A life-threatening case of disseminated nocardiosis due to Nocardia brasiliensis

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Abstract

Nocardiosis is a rare disease caused by infection with Nocardia species, aerobic actinomycetes with a worldwide distribution. A rare life-threatening disseminated Nocardia brasiliensis infection is described in an elderly, immunocompromised patient. Microorganism was recovered from bronchial secretions and dermal lesions, and was identified using molecular assays. Prompt, timely diagnosis and appropriate treatment ensured a favorable outcome.

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Most cited references 12

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Review of nocardial infections in France 1987 to 1990.

P Boiron, F Provost, Hans B. Dupont … (1992)

On the basis of the numbers of Nocardia strains referred to the National Reference Center for Mycoses and Antifungal Agents (NRC), Institut Pasteur, Paris, in the period from 1987 to 1990, it was estimated that between 150 and 250 cases of nocardiosis are diagnosed in France each year. A total of 63 clinical isolates were referred to the NRC and identified as Nocardia asteroides (66.7%), Nocardia farcinica (23.8%), Nocardia brasiliensis (3.2%), Nocardia otitidiscaviarum (4.8%) and Nocardia carnea (1.5%). Nocardia asteroides accounted for 71.4% of pulmonary infections, 80.0% of central nervous system infections and 80.0% of systemic infections. Patients infected with Nocardia farcinica died in 57.1% of cases, compared with 17.6% of patients infected with Nocardia asteroides. Corticosteroid therapy represented a significant factor in mortality. Isolates of Nocardia asteroides revealed variable resistance, whereas isolates of Nocardia farcinica were resistant to most antimicrobial agents. Only amoxicillin/clavulanic acid, imipenem, cefoxitin, kanamycin, amikacin, minocycline and vancomycin showed activity against both species. Nocardiosis caused by Nocardia farcinica may be a growing problem because of the relatively high incidence in AIDS patients and the resistance of this species to most antimicrobial agents.

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The clinical spectrum of Nocardia brasiliensis infection in the United States.

R Smego, H A Gallis (2015)

Seven cases of infection due to Nocardia brasiliensis were identified over a 13-year period at Duke University Medical Center, Durham, North Carolina. These seven cases and a review of 55 cases in the literature reported from the United States show that N. brasiliensis can cause a wide spectrum of disease. Forty-six of the 62 patients had disease of skin and soft tissues. Cutaneous manifestations included cellulitis, pustules, ulcerations, pyoderma, subcutaneous abscesses, a lymphocutaneous syndrome, and mycetoma. Six patients had pleuropulmonary disease, and one patient had isolated central nervous system (CNS) involvement. Dissemination of disease, a characteristic generally attributed to Nocardia asteroides infection, was seen in eight instances. Patient ages ranged from one to 79 years; 51 of the patients were males. N. brasiliensis was an opportunistic pathogen in only 28% of the cases for which adequate clinical information was available, although trauma was an important predisposing feature of cutaneous disease (19 of 43 cases). Infection may be acquired either by cutaneous inoculation or respiratory inhalation. Clinical outcome is related to the site and extent of disease and to the presence or absence of serious underlying disease. All patients with skin and soft-tissue infections recovered, as did 83% of those with pulmonary involvement. For patients with disseminated or CNS disease, however, mortality was 67%. Traditional therapy with sulfonamides is not optimal for metastatic nocardial disease, and administration of trimethoprim-sulfamethoxazole may increase rates of cure.

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Report of human nocardiosis in Italy between 1993 and 1997.

C. Farina, P Boiron, I Ferrari … (2001)

During a 5-year period, from 1993 to 1997, nocardial infection was diagnosed in 26 patients admitted to hospitals in 11 cities in Italy. Pathogens were identified as Nocardia asteroides in 18 cases, as N. farcinica in five cases, as N. nova in two and as N. brasiliensis in one case. All cases were difficult to diagnose, as usually it happens with this disease: physicians have to be alert to suspect nocardial infection so that appropriate therapy can be early given. This is the second retrospective report on Nocardia spp. infection conducted in Italy, suggesting the utility to organise a permanent network for a national survey system for nocardiosis.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Crit Care Med

Journal ID (iso-abbrev): Indian J Crit Care Med

Journal ID (publisher-id): IJCCM

Title: Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0972-5229

ISSN (Electronic): 1998-359X

Publication date (Print): Oct-Dec 2012

Volume: 16

Issue: 4

Pages: 234-237

Affiliations

[1] From: 2 ^nd Critical Care Department, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, Greece, EU

[1 ]Department of Clinical Microbiology, “Attikon” General University Hospital, Medical School, National and Kapodistrian University of Athens, Greece, EU

[2 ]Institute of Continuing Medical Education of Ioannina, Department of Internal Medicine, Greece, EU

Author notes

Correspondence: Dr. Elisabeth Paramythiotou, 35 Parou str, Agia Paraskevi, Athens, Greece, EU. E-mail: lparamyth61@ 123456hotmail.com

Article

Publisher ID: IJCCM-16-234

DOI: 10.4103/0972-5229.106512

PMC ID: 3610462

PubMed ID: 23559737

SO-VID: 2281646e-0070-4a43-b088-1185056d9205

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A life-threatening case of disseminated nocardiosis due to Nocardia brasiliensis

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Most cited references 12

Review of nocardial infections in France 1987 to 1990.

The clinical spectrum of Nocardia brasiliensis infection in the United States.

Report of human nocardiosis in Italy between 1993 and 1997.

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