Nocardia asteroides as a mammary pathogen of cattle. I. The disease in cattle and the comparative virulence of 5 isolates.
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The authors describe the finding of Nocardia asteroides from a haemoculture in a patient with right-sided pneumonia and several predisposing factors (TB, chronic bronchitis, anamnestic hepatitis, chronic hepatopathy, anaemia, ethylism and a neoplasm revealed in the final stage). Early bacteriological diagnosis and aimed antimicrobial therapy led to radical improvement of the very dramatic clinical condition. The authors discuss the possible higher incidence of the infectious agent, which previously was detected only very rarely.
Pleural involvement in nocardiosis is rarely reported from India. A case of hydropneumothorax due to Nocardia asteroides in a patient with diabetes mellitus is reported. Tube thoracostomy drainage and therapy with trimethoprim-sulphamethoxazole for seven months prevented reaccumulation of pleural fluid and improved the general condition but failed to expand the lung. Bronchoscopy may be useful if multiple sputum examinations are negative in diagnosing pulmonary nocardiosis.
A 40-day-old male infant presented with fever and non-productive cough for 3 weeks, tachypnea and dyspnea 5 days before admission. The chest radiograph and computed tomographic (CT) scan revealed right lung consolidation with pleural effusion. Pleural tapping showed frank pus that grew Nocardia asteroides. The CT scan of the brain and abdomen were normal. The patient was treated with 15 mg/kg/day of trimethoprim and 75 mg/kg/day of sulfamethoxazole intravenously for 3 weeks and then orally for 6 months with complete recovery. T cell quantitative studies were normal and anti-HIV was non-reactive. A flow cytometric assay with Staphylococcal aureus and phorbol myristate acetate (PMA) as the stimulants showed normal oxidative burst which represented normal intracellular killing. One year after completion of treatment, he was healthy and the chest radiograph was normal.
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A 62-year-old woman was admitted with fever and bloody sputum. A mass shadow in the left S3 and obstruction of the left B3 were seen on a chest radiograph and CT. Obstructive pneumonia was suspected, and cefotiam and imipenem/cilastatin were administered. However, this treatment did not show adequate efficacy. Bronchoscopy demonstrated a yellowish-white polypoid lesion in the left B3, but histopathological findings with HE staining yielded no definite diagnosis. Subsequently, Nocardia asteroides was detected in sputum test. A sulfamethoxazole-trimethoprim combination and minocycline were administered, and the clinical findings improved. Gram-positive microfilaments were confirmed retrospectively in the pathologic specimen, and a diagnosis of pulmonary nocardiosis was made.
We describe herein a provocative case involving an immunosuppressed patient with disseminated Histoplasma capsulatum and also disseminated Nocardia asteroides, which was documented by multiple routine blood culture samples. Nocardia asteroides was isolated from 15 routine blood cultures using the nonradiometric blood culture system (Bactec NR-660, Becton Dickinson, Towson, Md). Several different species of the genus Nocardia proved to thrive in blood culture bottles (Bactec) when experimental inoculations were performed. The paucity of reports in the literature of disseminated nocardiosis with positive blood cultures has led us to consider cause for the apparent poor recovery of these organisms from blood culture media. We suggest that the media (Bactec) can successfully support growth of Nocardia species and that other variables, such as incubation times and subculture, should be considered to optimize isolation of this pathogen in blood culture systems.