[Human nocardiosis with multiple cerebral abscesses; bacteriological study].
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Nocardia lysozyme digest (NLD) was administered intraperitoneally (i.p.) at a dose of 500 micrograms/kg to normal and immunosuppressed mice for 3 consecutive days prior to inoculation with Klebsiella pneumoniae. A protective effect was observed when the pathogen was injected subcutaneously and intravenously, as opposed to an aggravating effect obtained in the case of intraperitoneal inoculation The i.p. administration of NLD partially restored the immunosuppression caused by cyclophosphamide but did not change cobra venom-induced deterioration of the infection. The results obtained could be regarded as a consequence of the lowered alternative pathway serum complement activity and the crucial role of the diminished level of complement in the peritoneal cavity.
Pulmonary infection by Nocardia is an uncommon opportunistic infection in humans. Thirty-five patients with pulmonary nocardiosis were identified in two tertiary referral hospitals. A retrospective review of the patient characteristics, clinical and laboratory features including antimicrobial susceptibility at diagnosis was carried out. Radiological features derived from chest radiographs and CT scans were also documented. In our population, the predominant risk factors were immuno-compromised state, corticosteroid therapy, and underlying pulmonary pathology. The presenting features were similar to those previously described but disseminated infection was not common. The radiological changes were diverse and non-specific. Nocardia asteroides was the commonest species. Most Nocardia isolates were susceptible to imipenem, ceftriaxone, amikacin, and cotrimoxazole. Co-existing microbial agents are common and reflect the underlying complex disorders.
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In previously healthy, 49-year-old man, CNS infection due to Nocardia asteroides was manifested initially as sterile meningitis and then as a single large brain abscess and was treated successfully with medical therapy alone. Resolution of the brain abscess was documented with serial computed tomographic scans. The strain of N asteroides was sensitive to both sulfisoxazole and ampicillin. Although surgical intervention must always be considered in the treatment of brain abscess caused by N asteroides, medical therapy is preferable if the patient responds initially.
This report describes 16 cases of candidiasis, seven of aspergillosis, four of mucormycosis, two of cryptococcosis and one of nocardiosis in which the kidney was involved. Characteristic patterns of renal tissue injury were seen in each of these infections. Candida and nocardia caused microabscesses in the cortex and medulla. Tissue destruction was minimal with candidiasis and when present was confined to the papillary tips and produced only mild impairment of renal function. Aspergillus and mucor invaded blood vessels resulting in thrombosis and extensive necrosis of cortical and medullary tissue and most patients had clinical and biochemical evidence of renal disease. Cryptococcosis caused no tissue reaction or clinically evident renal disease in the two immunosuppressed patients studied.
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Pulmonary infection due to Nocardia sp. is an infrequent disease that affects principally to immunodefficient patients although it can be also seen in patients with normal immunity. Diagnosis is based in isolation of micro-organism in respiratory samples while clinical presentation and radiology are non specific. Treatment is made with trimethropim-sulfametoxazole (TMP/SMX), though resistance has developed in some patients. The recommended length of treatment is 6 weeks to 12 months depending on the immunitaly status. We present the case of a male patient of 81 years old affected with COPD and treated with glucocorticoids in a chronic basis, who was admitted because relapsing fever episodes during 3 months before, weight loss and new hard pulmonary infiltrates with Nocardia sp. cultured sputum, and evolution to clinical, radiological and microbiologic resolution with TMP/SMX treatment.
In recent years, the reported incidence of nocardiosis, a localized or disseminated infection caused by Nocardia, has been increasing. This increase can be attributed to the improvements in diagnostic capabilities and the higher clinical index of suspicion, as well as the increased prevalence of immunosuppressed patients. We report a case of pulmonary nocardiosis in a healthy young female who presented with cough and hemoptysis, which persisted even after empiric treatment for pulmonary tuberculosis. CT scan of her chest showed infiltrates in the right upper, middle and lower lobes with pleural effusion. Bronchoscopy revealed a friable endobronchial mass. Special stains confirmed the diagnosis of nocardiosis. The patient's symptoms and clinical findings improved with trimethoprim-sulfamethoxazole. To the best of our knowledge, this is the fourth case of this illness presenting as endobronchial mass reported in the literature. Pulmonary nocardiosis should be considered in the differential diagnosis of hemoptysis, even in immunocompetent patients.
Two fatal cases of infection with Nocardia asteroides are described with necropsy findings in one. Both patients had been anaemic and had received steroid therapy. The bacteriological problems of species recognition in the genus Nocardia are considered and the results of infection in experimental animals described.
A case of primary Nocardial infection of the hand is presented. This case was notable for lymphocutaneous involvement, and the development of multiple ascending subcutaneous abscesses after healing of the primary lesion. This clinical entity is uncommon, and indicates an atypical infection. Prolonged cultures are required to isolate Nocardia. The infection resolved fully with multiple surgical debridements and prolonged antibiotic therapy.
Astrocytes and microglia were obtained from brains of newborn mice and infected with Nocardia asteroides. Scanning electron micrographs showed nocardiae adhering to the astrocyte cell surface and entering the cytoplasm. After 6 h of incubation the intracellular nocardiae appeared as filaments, demonstrating that growth was occurring. In contrast, the microglia phagocytized nocardiae, but after 6 h the presence of coccoid cells indicated that nocardial growth was inhibited.