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PubMedDate not supplied

Subcutaneous nodules attributed to nocardiosis in a renal transplant recipient on tacrolimus therapy.

We report a renal transplant patient who suffered from disseminated nocardiosis after empirical tacrolimus rescue therapy for chronic allograft rejection. The nocardiosis presented initially as only mildly tender subcutaneous calf nodules without any other signs of inflammation nor constitutional upset, which later spread to the lung and brain causing bronchopneumonia and brain abscesses. The risk factors for nocardial infection in our patient include the use of potent immunosuppressive agents such as tacrolimus, poorly controlled diabetes mellitus and kidney dysfunction. She responded well to combination antibiotic therapy comprising parenteral meropenem, cefotaxime and oral minocycline. We conclude that in transplant recipients, especially those receiving newer and more potent immunosuppressive agents like tacrolimus, nocardial infection can present as apparently 'cold' subcutaneous nodules without any systemic upset. An associated brain lesion should be excluded even in patients without neurological symptoms.

Anti-Bacterial Agents↗
PubMed1978

Persistent nocardemia following renal transplantation. Association with pulmonary nocardiosis.

Pulmonary nocardiosis occurred in a renal homotransplant patient and was diagnosed by persistently positive blood cultures. Infection developed at a time when efforts were being made with moderate dosages of immunosuppressive drugs to prevent rejection of the transplant. The subsequent nocardemia lasted for one week. The remaining kidney function was preserved, and the patient had a very favorable outcome because of early diagnosis and prompt treatment with sulfisoxazole.

Adult↗
PubMed2006

Nocardia paucivorans--a cause of disseminated nocardiosis.

We describe a 53-year-old man without discernable immunocompromise who presented with cerebral and cutaneous dissemination of primary pulmonary Nocardia paucivorans infection. This report also identifies 32 other patients in our health area with clinical isolates of N. paucivorans over the last 20 years, extending the reported spectrum of disease caused by this organism. At least 30% (10/33) of these patients had disseminated disease indicating a propensity of this species to disseminate.

Brain Diseases↗
PubMed1986

Nocardiosis in the community hospital. Report of three cases.

Nocardiosis is an infectious disease that occurs in both normal and immunocompromised hosts. In North America, the most common presentation is that of primary subacute pneumonia. In Central and South America, primary cutaneous infections are more common. The diagnosis is often missed because of contamination of cultures and the need to culture specimens for extended periods. Because of this difficulty in diagnosis, the incidence of nocardiosis may actually be higher than what published data reveal. Incision and drainage of abscesses and extended drug therapy (eg, with sulfonamides) are the cornerstones of treatment.

Abscess↗
PubMed1976

Nocardial infections in the United States, 1972-1974.

A survey of members of the Infectious Diseases Society of America indicated that nocardial infections are not rare. Probably between 500 and 1,000 cases are recognized in the United States each year, of which 85% are serious pulmonary or systemic infections. Although nocardial infections are usually opportunistic infections in the compromised host, at least 15% of the infections in this series occurred in patients without a definable predisposing condition. Nocardial infections occurred in a random geographic distribution within this country, with affected males outnumbering females by 3:1. Most patients were between the ages of 21 and 50 years; however, the age range was broad. The number and variety of infections caused by Nocardia species other than Nocardia species other than Nocardia asteroides have been underestimated. Between 8.6% and 18.8% of pulmonary-systemic infections in this series were caused by species of Nocardia other than N. asteroides.

Adolescent↗
PubMed1998

Identification and antibiotic susceptibility of Nocardia farcinica and N. nova in the UK.

Nocardia asteroides has long been recognised as a heterogeneous group of organisms. The description and identification of two new subgroups, N. farcinica and N. nova, in other countries encouraged us to re-examine a collection of N. asteroides isolates from the UK. Of 73 clinical isolates identified as N. asteroides from different parts of England and Wales during 1991-1993, and now subjected to further differentiation tests by the Mycobacterial/Nocardial Reference Laboratory, 15 (20.5%) were identified as N. farcinica based on three out of four characteristics: growth property, acetamide production, rhamnose assimilation and a distinct antibiogram. No isolates were identified as N. nova. A revised identification and susceptibility system has significant clinical and taxonomic implications. Its introduction will improve speciation, identify antibiotic resistance and influence the choice of safer alternative therapy for patients infected with Nocardia spp. in the UK.

Bacterial Typing Techniques↗
PubMed2003

Pulmonary nocardiosis in a patient with CML relapse undergoing imatinib therapy after bone marrow transplantation.

We describe a case of pulmonary nocardiosis in a female patient with graft-versus-host disease (GVHD) underwent therapy with imatinib mesylate for a relapse of chronic myeloid leukemia (CML) after allogeneic bone marrow transplantation (BMT). The patient developed chronic GVHD 8 months after the use of imatinib and was on corticosteroid therapy. Three months after the development of chronic GVHD, she acquired pulmonary nocardiosis and a computed tomography (CT) scan of the chest showed multiple nodular lesions with cavitations over both lungs. She was successfully treated with single-agent trimethoprim-sulfamethoxazole (TMP/SMX) and the infection did not recur. Our case indicated that pulmonary nocardiosis could occur in patients with GVHD undergoing imatinib and corticosteroid therapy and might be treated by single-agent TMP/SMX.

Adrenal Cortex Hormones↗
PubMed1995

Nocardiosis diagnosed by lung FNA: a case report.

A 63-yr-old woman with systemic lupus erythematosus (SLE) diagnosed 12 mo previously and treated with prednisolone and cyclophosphamide presented with recent fever and dyspnoea. The etiology of a 3 cm diameter centrally cystic coin lesion in the lower lobe of the left lung was obscure. Blood cultures and sputum examination had been non-contributory, and the diagnosis of Nocardia asteroides infection was initially made by cytologic examination of material obtained by lung fine-needle aspiration (FNA). It is notoriously difficult to detect this organism by conventional sputum examination or with histologic sections, and it has rarely been detected by lung FNA. If this organism is demonstrated, appropriate microbiologic cultures for confirmation and susceptibility testing should be instituted. Long-term antimicrobial therapy is needed. In this case, complete resolution of the lung lesion followed 5 mo of therapy.

Biopsy, Needle↗
PubMed2007

Mycetoma in children: experience with 15 cases.

BACKGROUND: Mycetoma is a chronic infection caused by aerobic actinomycetes and filamentous fungi. It is an occupational disease frequent in tropical countries and is uncommon in children. METHODS: A retrospective (25 years) report of mycetomas was conducted in children less than 15 years of age. Each of the cases was studied clinically and proven with microbiologic tests: direct examinations (to identify and classify the grains), cultures and identification based on morphology and biochemical tests. The therapeutic experience of the cases was also reviewed. RESULTS: In a 25-year period, a total of 334 mycetomas were seen at our institution, 15 of which (4.5%) were in patients 15 years of age and younger (mean age: 11.2 years, age range: 6-15 years). Twelve cases were males and 3 females. The main clinical location was the foot in 10 of 15 (66.6%). Etiologies included 13 actinomycetomas and 2 eumycetomas. Etiologic agents were Nocardia brasiliensis in 12 cases, Nocardia asteroides in one and Madurella mycetomatis in 2. Eleven of the13 cases of actinomycetomas treated with trimethoprim-sulfamethoxazole plus diaminodiphenylsulfone were cured. The 2 failures were successfully treated with amoxicillin/clavulanate. One of the eumycetomas was cured with itraconazole therapy, whereas the other failed various treatments eventuating in surgical amputation. CONCLUSIONS: Mycetomas are exceptional in children; in our setting, actinomycetomas are more frequent than eumycetomas. The clinical and microbiologic diagnosis is simple. Overall, treatment response is better for actinomycetomas than for eumycetomas.

Adolescent↗
PubMed2001

[Acute community acquired pneumopathy caused by Nocardia asteroides in a 93-year-old female patient].

BACKGROUND: Lower respiratory tract infection (LRTI) by Nocardia species is most often considered as an opportunistic infection occurring mainly in middle-aged adults. CASE REPORT: A 93-year old woman without any significant comorbidity other than a mild asthma, presenting with a non-resolving pneumonia, was successfully treated for a community-acquired LRTI by Nocardia asteroides. DISCUSSION: LRTI by Nocardia asteroides is a rare occurrence. Although more frequent in immuno-compromised patients (50 to 85% of cases reported), Nocardia asteroides infection also occurs in immuno-competent individuals. Very few reports describe LRTI infection by Nocardia sp. in the very old, and almost exclusively in patients with major co-morbidities or variable degrees of immuno-suppression.

Acute Disease↗
PubMedDate not supplied

Cutaneous abscess caused by Nocardia brasiliensis: report of a case.

We report a case of cutaneous Nocardia brasiliensis infection. The patient had received radiotherapy and anti-neoplastic chemotherapy for epidermoid carcinoma of the left sphenoid sinus with bone destruction. He developed fever and an ulcer on the dorsal medial surface of the left hand after an intravenous infusion of chemotherapeutic agents in the same site 3 days earlier. Needle aspiration of the abscess disclosed polymorphonuclear leukocytes, and a partially acid-fast, gram-positive filamentous branching organism. Cultures of the aspirate grew N. brasiliensis 1 week later. The patient was treated successfully with a regimen of parenteral ceftazidime and amikacin with definite improvement 1 week later. Therapy was continued for 1 more week, and then the patient was switched to oral trimethoprim-sulfamethoxazole for 3 months with no recurrence. The diagnosis, clinical manifestations, treatment and prognosis of cutaneous abscesses cause by N. brasiliensis are discussed.

Abscess↗
PubMed1989

Cerebral nocardiosis--clinical and pathological findings in three patients.

Cerebral nocardiosis is an uncommon but increasingly diagnosed infection in Australia. We report three cases. One occurred in an immunosuppressed male in whom the diagnosis was made at autopsy, one in an otherwise healthy elderly woman with subcutaneous nocardiosis, and the third was a posterior fossa nocardial abscess without systemic involvement occurring in a previously healthy woman after surgical excision of a meningioma. Primary cerebral nocardiosis is rare, with only two cases of primary posterior fossa nocardiosis reported. The cases highlight the difficulty of diagnosis and the need for aggressive treatment with a combined approach of surgical drainage and antibiotic therapy. The antibiotic regime of choice is the subject of controversy. Rifampicin, cephalosporins, imipenem, sulphonamides and other agents were used with varying success in our patients. Cerebral nocardiosis should be considered in any patient with a cerebral space occupying lesion.

Aged↗
PubMedDate not supplied

Clinical profile of pulmonary nocardiosis.

Pulmonary nocardiosis mimics pulmonary tuberculosis in both clinical symptoms, being chronic in nature and radiological characteristics, and it is often wrongly treated with anti-tuberculosis drugs. The present study was undertaken to determine the prevalence of pulmonary nocardial infection in patients having chronic chest symptoms and to study their clinical response to specific chemotherapeutic agents. All the patients, who had a negative sputum for AFB on direct smear examination consecutively, were investigated for nocardiosis by examining the sputum with KOH preparation and modified Ziehl-Neelsen method. This was later confirmed by fungal culture of the sputum and inoculation on McClung's broth for paraffin baiting technique. Fibreoptic bronchoscopy was performed on all the suspected cases and the bronchial aspirate was examined similarly. The confirmed cases of nocardiosis were treated with cotrimaxazole and doxycycline for a total duration of six months. The prevalence of pulmonary nocardiosis in the present study was 1.9 percent. All the patients were immunocompetent. All the patients showed a good clinical response to chemotherapy at the end of six months of treatment. No relapse has been observed on follow up.

Adolescent↗
PubMed2001

Nocardia asteroides lung abscess in acute ulcerative colitis treated with cyclosporine.

Cyclosporine is a potent suppresser of cell-mediated immunity that is mainly used in organ transplantation to prevent rejection. It is also being used increasingly outside of transplantation and probably is the only new treatment to have made an impact in acute ulcerative colitis (UC) resistant to steroid therapy. We describe a case of Nocardia asteroides lung abscess in a patient treated with cyclosporine for acute steroid resistant UC that was successfully managed with antibiotics and by discontinuing cyclosporine. With increasing use of cyclosporine for acute UC it is to be anticipated that opportunistic infections such as Nocardia will be more frequently encountered in the future.

Acute Disease↗
PubMed2005

Nocardiosis in persons with human immunodeficiency virus infection, transplant recipients, and large, geographically defined populations.

To quantify the risk of nocardiosis in various populations, I systematically reviewed articles published between 1966 and 2004. The incidence of nocardiosis in 3 large, geographically defined populations ranged from 0.35 to 0.4 cases per 10(5) persons year. In contrast, the incidence of nocardiosis among people with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS) in 1 study was 53 nocardiosis cases per 10(5) persons x year, approximately 140 times greater than that in the geographically defined populations. The frequency of nocardiosis cases in 4 populations of HIV-infected people averaged 608 cases per 10(5) persons. The incidence of nocardiosis in bone marrow-transplant recipients at 1 hospital was 128 cases per 10(5) persons x year, an incidence approximately 340 times greater than that in the geographically defined populations and in the same range as in HIV-infected people. The frequency of nocardiosis in 21 series of cases in recipients of a variety of transplanted organs averaged 1122 cases per 10(5) persons. These estimated incidence rates are imprecise because they were not collected through prospective surveillance systems, but the estimates for the 3 groups were internally consistent and provide useful information for clinicians.

France↗