiopathic thrombocytopenia treated with glucocorticoids, which later presented with severe pulmonary infection with widely distributed nodules on chest computed tomography. Fungal infection or tuberculosis was under initial suspicion and microbiological tests of bronchoalveolar lavage fluid eventually yielded an affirmative result of Nocardia cyriacigeorgica. The patient responded in the beginning; however, therapeutic strategies had to be altered several times due to adverse events. The patient eventually ended up with radiographic resolution at the end of six months. We wish to share some experience in dealing with this disease especially recognizing pulmonary nocardiosis in computed tomography imaging.
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24
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Barry M, AlShehri S, Alguhani A, Barry M, Alhijji A, Binkhamis K, Al-Majid F, Al-Shahrani FS, Muayqil T. A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim-sulfamethoxazole: case report and literature review. Ann Clin Microbiol Antimicrob 2022; 21:17. [PMID: 35578282 PMCID: PMC9112502 DOI: 10.1186/s12941-022-00511-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
Background Disseminated nocardiosis still causes significant morbidity and mortality and is often caused by Nocardia asteroides, N. basiliensis, and N. farcinica and are often treated with trimethoprim–sulfamethoxazole (TMP–SMX). Nocardia otitidiscaviarum (N. otitidiscaviarum) rarely causes disseminated disease and resistance to TMP–SMX is even more rare. Case presentation A 37-year-old woman with metastatic breast cancer and right ear deafness with recent occupational gardening and manipulating soil, presented to the hospital with first time seizure and multiple skin nodules. Magnetic resonance imaging (MRI) showed ring enhancing lesions, biopsy of the skin and brain lesions grew N. otitidiscaviarum. She was empirically treated with TMP–SMX and Imipenem–Cilastatin, however, almost three weeks into therapy, susceptibility results revealed it to be resistant to both antimicrobials, she was subsequently changed to Amikacin, Linezolid, Moxifloxacin, and Doxycycline but ultimately died. Conclusions This case report highlights the importance of suspecting a rare Nocardia species in patients at risk with proper occupational exposure, moreover, TMP–SMX resistance should be suspected with lack of clinical response, this may have important implications on clinical practice when facing similar infections.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia. .,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia. .,Division of Infectious Diseases, Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - Shahad AlShehri
- Infectious Diseases Unit, Internal Medicine Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ahlam Alguhani
- Infectious Diseases Unit, Internal Medicine Department, King Abdullah Medical City National Guard, Riyadh, Saudi Arabia
| | - Mohammad Barry
- Medical Imaging Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
| | - Ali Alhijji
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khalifa Binkhamis
- Department of Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fahad Al-Majid
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Fatimah S Al-Shahrani
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia.,King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Taim Muayqil
- King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.,Division of neurology, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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25
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Yagi R, Ooi Y, Nonoguchi N, Wanibuchi M. Brain abscess caused by Nocardia thailandica infection in systemic lupus erythematosus patient with steroid therapy. Surg Neurol Int 2022; 13:126. [PMID: 35509587 PMCID: PMC9062894 DOI: 10.25259/sni_78_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/06/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Nocardia is an aerobic Gram-negative bacillus belonging to actinomycetes and has been reported to be an infectious disease in healthy individuals. However, more than 60% have some underlying illnesses and are said to be opportunistic infections.
Case Description:
The case was a 69-year-old man who had been on long-term steroids for systemic lupus erythematosus. He developed with nausea and gait disturbance and was suspected of having a brain abscess by imaging. Abscess drainage detects actinomycetes that appear to belong to the genus Nocardia and brain abscess by Nocardia thailandica using matrix-assisted laser desorption/ionization time-of-flight mass analysis (MALDITOFMS) I was diagnosed. He died during the course of the treatment, and his organs did not detect his N. thailandica at necropsy, so he concluded that bacterial death from long-term administration of antibiotics was the cause of death.
Conclusion:
N. thailandica is a very rare bacterium belonging to Nocardia asteroides and is said to easily form brain lesions. In immunocompromised patients, prophylaxis with antibiotics and detailed examination of lung lesions for surveillance were considered necessary. This paper is the first report of a brain abscess caused by N. thailandica, including a review of the literature.
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Affiliation(s)
- Ryokichi Yagi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan,
| | - Yukimasa Ooi
- Department of Infection Control and Prevention, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan
| | - Naosuke Nonoguchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan,
| | - Masahiko Wanibuchi
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan,
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Kullab S, Basamad SW, Alnwaisir M, Alhowari M, Nohuz E. Disseminated Nocardiosis in a Breast Cancer Patient Caused by Nocardia otitidiscaviarum: A Case Report of Tertiary Centre in Saudi Arabia. Cureus 2022; 14:e22686. [PMID: 35386145 PMCID: PMC8969910 DOI: 10.7759/cureus.22686] [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: 02/28/2022] [Indexed: 11/05/2022] Open
Abstract
Nocardiosis is a rare opportunistic disease that primarily affects patients with deficient immune systems. Nocardia otitidiscaviarum is one of the rare species of Nocardia and it represents less than 3% of all Nocardia cases. Clinical presentation can be varied according to the affected organ. This study describes a case of a breast cancer patient who is immunocompromised due to the chemotherapy. This patient presented with a feature of febrile neutropenia. Investigations of this case led to the diagnosis of Nocardia otitidiscaviarum. Treatment of this underlying infection required to hold the chemotherapy for good time and to adapt patient-specific cancer treatment according to the balance between both need of cancer control and infection treatment according to the susceptibility test as in our case.
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Zou J, Peng B, Qu J, Zheng J. Are Bacterial Persisters Dormant Cells Only? Front Microbiol 2022; 12:708580. [PMID: 35185807 PMCID: PMC8847742 DOI: 10.3389/fmicb.2021.708580] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 12/15/2021] [Indexed: 11/13/2022] Open
Abstract
Bacterial persisters are a sub-population of phenotypic variants that tolerate high concentrations of antibiotics within the genetically homogeneous cells. They resume division upon the removal of drugs. Bacterial persistence is one of major causes of antibiotic treatment failure and recurrent infection. Cell dormancy, triggered by toxin/antitoxin pair, (p)ppGpp, SOS response and ATP levels, is known to be the mechanistic basis for persistence. However, recent studies have demonstrated that bacteria with active metabolism can maintain persistence by lowering intracellular antibiotic concentration via an efflux pump. Additionally, others and our work have showed that cell wall deficient bacteria (CWDB), including both L-form and spheroplasts that produced by β-lactam antibiotics, are associated with antibiotic persistence. They are not dormant cells as their cell walls have been completely damaged. In this review, we discuss the various types of persisters and highlight the contribution of non-walled bacteria on bacterial persistence.
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Affiliation(s)
- Jin Zou
- Department of Clinical Laboratory, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China.,Faculty of Health Sciences, University of Macau, Zhuhai, Macau SAR, China
| | - Bo Peng
- School of Life Sciences, Sun Yat-sen University, Guangzhou, China.,Laboratory for Marine Biology and Biotechnology, Qingdao National Laboratory for Marine Science and Technology, Qingdao, China
| | - Jiuxin Qu
- Department of Clinical Laboratory, The Third People's Hospital of Shenzhen, Southern University of Science and Technology, National Clinical Research Center for Infectious Diseases, Shenzhen, China
| | - Jun Zheng
- Faculty of Health Sciences, University of Macau, Zhuhai, Macau SAR, China.,Institute of Translational Medicine, University of Macau, Zhuhai, Macau SAR, China
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28
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Cheng Y, Wang TY, Yuan HL, Li W, Shen JP, He ZX, Chen J, Gao JY, Wang FK, Gu J. Nocardia Infection in Nephrotic Syndrome Patients: Three Case Studies and A Systematic Literature Review. Front Cell Infect Microbiol 2022; 11:789754. [PMID: 35141169 PMCID: PMC8819730 DOI: 10.3389/fcimb.2021.789754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/29/2021] [Indexed: 01/23/2023] Open
Abstract
Objective The multicenter literature review and case studies of 3 patients were undertaken to provide an updated understanding of nocardiosis, an opportunistic bacterial infection affecting immunosuppressed nephrotic syndrome (NS) patients receiving long-term glucocorticoid and immunosuppressant treatment. The results provided clinical and microbiological data to assist physicians in managing nocardiosis patients. Methods Three cases between 2017 and 2018 from a single center were reported. Additionally, a systematic review of multicenter cases described in the NCBI PubMed, Web of Science, and Embase in English between January 1, 2001 and May 10, 2021 was conducted. Results This study described three cases of Nocardia infection in NS patients. The systematic literature review identified 24 cases with sufficient individual patient data. A total of 27 cases extracted from the literature review showed that most patients were > 50 years of age and 70.4% were male. Furthermore, the glucocorticoid or corticosteroid mean dose was 30.9 ± 13.7 mg per day. The average time between hormone therapy and Nocardia infection was 8.5 ± 9.7 months. Pulmonary (85.2%) and skin (44.4%) infections were the most common manifestations in NS patients, with disseminated infections in 77.8% of patients. Nodule/masses and consolidations were the major radiological manifestations. Most patients showed elevated inflammatory biomarkers levels, including white blood cell counts, neutrophils percentage, and C-reactive protein. Twenty-five patients received trimethoprim-sulfamethoxazole monotherapy (18.5%) or trimethoprim-sulfamethoxazole-based multidrug therapy (74.1%), and the remaining two patients (7.4%) received biapenem monotherapy. All patients, except the two who were lost to follow-up, survived without relapse after antibiotic therapy. Conclusions Nephrotic syndrome patients are at high risk of Nocardia infection even if receiving low-dose glucocorticoid during the maintenance therapy. The most common manifestations of nocardiosis in NS patients include abnormal lungs revealing nodules and consolidations, skin and subcutaneous abscesses. The NS patients have a high rate of disseminated and cutaneous infections but a low mortality rate. Accurate and prompt microbiological diagnosis is critical for early treatment, besides the combination of appropriate antibiotic therapy and surgical drainage when needed for an improved prognosis.
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Affiliation(s)
- Yan Cheng
- Department of Basic Medical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Tian-yi Wang
- Department of Respiratory Medicine, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Hong-li Yuan
- Department of Radiology, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Wei Li
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jing-ping Shen
- Department of Nutrition, Beidaihe Rehabilitation and Recuperation Center, Qinhuangdao, China
| | - Zheng-xin He
- Department of Basic Medical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jing Chen
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jie-ying Gao
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Fu-kun Wang
- Department of Clinical Laboratory, The 980th Hospital of the PLA Joint Logistical Support Force (Bethune International Peace Hospital), Shijiazhuang, China
| | - Jiang Gu
- Department of Microbiology and Biochemical Pharmacy, College of Pharmacy, Army Medical University, Chongqing, China
- *Correspondence: Jiang Gu,
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29
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DiMeglio M, Shaikh H, Newman J, Vasquez Rubio G. Nocardiosis of the Central Nervous System: A rare complication of COVID management? IDCases 2022; 29:e01599. [PMID: 36032175 PMCID: PMC9403338 DOI: 10.1016/j.idcr.2022.e01599] [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: 05/12/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 11/26/2022] Open
Abstract
This case report examines a previously immunocompetent male that was treated with a prolonged course of corticosteroids for COVID pneumonia. He then returned with worsening headaches followed by flaccid paralysis of extremities due to cerebral and spinal cord abscesses secondary to Nocardia farcinica. A review of the literature on the mechanism of immunosuppression with COVID infection and corticosteroids is provided.
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30
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Christensen BB, Moran JMT, Torous VF. Nocardiosis diagnosed on bronchoalveolar lavage: Role of cytopathology. Diagn Cytopathol 2021; 50:E107-E113. [DOI: 10.1002/dc.24916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Bianca B. Christensen
- Department of Pathology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA
| | - Jakob M. T. Moran
- Department of Pathology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA
| | - Vanda F. Torous
- Department of Pathology Massachusetts General Hospital and Harvard Medical School Boston Massachusetts USA
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31
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Caso Coelho V, Pereira Neves SD, Cintra Giudice M, Benard G, Lopes MH, Sato PK. Evaluation of antimicrobial susceptibility testing of Nocardia spp. isolates by broth microdilution with resazurin and spectrophotometry. BMC Microbiol 2021; 21:331. [PMID: 34865615 PMCID: PMC8647337 DOI: 10.1186/s12866-021-02394-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 11/19/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Nocardia species are ubiquitous in natural environments and can cause nocardiosis. In the present study, the use of Resazurin salt and Spectrophotometry were proposed as alternative methods to reduce subjectivity in the interpretation of susceptibility results to antimicrobials by the broth microdilution method for Nocardia spp. RESULTS The susceptibility of Nocardia spp. isolates to Amikacin, Ciprofloxacin, Minocycline and Trimethoprim-Sulfamethoxazole was evaluated by Minimum Inhibitory Concentration (MIC) determinations by the broth microdilution method. To verify cellular growth, the colour-changing dye Resazurin was applied, the Optical Densities were measured on a spectrophotometer, and both were compared to Clinical and Laboratory Standards Institute (CLSI) Gold Standard method (visual MIC determination). Percentages of essential and categorical agreements and interpretative categorical errors were calculated within each method (intra-reading) and between them (inter-reading). The Gold Standard visual reading demonstrated 100% of essential and categorical intra-reading agreements for Amikacin, and there was no error when compared with the alternative methods. For Ciprofloxacin, the comparison between the Gold Standard and the Spectrophotometric reading showed 91.5% of essential agreement. In the categorical intra-reading analysis for Minocycline, there were 88.1 and 91.7% in the Gold Standard and in the Spectrophotometric readings, respectively, and 86.4% of concordance between them. High rates of categorical agreement were also observed on the Trimethoprim-Sulfamethoxazole analyses, with 93.7% for the Gold Standard, 84.9% for the Resazurin readings, and 80.5% between them. CONCLUSIONS The alternative methods with Resazurin and Spectrophotometric readings showed high agreement rates with the Gold Standard.
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Affiliation(s)
- Vivian Caso Coelho
- Laboratory of Medical Investigation in Immunology (LIM48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho de Aguiar 470, IMT 2, terreo, Sao Paulo, SP, 05403-000, Brazil
- Department of Infectious Diseases, FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Mauro Cintra Giudice
- Laboratory of Medical Investigation in Micology (LIM53), HCFMUSP, Sao Paulo, Brazil
- Instituto de Medicina Tropical de Sao Paulo, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
- Present Address: Faculdades Oswaldo Cruz, Sao Paulo, Brazil
| | - Gil Benard
- Laboratory of Medical Investigation in Micology (LIM53), HCFMUSP, Sao Paulo, Brazil
- Instituto de Medicina Tropical de Sao Paulo, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marta Heloisa Lopes
- Laboratory of Medical Investigation in Immunology (LIM48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho de Aguiar 470, IMT 2, terreo, Sao Paulo, SP, 05403-000, Brazil
- Department of Infectious Diseases, FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Paula Keiko Sato
- Laboratory of Medical Investigation in Immunology (LIM48), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Eneas Carvalho de Aguiar 470, IMT 2, terreo, Sao Paulo, SP, 05403-000, Brazil.
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Ringer M, Radcliffe C, Kerantzas CA, Malinis M, Azar MM. Nocardiosis and elevated beta-d-glucan in solid organ transplant recipients. IDCases 2021; 26:e01322. [PMID: 34786341 PMCID: PMC8577490 DOI: 10.1016/j.idcr.2021.e01322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/29/2022] Open
Abstract
Beta-D-glucan (BDG) testing can expedite the diagnosis of invasive fungal infections in immunocompromised hosts. Elevated BDG levels have been reported in both in-vitro studies assessing cross-reactivity with Nocardia spp. and published cases of patients with nocardiosis, but there is little data on this association in solid organ transplantation (SOT) recipients. To explore this association, we conducted a case series of SOT recipients with culture-proven nocardiosis and BDG testing who received their care at our institution between 2016 and 2021. We found thirteen cases of nocardiosis in SOT recipients, of which three cases met our case definition of an elevated BDG. Their clinical courses are detailed in the present report. We found that BDG may be elevated in SOT with nocardiosis with no identified cause of false positive BDG, though a causal association cannot be determined. Future prospective studies that better evaluate the association between nocardiosis and BDG are warranted, as are studies that better characterize the possible variability in reactivity amongst Nocardia spp.
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Affiliation(s)
- Matthew Ringer
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher Radcliffe
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
- Correspondence to: Section of Infectious Diseases, Department of Internal Medicine, PO Box 208022, New Haven, CT 06520, USA.
| | | | - Maricar Malinis
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Marwan M. Azar
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA
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Abe S, Tanabe Y, Ota T, Fujimori F, Youkou A, Makino M. Case report: pulmonary nocardiosis caused by Nocardia exalbida in an immunocompetent patient. BMC Infect Dis 2021; 21:776. [PMID: 34372796 PMCID: PMC8351411 DOI: 10.1186/s12879-021-06416-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 07/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nocardiosis is known as an opportunistic infection in immunocompromised hosts, but it occasionally has been reported in immunocompetent patient. The Nocardia exalbida is first-reported in 2006 from Japan, and a few cases of have been reported in only immunocompromised host, and the characteristic is still unclear. We herein describe the first case of pulmonary nocardiosis caused by N. exalbida in an immunocompetent patient. CASE PRESENTATION A77 -year-old Japanese man was admitted to our hospital on November 2, 2018. He was a lifelong non-smoker with no childhood history of respiratory disease. He had a medical history of dyslipidemia. One month before this admission fevers, sputum, mild cough were developed and he was evaluated in a clinic near our hospital. His diagnosis was community acquired pneumonia within his right middle lobe. He was treated with ceftriaxone 1 g/day intravenously for a week, however his symptoms relapsed a few days later. So, the physician retried ceftriaxone for another 3 days, but his symptoms did not improve. He was referred to our hospital. He was treated with sitafloxacin as an outpatient for a week, however his symptoms got worse. The chest CT showed consolidation and atelectasis in his right middle lobe. Low density area was scattered in consolidation, and right pleural effusion was observed. The patient was diagnosed with pulmonary abscess and he was admitted. Administration of piperacillin/tazobactam improved his condition. We switched antibiotics to amoxicillin/clavulanate, and he was discharged. After 2 weeks, he relapsed and was admitted again. After administration of piperacillin/tazobactam for 3 weeks, we perform bronchoscopy and Nocardia species were cultured from samples of the bronchial wash. The isolates were identified as N. exalbida using 16S rRNA gene sequencing. We prescribed Trimethoprim / Sulfamethoxazole (TMP/SMX) for 4 months. Then we switched to minocycline for renal dysfunction caused from TMP-SMX for 1 more month. After 5 months therapy, Consolidation on CT disappeared, and Nocardiosis was cured. CONCLUSION we reported the first case of pulmonary nocardiosis caused by N. exalbida in an immunocompetent patient. N. exalbida infection might be associated with a good response to treatment.
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Affiliation(s)
- Seitaro Abe
- Department of Respiratory Medicine, Niigata prefecturasl Shibata hospital, 1-2-8 Shibata, Niigata, 957-8588, Japan
| | - Yoshinari Tanabe
- Department of Respiratory Medicine, Niigata prefecturasl Shibata hospital, 1-2-8 Shibata, Niigata, 957-8588, Japan.
| | - Takeshi Ota
- Department of Respiratory Medicine, Niigata prefecturasl Shibata hospital, 1-2-8 Shibata, Niigata, 957-8588, Japan
| | - Fumio Fujimori
- Department of Respiratory Medicine, Niigata prefecturasl Shibata hospital, 1-2-8 Shibata, Niigata, 957-8588, Japan
| | - Akira Youkou
- Department of Infectious Disease, Niigata City general hospital, Niigata, Japan
| | - Masato Makino
- Department of Respiratory Medicine, Niigata prefecturasl Shibata hospital, 1-2-8 Shibata, Niigata, 957-8588, Japan
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Samannodi M. Disseminated Nocardia Paucivorans in an immunocompetent patient: A case report and literature review. Clin Case Rep 2021; 9:e04659. [PMID: 34401175 PMCID: PMC8346600 DOI: 10.1002/ccr3.4659] [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] [Received: 06/03/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 11/07/2022] Open
Abstract
Nocardia paucivorans can cause disseminated infection in immunocompetent hosts in rare occasions. Nocardia paucivorans is usually susceptible to many antibiotics including Trimethoprim/Sulfamethoxazole. Duration of treatment is usually 6-12 months.
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Affiliation(s)
- Mohammed Samannodi
- Department of MedicineCollege of MedicineUmm AlQura UniversityMakkahSaudi Arabia
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35
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Jiao M, Deng X, Yang H, Dong J, Lv J, Li F. Case Report: A Severe and Multi-Site Nocardia farcinica Infection Rapidly and Precisely Identified by Metagenomic Next-Generation Sequencing. Front Med (Lausanne) 2021; 8:669552. [PMID: 34109198 PMCID: PMC8183679 DOI: 10.3389/fmed.2021.669552] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/29/2021] [Indexed: 01/29/2023] Open
Abstract
Nocardia genus is an aerobic, gram-positive, and opportunistic pathogen, which mainly affects cell-mediated immunosuppressed patients. Early diagnosis and treatment greatly improve prognosis. However, the limitation of golden standard-bacterial culture exists. Here, we report a 61-year-old male with pneumonia, sepsis and intermuscular abscesses induced by Nocardia farcinica. Venous blood culture reported negative results. Former improper diagnosis and treatment did not improve his condition. With the assistant of metagenomic next-generation sequencing, the pathogen was identified as Nocardia farcinica. He was then applied with accurate treatment and had a remarkable clinical and radiological improvement.
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Affiliation(s)
- Mengfan Jiao
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Precision Medicine Center, Gene Hospital of Henan Province, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiang Deng
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongfu Yang
- Department of Integrated Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junqiang Dong
- Department of Imaging and Nuclear Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Lv
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fang Li
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Disseminated nocardiosis due to Nocardia terpenica. J Infect Chemother 2021; 27:1365-1368. [PMID: 33910776 DOI: 10.1016/j.jiac.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/06/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022]
Abstract
We report the first case of disseminated nocardiosis due to trimethoprim/sulfamethoxazole-resistant Nocardia terpenica successfully treated with meropenem and clarithromycin. The patient travelled to Japan from Australia via Southeast Asia, which led to differential diagnoses of multiple lung nodules including miliary tuberculosis and melioidosis as well as nocardiosis. Because of variety of susceptibility depending on the Nocardia species, clinicians need to confirm the species and investigate its susceptibility.
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Lenskaya V, DeChavez V, Kaufman B, Caplivski D. Primary cutaneous nocardiosis caused by Nocardia nova with possible Apremilast contribution. IDCases 2021; 24:e01078. [PMID: 33850720 PMCID: PMC8024659 DOI: 10.1016/j.idcr.2021.e01078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/15/2021] [Accepted: 03/16/2021] [Indexed: 11/17/2022] Open
Abstract
Primary cutaneous nocardiosis accounts for 5-8 % of all nocardiosis cases and represents a diagnostic dilemma among immunocompetent and immunocompromised hosts. Herein, we present a case of a 30-year-old male with history of psoriasis with recent addition of Apremilast. Patient received intralesional triamcinolone injections for psoriatic plaques on the hands and abdomen prior to traveling to warm climate vacation. While on vacation, patient developed hand swelling and painful, red nodules on the dorsal hands and abdomen, sites where he received intralesional injections. Patient was empirically given doxycycline, but continued to develop new nodules. An abdominal lesion was biopsied for H&E and tissue culture. Tissue culture revealed beaded gram-positive rods identified as Nocardia nova by MALDI-TOF. Patient was switched to trimethoprim-sulfamethoxazole with significant improvement. This case represents an atypical primary cutaneous nocardiosis with Nocardia nova most likely in the setting of intralesional steroid injections and possible contribution of Apremilast.
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Affiliation(s)
- Volha Lenskaya
- Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, 10129, NY, United States
- Corresponding author at: 1468 Madison Ave, Annenberg, 15th floor, New York, NY, 10029, United States.
| | - Vincent DeChavez
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, 10129, NY, United States
| | - Bridget Kaufman
- Department of Dermatopathology, Icahn School of Medicine at Mount Sinai, New York, 10129, NY, United States
| | - Daniel Caplivski
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, 10129, NY, United States
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Abstract
A 47-year-old man was referred for ongoing workup of an enlarging lung mass. Extensive workup of the mass had been unrevealing for several months until cultures grew Nocardia beijingensis He was successfully treated with trimethoprim/sulfamethoxazole and then doxycycline with near-complete resolution of the mass on follow-up. This case presents a rare species of N. beijingensis It highlights the importance of considering nocardiosis in immunocompetent adults and the challenge in initiating targeted treatment due to delayed culture results.
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Affiliation(s)
- Rasha Raslan
- Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Pamela Bailey
- Department of Infectious Disease, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sangeeta Sastry
- Department of Infectious Disease, Virginia Commonwealth University, Richmond, Virginia, USA
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Mehrabadi SM, Taraghian M, Pirouzi A, Khaledi A, Neshani A, Rashki S. Pulmonary Nocardiosis in Suspected Tuberculosis Patients: A Systematic Review and Meta-Analysis of Cross-Sectional Studies. Ethiop J Health Sci 2020; 30:293-300. [PMID: 32165819 PMCID: PMC7060384 DOI: 10.4314/ejhs.v30i2.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background nocardiosis is an opportunistic infectious disease in immunocompromised patients. The most common form of nocardiosis infection in humans is pulmonary nocrdiosis caused by inhaling Nocardia species from the environment. Thus, this study aimed to evaluate the pulmonary nocardiosis in patients with suspected tuberculosis using systematic review and meta-analysis. Methods We conducted a systematic search for cross-sectional studies focused on the pulmonary nocardiosis among patients with pulmonary tuberculosis based on the Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) published from January 2001 to October 2019. The search was conducted in MEDLINE/PubMed, Web of Science, Scopus, Cochrane Library, Google Scholar, Science Direct databases, and Iranian databases. Medical subject headings (MeSH) and text words were searched: “pulmonary nocardiosis”, “nocardiosis”, OR “nocardial infection”, “pulmonary nocardial infections/agents”, AND “pulmonary tuberculosis”, OR “pulmonary TB”, AND “Iran”. Two of the reviewers enrolled independently articles published in English and Persian languages according to the inclusion and the exclusion criteria. Comprehensive Meta-Analysis software (Version 3.3.070) was used for meta-analysis. Results Only 4 studies met the eligibility criteria. The pulmonary nocardiosis prevalence varied from 1.7% to 6.7%. The combined prevalence of nocardiosis among patients with suspected pulmonary tuberculosis in Iran was 4.8% (95% CI: 3–7.3, Q=5.8, Z=12.7). No heterogeneity was observed between studies because I2 was 48.3. N. cyriacigeorgica and N. asteroides were reported as the prevalent isolates, respectively. Conclusions This review showed in patients suspected TB when they were negative in all diagnosis laboratory tests, nocardiosis cases which be considered.
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Affiliation(s)
- Susan Mansuri Mehrabadi
- Medical Student, Department of Medicine, Kazeroun Branch, Islamic Azad University, Kazeroun, Iran
| | - Mina Taraghian
- Department of Microbiology, School of Basic Sciences, Hamedan Branch, Islamic Azad University, Hamedan, Iran
| | - Aliyar Pirouzi
- Cellular and Molecular Gerash Research Center, Gerash University of Medical Sciences, Gerash, Iran
| | - Azad Khaledi
- Cellular and Molecular Gerash Research Center, Gerash University of Medical Sciences, Gerash, Iran.,Infectious Diseases Research Center, Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Alireza Neshani
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Somaye Rashki
- Infectious Diseases Research Center, Department of Microbiology and Immunology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
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Nocardia veterana infections: case report and systematic review. New Microbes New Infect 2020; 39:100833. [PMID: 33456780 PMCID: PMC7797559 DOI: 10.1016/j.nmni.2020.100833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/30/2022] Open
Abstract
Members of the genus Nocardia are filamentous, Gram-positive, aerobic bacteria and exist ubiquitously in most environments. In 2001, the species Nocardia veterana was first isolated, and it predominantly causes pulmonary infections in immunocompromised hosts. We present the first report of a soft-tissue abscess caused by N. veterana in a 59-year-old woman being treated for chronic cutaneous graft-versus-host disease. After failing to improve with empirical treatment, two incision and drainage procedures were required. She subsequently completed a 1-year course of oral antibiotic therapy consisting of trimethoprim-sulfamethoxazole then azithromycin. No relapse occurred over the next 5 years of follow up. To better characterize N. veterana infections, we performed a systematic literature review and summarized all previously reported cases. Overall, the rising prevalence of immunocompromising conditions warrants increased vigilance for infections caused by atypical or opportunistic pathogens.
Systematic review of Nocardia veterana infections. First report of N. veterana soft tissue abscess. N. veterana typically causes pulmonary infections in immunocompromised hosts.
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Recurrent Empyema Thoracic Secondary to Pulmonary Nocardiosis in Immunocompetent Patients. Case Rep Pulmonol 2020; 2020:8840920. [PMID: 33178475 PMCID: PMC7609154 DOI: 10.1155/2020/8840920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/09/2020] [Accepted: 10/15/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary nocardiosis is a rare disorder that mainly affects immune-compromised patients. We report a 37-year-old male who presented with persistent fever associated with productive cough. During this course of therapy, he had recurrent admissions for empyema thoracic. Clinically, his vital signs were normal. Blood investigations show leukocytosis with a significantly raised erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Sputum acid-fast bacilli (AFB) was scanty 1+ and sputum mycobacterium culture was negative. Chest X-ray (CXR) showed consolidative changes with mild to moderate pleural effusion on the right side. Skin biopsy was taken and showed Paecilomyces species. A computed tomography scan (CT thorax) was performed and revealed a multiloculated collection within the right hemithorax with a split pleura sign. Decortications were performed and tissue culture and sensitivity (C+S) growth of Nocardia species. And it is sensitive to sulfamethoxazole-trimethoprim and completed treatment for 4 months. This case highlights that pulmonary nocardiosis should be kept in mind in also immune-competent patients, especially in suspected cases of tuberculosis not responding to antitubercular therapy.
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Malik MB, Ahsan NJ, Hilal K, Mahmood SF, Siddiqui MAR. Subretinal abscess as an initial presentation of systemic nocardiosis. BMJ Case Rep 2020; 13:13/11/e236898. [PMID: 33139365 DOI: 10.1136/bcr-2020-236898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of subretinal abscess as the initial presentation of systemic nocardiosis. The patient was a known case of chronic inflammatory demyelinating polyneuropathy and on long-term immunosuppressants. He presented with a rapidly progressive, unilateral decline in visual acuity in the right eye. Dilated fundus examination showed a large whitish subretinal lesion. A working diagnosis of subretinal abscess was made. The appearance was highly suspicious for Nocardia abscess. On further direct questioning, it was noted that the patient had been experiencing low-grade fever and non-productive cough for 1 month. The patient was referred to infectious diseases for systemic work-up and a vitreous tap was done, along with intravitreal antibiotics. Blood culture and bronchoalveolar lavage both reported Nocardia species. Sensitivity-guided antibiotic therapy resulted in improved systemic condition and a quiet and comfortable right eye, but vision could not be saved due to late presentation.
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Affiliation(s)
- Muhammad Bilal Malik
- Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Nida Jawed Ahsan
- Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Kiran Hilal
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Faisal Mahmood
- Section of Infectious Diseases, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - M A Rehman Siddiqui
- Section of Ophthalmology, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
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Martínez-Barricarte R. Isolated Nocardiosis, an Unrecognized Primary Immunodeficiency? Front Immunol 2020; 11:590239. [PMID: 33193422 PMCID: PMC7606290 DOI: 10.3389/fimmu.2020.590239] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 08/31/2020] [Indexed: 01/19/2023] Open
Abstract
Nocardiosis is an infectious disease caused by the gram-positive bacterium Nocardia spp. Although it is commonly accepted that exposure to Nocardia is almost universal, only a small fraction of exposed individuals develop the disease, while the vast majority remain healthy. Nocardiosis has been described as an "opportunistic" disease of immunocompromised patients, suggesting that exposure to the pathogen is necessary, but a host predisposition is also required. Interestingly, increasing numbers of nocardiosis cases in individuals without any detected risk factors, i.e., without overt immunodeficiency, are being reported. Furthermore, a growing body of evidence have shown that selective susceptibility to a specific pathogen can be caused by a primary immunodeficiency (PID). This raises the question of whether an undiagnosed PID may cause nocardiosis affecting otherwise healthy individuals. This review summarizes the specific clinical and microbiological characteristics of patients with isolated nocardiosis published during the past 30 years. Furthermore, it gives an overview of the known human immune mechanisms to fend off Nocardia spp. obtained from the study of PIDs and patients under immunomodulatory therapies.
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Affiliation(s)
- Rubén Martínez-Barricarte
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Pathology, Microbiology, and Immunology, Vanderbilt Center for Immunobiology, Vanderbilt Institute for Infection, Immunology, and Inflammation, Vanderbilt University Medical Center, Nashville, TN, United States
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Nouioui I, Cortés-Albayay C, Neumann-Schaal M, Vicente D, Cilla G, Klenk HP, Marimón JM, Ercibengoa M. Genomic Virulence Features of Two Novel Species Nocardia barduliensis sp. nov. and Nocardia gipuzkoensis sp. nov., Isolated from Patients with Chronic Pulmonary Diseases. Microorganisms 2020; 8:microorganisms8101517. [PMID: 33019781 PMCID: PMC7600791 DOI: 10.3390/microorganisms8101517] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 11/16/2022] Open
Abstract
Strains 335427T and 234509T, isolated from two 76-year-old patients with chronic pulmonary diseases, were the subject of polyphasic taxonomic studies and comparative genomic analyses for virulence factors. The 16 rRNA gene sequence similarity between strains 335427T and 234509T and their closest phylogenetic neighbors Nocardia asiatica NBRC 100129T and Nocardia abscessus NBRC 100374T were 99.5% and 100%, respectively. Digital DNA-DNA hybridization values between the aforementioned studied strains were well below the 70% threshold for assigning prokaryotic strains to a novel species. Strains 335427T and 234509T have genome sizes of 8.49 Mpb and 8.07 Mpb, respectively, with G + C content of 68.5%. Isolate 335427T has C16:0, C18:1 ω9c, C18:0 and C18:0 10 methyl as major fatty acids (>15%) and mycolic acids formed of 52-54 carbon atoms. However, only C18:1 ω9c was detected for isolate 234509T, which had mycolic acids with 44-56 carbon. Based on phenotypic and genetic data, strains 335427T (DSM 109819T = CECT 9924T) and 234509T (DSM 111366T = CECT 30129T) merit recognition as novel species, which are named Nocardia barduliensis sp. nov. and Nocardia gipuzkoensis sp. nov., respectively. All the strains studied had homologous VF-associated genes to those described in M. tuberculosis, including experimentally verified virulence genes in humans related to tuberculosis. The narGHIJ (nitrate reduction pathway) and gvpAFGOJLMK (gas vesicles) genetic maps of strains 335427T, 234509T, NBRC 100129T and NBRC 100374T showed the same syntenic block and raise the question of whether their functions are interlinked during the infection of the human host. However, further research is required to decipher the role of the gas vesicle in the pathogenicity mechanism of Nocardia spp.
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Affiliation(s)
- Imen Nouioui
- Leibniz Institute DSMZ–German Collection of Microorganisms and Cell Cultures, 38124 Braunschweig, Germany;
- Correspondence: (I.N.); (M.E.)
| | - Carlos Cortés-Albayay
- Laboratory of Microbial Complexity and Functional Ecology, Antofagasta Institute, University of Antofagasta, Antofagasta 1240000, Chile;
| | - Meina Neumann-Schaal
- Leibniz Institute DSMZ–German Collection of Microorganisms and Cell Cultures, 38124 Braunschweig, Germany;
| | - Diego Vicente
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
| | - Gustavo Cilla
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
| | - Hans-Peter Klenk
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Jose María Marimón
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
| | - Maria Ercibengoa
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Osakidetza Basque Health Service, Donostialdea Integrated Health Organisation, Microbiology Department, 20014 San Sebastian, Spain; (D.V.); (G.C.); (J.M.M.)
- Correspondence: (I.N.); (M.E.)
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Mehta HH, Shamoo Y. Pathogenic Nocardia: A diverse genus of emerging pathogens or just poorly recognized? PLoS Pathog 2020; 16:e1008280. [PMID: 32134995 PMCID: PMC7058287 DOI: 10.1371/journal.ppat.1008280] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Heer H. Mehta
- Department of BioSciences, Rice University, Houston, Texas, United States of America
- * E-mail:
| | - Yousif Shamoo
- Department of BioSciences, Rice University, Houston, Texas, United States of America
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Kapoor R, Adapa S, Vakiti A, Gani IY, Mulloy L, Padala SA. A Rare Case of Drug-Resistant Nocardia transvalensis Infection in a Renal Transplant Patient. J Investig Med High Impact Case Rep 2020; 8:2324709620909243. [PMID: 32108507 PMCID: PMC7052443 DOI: 10.1177/2324709620909243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Nocardia transvalensis is a rare species of
Nocardia and is known to be a drug-resistant organism.
Multiple cases have been reported of Nocardia species causing
opportunistic infections in immunocompromised hosts. To our knowledge, we report
the first case of successfully treated drug-resistant Nocardia
transvalensis causing pulmonary nocardiosis in a renal transplant
patient. Our case validates the importance of prompt identification of
Nocardia species and their drug sensitivities to improve
clinical outcomes and reduce mortality.
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Affiliation(s)
- Rajan Kapoor
- Augusta University Medical Center, Augusta, GA, USA
| | | | | | | | - Laura Mulloy
- Augusta University Medical Center, Augusta, GA, USA
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Retrospective Analysis of Antimicrobial Susceptibility Profiles of Nocardia Species from a Tertiary Hospital and Reference Laboratory, 2011 to 2017. Antimicrob Agents Chemother 2020; 64:AAC.01868-19. [PMID: 31818815 DOI: 10.1128/aac.01868-19] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/30/2019] [Indexed: 12/22/2022] Open
Abstract
Nocardia species are found worldwide and are opportunistic pathogens of both immunocompromised and immunocompetent hosts. Recent updates to the taxonomy of this genus have indicated that there are more than 90 recognized species of Nocardia with 54 species reported to be clinically relevant. In this paper, we report the species distribution, specimen source distribution, and antimicrobial susceptibility profiles of 2,091 clinical isolates recovered for the years 2011 to 2017 using the updated taxonomy. The most commonly isolated species included Nocardia nova complex, Nocardia cyriacigeorgica, and Nocardia farcinica complex, with an additional 25 species or species complexes recovered from clinical specimens. The antimicrobial susceptibility profile was highly variable between the species, but in general, amikacin, linezolid, and trimethoprim-sulfamethoxazole demonstrated good in vitro activity against most species.
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Wadhwa T, Baveja U, Kumar N, Govil D, Sengupta S. Clinical manifestations of nocardiosis: Study of risk factors and outcomes in a tertiary care hospital. J Lab Physicians 2020; 9:288-295. [PMID: 28966493 PMCID: PMC5607760 DOI: 10.4103/jlp.jlp_111_16] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
PURPOSE The aim of this study is to evaluate the predisposing risk factors, clinical presentations, laboratory parameters, and treatments taken and outcomes in patients of nocardiosis in the span of 5 years in a tertiary care hospital. MATERIALS AND METHODS The patients whose specimens showed Nocardia like organism in Gram-staining, Kinyoun staining and characteristic colonies in culture were included in the retrospective analysis study. Retrospective analysis of associated risk factors, clinical presentations, and radiological findings was performed. RESULTS Of the thirteen patients, 11 (76.9%) had immunosuppressive pathologies including solid organ transplantation, autoimmune disease, use of steroids, and immunosuppressive drugs as important risk factors. Four types of clinical manifestations were observed, pulmonary (46.1%), cutaneous (23.07%), cerebral (15.3%), and bacteremia (15.3%). The most common presentation was pulmonary with steroid therapy as a significant risk factor. Consolidation and pleural effusion were the common radiological findings in these cases. In eight of the nine patients anti-nocrdial drugs were given. Cotrimoxazole as monotherapy was given in four cases (44.44%), cotrimoxazole in combination with meropenem in two cases (22.22%); minocycline and linezolid were given in one case each. The overall mortality was 36.36% and was seen in patients with pulmonary nocardiosis. CONCLUSIONS The study indicates that Nocardial infections are re-emerging on account of an increase in numbers of immunocompromised patients due to increased organ transplants, autoimmune diseases, malignancies, and use of immunosuppressive drugs and steroids. The diagnosis is often missed/not suspected and delayed because of the clinical resemblance to many other infections. Nocardial infection should be suspected and assessed particularly in immunocompromised patients not responding to treatment/improving clinically.
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Affiliation(s)
- Teena Wadhwa
- Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
| | - Usha Baveja
- Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
| | - Navin Kumar
- Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
| | - Deepak Govil
- Department of Critical Care, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
| | - Sharmila Sengupta
- Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
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Williams E, Jenney AW, Spelman DW. Nocardia bacteremia: A single-center retrospective review and a systematic review of the literature. Int J Infect Dis 2020; 92:197-207. [PMID: 31978577 DOI: 10.1016/j.ijid.2020.01.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/21/2019] [Accepted: 01/13/2020] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Nocardia bacteremia is a rare but severe disease associated with high mortality. This systematic review is the largest and most comprehensive review performed over the past 20 years. METHODS A single-center retrospective review of Nocardia bacteremia was performed using hospital microbiology records from January 1, 2010 to December 31, 2017. A systematic literature review was also performed to identify cases of Nocardia bacteremia described in the NCBI PubMed database in English between January 1, 1999 and December 31, 2018. RESULTS Four new cases of Nocardia bacteremia are described. The systematic review identified 134 cases with sufficient information available for analysis. Of the total 138 cases, the median age was 58 years (interquartile range (IQR) 44-69 years) and 70% were male. Eighty-one percent were immunocompromised (corticosteroid use (49%), hematological malignancy (20%), solid organ transplant (20%), solid organ malignancy (19%), and hematopoietic stem cell transplantation (15%)) and 29% had endovascular devices. Pulmonary infection was the most common concurrent site of clinical disease (67%). The median incubation time to the detection of Nocardia bacteremia was 4 days (IQR 3-6 days). Blood cultures were the only positive microbiological specimen in 38% of cases. The median total duration of treatment was 75 days (IQR 25-182 days). Thirty-day all-cause mortality was 28% and overall all-cause mortality was 40%. CONCLUSIONS Nocardia bacteremia is most frequently identified in immunocompromised patients and those with intravascular devices. Although rare, it represents a serious infection with high associated overall mortality.
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Affiliation(s)
- Eloise Williams
- Microbiology Unit, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia; Department of Infectious Diseases, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia.
| | - Adam W Jenney
- Microbiology Unit, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia; Department of Infectious Diseases, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia; Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Denis W Spelman
- Microbiology Unit, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia; Department of Infectious Diseases, Alfred Health, 55 Commercial Rd, Melbourne, Victoria, Australia; Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
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50
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Abstract
Nocardiosis is a neglected tropical disease. It has varied geographical presence and a spectrum of clinical presentations. This review aims to focus on the epidemiology of nocardial infections with a systematic approach to their diagnosis and treatment. Nocardiacauses chronic infections and ailments, and may remain cryptic but progressive in its course. Unless suspected, diagnosis can be easily missed resulting in increased morbidity and mortality. Thorough knowledge of local epidemiology, demography, clinical course and presentation, diagnostic modalities, and antibiotic susceptibility patterns of the prevalent Nocardia species is essential to curb spread of this infection. This is a systematic review in which internet search has been done for citation indices (Embase, PubMed, Ovid, and other individual journals) till March 2020 utilizing the following key words "Nocardia," "taxonomy," "prevalence," "clinical features," "diagnosis," "treatment," and "susceptibility." We selected a total of 87 review articles, case series, and case reports all in English language.
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