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PubMed2002

Primary Nocardia osteomyelitis as a presentation of AIDS.

Human infection with Nocardia species presents as a wide range of clinical syndromes. Nocardia is an important opportunistic pathogen in immunocom-promised patients. We report a case of primary Nocardia asteroides osteomyelitis as the initial clinical presentation of AIDS. The infection was successfully treated with a prolonged course of trimethoprim-sulfamethoxazole in conjunction with HAART. Nocardia osteomyelitis should be recognized as an unusual but important and treatable opportunistic infection in patients living with HIV infection.

AIDS-Related Opportunistic Infections↗
PubMed1984

The role of cell-wall associated lipids in the pathogenesis of lesions in experimental murine nocardiosis vs lesions produced by Mycobacterium fortuitum.

The pulmonary pathogens, Nocardia asteroides and Mycobacterium fortuitum classically produce a markedly different tissue response ranging from the acute suppurative lesion of nocardiosis to the granulomatous disease produced by the Mycobacterium. Both organisms have similar cell-wall associated lipids which have been chemically characterized as types of saturated and unsaturated fatty acids. Earlier studies of virulence factors from M. tuberculosis and other Mycobacteria have shown that much of the host response is due to lipid constituency of the organism cell wall. In order to determine that contribution which the cell-wall associated lipids make in the pathogenesis of nocardiosis produced by N. asteroides and mycobacteriosis due to M. fortuitum, separate lipid fractions were obtained using the Anderson extraction technique as modified by Asselineau (Asselineau, J. 1966. The Bacterial Lipids. Hermann, Paris). These lipid fractions were injected into mice and the lesion development observed. Waxes A and D from the two organisms exhibited distinct differences in tissue response. Wax A from Nocardia produced a pronounced tissue response composed of multiple abscesses, macrophages, and reactive fibrous tissue. Wax A from Mycobacterium showed transient aggregations of polymorphonuclear leukocytes. Mycobacteria-derived wax D elicited a marked granulomatous response which persisted throughout the duration of the study, contrasting with a minimally acute inflammatory response to Nocardia-derived wax D. The phosphatide and soluble-fat fractions also showed aggressive lesions; however, these were similar for both organisms. These results indicate that the differences in tissue response elicited by lipids from N. asteroides and M. fortuitum may reside in wax fractions A and D.

Animals↗
PubMed1994

Case report: Nocardia osteomyelitis.

Osteomyelitis is an unusual manifestation of infection with Nocardia spp, and most cases result from direct extension from a primary lung or cutaneous lesion. The authors report what they believe to be the first case of Nocardia vertebral osteomyelitis occurring postoperatively, and review the literature on the 19 previously reported cases of Nocardia osteomyelitis due to hematogenous dissemination or direct inoculation, excluding those occurring from direct extension of a mycetoma or primary lung infection.

Adult↗
PubMed1995

[Disseminated nocardiosis in 3 immunocompetent patients].

Nocardia asteroide infections, an aerobic actinomycete, have several forms and lungs, skin and brain are the organs most frequently involved. When the infection suspected, special staining methods must be ordered to identify the agent. We report three immunocompetent patients with disseminated nocardiosis, two presenting with nodular lesions of skin and lungs and one presenting with pulmonary involvement and brain abscesses. The importance of clinical suspicion and early diagnosis of nocardiosis is emphasized.

Adolescent↗
PubMed1978

Nocardiosis. Case report and review of the diagnosis and treatment.

Purulent draining skin sinuses are a striking clinical finding when Nocardia organisms infect skin or deeper tissues and the lesion is often mistakenly ascribed to actinomycotic infection. This distinction is important because in contrast to actinomycosis, nocardiosis does not respond to treatment with penicillin or most antibiotics, and a fulminating systemic infection may occur. Smears made from purulent discharges do not always show the organism and microbiological culture may likewise prove fruitless. This article reports a patient suffering from nocardiosis and the pitfalls in diagnosis are illustrated. Successful culture of the organism was obtained by inoculating media with fresh biopsy material and a plea is made for routine use of this method. The need to use sulphadiazine in high doses initially, followed by maintenance treatment for considerable time, is emphasized.

Adult↗
PubMed1992

Successful treatment of disseminated nocardiosis complicated by cerebral abscess with ceftriaxone and amikacin: case report.

We report the case of an 85-year-old female patient who suffered from disseminated Nocardia asteroides infection complicated by a cerebral abscess. Treatment with amikacin for 2 weeks and ceftriaxone for 6 weeks led to complete recovery, and there was no recurrence of disease over a follow-up period of 12 months after therapy. The use of ceftriaxone in combination with amikacin might significantly shorten the duration of treatment for patients with disseminated nocardiosis. This combination of antibiotics merits further investigation with use of a larger sample of patients.

Aged↗
PubMed1984

Effects of hemodialysis on the pharmacokinetics of amoxicillin/clavulanic acid combination.

The effects that renal disease and hemodialysis have on the pharmacokinetics of amoxicillin/clavulanic acid combination were studied in a patient receiving this combination for the treatment of a Nocardia asteroides infection. Hemodialysis increased the clearance of both substances as evidenced by lower serum concentrations during the on-dialysis day, i.e., 2.3 +/- 0.8 vs. 5.9 +/- 1.2 micrograms/ml for clavulanic acid and 8.0 +/- 1.8 vs. 12.4 +/- 0.9 micrograms/ml for amoxicillin. Clavulanic acid appeared to be influenced to a greater extent as compared to amoxicillin because of its higher extraction ratio (0.74 vs. 0.44) as well as a higher observed ratio of amoxicillin to clavulanic acid during the on-dialysis day (3.59 +/- 1.27 vs. 2.28 +/- 0.65; p less than 0.05). Comparison of the area under the serum concentration-time (AUC) during the off-dialysis day with published AUC values suggested accumulation of amoxicillin/clavulanic acid. These data indicate that dosage adjustments for amoxicillin/clavulanic acid may be required in patients with chronic renal failure who are on hemodialysis. Further studies in this patient population are needed before specific dosing guidelines can be provided.

Amoxicillin↗
PubMed1999

Nocardial infection in a renal transplant recipient on tacrolimus and mycophenolate mofetil.

Infection with Nocardia spp. is an uncommon but important cause of morbidity and mortality in organ transplant recipients. Cotrimoxazole prophylaxis against urinary tract infection and Pneumocystis carinii pneumonia in these patients usually prevents nocardial infection also. We report the case of a patient on tacrolimus and mycophenolate mofetil who developed drug-induced diabetes mellitus followed by nocardial brain infection. This infection occurred despite conventional cotrimoxazole prophylaxis. Physicians should be aware that newer, more potent and more diabetogenic immunosuppressive regimens may increase the risk of opportunistic infections such as nocardiosis, even in the presence of "adequate" antimicrobial preventive measures.

Adult↗
PubMed1982

Association of prior nocardiosis and subsequent occurrence of nontuberculous mycobacteriosis in a defined, immunosuppressed population.

A retrospective epidemiologic and risk factor analysis demonstrated an association of prior nocardiosis to the subsequent development of nontuberculous mycobacteriosis in five cardiac allograft recipients. Strong statistical support for this association was derived from five separate analytical approaches, including comparisons with time-matched cohorts and by multivariate regression analysis. Each of the five patients in the study had had uncomplicated pulmonary nocardiosis and had been treated successfully with long-term sulfonamide therapy. Although each patient remained clinically, radiographically, and bacteriologically free of recurrent nocardial disease during an average follow-up period of approximately three years, each patient subsequently (after a mean period of greater than two years from the diagnosis of nocardiosis) developed infection due to Mycobacterium kansasii or Mycobacterium avium-intracellulare-scrofulaceum. Detailed statistical studies failed to identify factors that could account for this observation.

Adult↗
PubMed1975

Current status of treatment of pneumonia.

Proper treatment of pneumonia is dependent upon a correct diagnosis. Pneumonia may be due to infectious agents, allergic phenomena, or chemical causes. Treatment regimens are outlined for the various types of pneumonia--pneumococcal, staphylococcal, fungal, and pneumonia due to gram-negative and anaerobic gram-negative bacilli, to Blastomyces dermatitidis, and to the parasite Pneumocystis carinii. In discussing current concepts of treatment, several well-known methods are emphasized, as well as newer developments, knowledge of which is essential for optimal treatment of pneumonia.

Ampicillin↗
PubMed1984

Concomitant pulmonary aspergillosis and nocardiosis in a patient with chronic granulomatous disease of childhood.

Chronic granulomatous disease is characterized by recurrent infections with microorganisms which produce catalase, an enzyme that detoxifies endogenous or exogenous hydrogen peroxide to water and oxygen. Among 245 patients with CGD reviewed by Cohen et al, (7)20.4% had a history of fungal infection. The frequency with which fungal infections occur in patients with CGD emphasizes the importance of the phagocyte in defense against these pathogens. Our case of concomitant pulmonary aspergillosis and nocardiosis in a 15-year-old boy with CGD who had previous infections with both of these organisms illustrates several important points: (1) Aggressive diagnostic approaches (eg, open lung biopsy) are often required to make the diagnosis of fungal infections in patients with CGD; (2) patients with CGD can have multiple simultaneous infections with catalase-positive organisms; and (3) acute infections with Aspergillus or Nocardia do not provide lasting immunity in patients with CGD.

Adolescent↗
PubMed1992

Indications for open cervical node biopsy in HIV-positive patients.

Open node biopsy was the method of choice for diagnosing human immunodeficiency virus (HIV) infection before serologic testing became available. Currently, the otolaryngologist is often called on to assist in the management of HIV-positive patients with troublesome cervical adenopathy. Today's questions are: what is the place of fine-needle aspiration (FNA), and when is open cervical node biopsy indicated. A retrospective review was undertaken of 93 consecutive cervical node biopsies performed by our department during the 5-year period from 1985 to 1989. Twenty of the patients who underwent biopsy were HIV-positive. Of these twenty, ten carried an established diagnosis of acquired immune deficiency syndrome (AIDS). Seventeen of these patients underwent FNA before biopsy. In the eight patients with persistent generalized lymph-adenopathy (PGL) and nontender, nonenlarging nodes, pathologic analysis revealed lymphoid hyperplasia. Five of these patients had antecedent FNA, none demonstrating any pathologic changes. Of the twelve patients with enlarging or tendon nodes, the diagnosis of mycobacterial adenitis was made in eight, Nocardial infection in two, Burkitt's lymphoma in one, and metastatic Kaposi's sarcoma in one. In four of the patients diagnosed with mycobacterial infections, FNA yielded cytologic evidence of acid-fast bacilli and open lymph node biopsy added nothing. In contrast, FNA failed to reveal the diagnosis in both patients with Nocardial infection, and in the two patients with neoplastic disease. We conclude that cervical node biopsy is not indicated in the HIV or AIDS patient with nontender or nonenlarging nodes.(ABSTRACT TRUNCATED AT 250 WORDS)

AIDS-Related Complex↗