[CURRENT EPIDEMIOLOGICAL AND CLINICAL ASPECTS OF DEEP MYCOSES].
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We report a case of acute pleuropulmonary nocardial infection in a 24-year-old woman suffering from systemic lupus erythematosus. In most instances, No-cardia asteroides is an opportunistic pathogen. In our patient, the infection was facilitated by systemic lupus erythematosus and chronic use of corticosteroids and immunosuppressive drugs. N. asteroides was cultured from both pleural effusion and blood. No extrathoracic location was found and the patient improved upon intravenous antibiotics and pleural drainage. Owing to the poor tolerance of trimethoprim/sulfamethoxazole, the patient was treated successfully with imipenem. The predisposing factors, the clues to the diagnosis and the therapy of nocardiosis are briefly reviewed.
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Infection with nocardia is rare in BMT patients. We described the first reported case of pulmonary nocardiosis in an allogeneic marrow recipient with graft-versus-host disease. The patient developed nocardial infection while receiving trimethoprim-sulfamethoxazole as prophylaxis against Pneumocystis. The salient clinical presentation was right lower lung consolidation; the diagnosis was established by prolonged incubation of an open lung biopsy specimen. Antibiotic therapy included timentin and later, imipenem. However, the patient died with uncontrolled infection. Necropsy revealed nocardial lung abscesses and disseminated infection from cytomegalovirus.
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INTRODUCTION: We report a case of extensive pulmonary nocardiosis in a patient infected with HIV. CASE REPORT: It presented as bilateral cavitated masses and bulky necrotic mediastinal lymphadenopathy causing broncho-oesophageal fistulae. There was associated infection with Mycobacterium Avium. There was satisfactory progress following bipolar oesophageal isolation, nutrition via a jejunostomy and antibiotic therapy with co-amoxiclav. Healing of the fistulae after 11 months allowed surgical restoration of oesophago-gastric continuity. CONCLUSION: As with other bacteria, HIV can modify the clinical spectrum of nocardiosis.
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Pulmonary nocardiosis is the major clinical manifestation of human nocardiosis and disseminated infection can be seen in immunocompromised patients. N. asteroides is the predominant pathogen associated with disseminated diseases. We report 2 cases of pulmonary nocardiosis admitted with disseminated infection, caused by rare species of Nocardia: Nocardia transvalensis and Nocardia cyriacigeorgica.
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