RESUMEN
OBJECTIVES: Nocardia is an opportunistic infection among renal transplant recipients with an incidence of <1% but high mortality. Data from Pakistan are scarce. Our aim was to find the risk factors, clinical and radiographic findings, antimicrobial sensitivity, and outcomes of Nocardia infection among renal transplant recipients in Pakistan. MATERIALS AND METHODS: All adult renal transplant recipients diagnosed with nocardiosis between 2013 and 2020 were included. The cases were matched 1:2 with controls based on sex, age (±1 year), and transplant date (±1 year). Risk factors, clinical features, antibiotic sensitivities and outcomes were analyzed. RESULTS: A total of 48 patients developed nocardiosis. Around 25% of patients presented with disseminated disease. Median time from transplant to disease development was 2.68 years. High-dose methylprednisolone and presence of cytomegalovirus infection within 90 days of disease development were independent risk factors for Nocardia infection. The mortality rate was 20%. Central nervous system disease and cytomegalovirus infection within 90 days were significantly associated with mortality. The most susceptible drugs were co-trimoxazole and linezolid. Imipenem susceptibility was only 20%. CONCLUSIONS: High-dose methylprednisolone and cytomegalovirus infection were independent risk factors for Nocardia infection. Central nervous system disease was associated with mortality. Nocardia species were highly resistant to ceftriaxone and imipenem in our patient population.
Asunto(s)
Antibacterianos , Huésped Inmunocomprometido , Trasplante de Riñón , Nocardiosis , Infecciones Oportunistas , Humanos , Nocardiosis/diagnóstico , Nocardiosis/mortalidad , Nocardiosis/epidemiología , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/mortalidad , Factores de Riesgo , Pakistán/epidemiología , Masculino , Femenino , Adulto , Infecciones Oportunistas/mortalidad , Infecciones Oportunistas/inmunología , Infecciones Oportunistas/diagnóstico , Infecciones Oportunistas/microbiología , Infecciones Oportunistas/epidemiología , Infecciones Oportunistas/tratamiento farmacológico , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Resultado del Tratamiento , Factores de Tiempo , Estudios Retrospectivos , Infecciones por Citomegalovirus/diagnóstico , Infecciones por Citomegalovirus/mortalidad , Infecciones por Citomegalovirus/epidemiología , Medición de Riesgo , Metilprednisolona/administración & dosificación , Inmunosupresores/efectos adversosRESUMEN
Nocardia is widely distributed in the natural environment and typically cause opportunistic infections. However, it is important to note that the pathogenicity of different Nocardia species may vary significantly. Here we reported the first case of brain abscess caused by Nocardia beijingensis (N. beijingensis) infection in China. A 70-year-old male immunocompetent individual came to our hospital for treatment due to headache. After examination, it was found that he had a brain abscess caused by N. beijingensis. By utilizing a combination of surgical intervention and antibiotic therapy, the patient ultimately achieved full recovery. In addition, we isolated this strain and displayed its ultrastructure through scanning electron microscopy. The phylogenetic tree was analyzed by 16 S rRNA sequence. A literature review of N. beijingensis infections in all immunocompetent and immunocompromised patients was presented. It highlighted that abscess formation appears to be a common manifestation of N. beijingensis infection, and N. beijingensis has become an emerging pathogen in immunocompetent individuals.
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Absceso Encefálico , Nocardiosis , Nocardia , Humanos , Masculino , Absceso Encefálico/microbiología , Absceso Encefálico/diagnóstico , Nocardiosis/diagnóstico , Nocardiosis/microbiología , Nocardiosis/tratamiento farmacológico , Anciano , Nocardia/aislamiento & purificación , Nocardia/genética , China , Inmunocompetencia , Antibacterianos/uso terapéutico , FilogeniaRESUMEN
PURPOSE: Anti-granulocyte-macrophage colony-stimulating factor autoantibodies (anti-GM-CSF Abs) are implicated in the pathogenesis of Cryptococcus gattii (C. gattii) infection and pulmonary alveolar proteinosis (PAP). Their presence has also been noted in nocardiosis cases, particularly those with disseminated disease. This study delineates a case series characterizing clinical features and specificity of anti-GM-CSF Abs in nocardiosis patients. METHODS: In this study, eight patients were recruited to determine the presence or absence of anti-GM-CSF Abs. In addition to the detailed description of the clinical course, we thoroughly investigated the autoantibodies regarding the characteristics, isotypes, subclasses, titers, and neutralizing capacities by utilizing the plasma samples from patients. RESULTS: Of eight patients, five tested positive for anti-GM-CSF Abs, all with central nervous system (CNS) involvement; patients negative for these antibodies did not develop CNS nocardiosis. Distinct from previously documented cases, none of our patients with anti-GM-CSF Abs exhibited PAP symptoms. The titer and neutralizing activity of anti-GM-CSF Abs in our cohort did not significantly deviate from those found in C. gattii cryptococcosis and PAP patients. Uniquely, one individual (Patient 3) showed a minimal titer and neutralizing action of anti-GM-CSF Abs, with no relation to disease severity. Moreover, IgM autoantibodies were notably present in all CNS nocardiosis cases investigated. CONCLUSION: The presence of anti-GM-CSF Abs suggests an intrinsic immunodeficiency predisposing individuals toward CNS nocardiosis. The presence of anti-GM-CSF Abs helps to elucidate vulnerability to CNS nocardiosis, even with low titer of autoantibodies. Consequently, systematic screening for anti-GM-CSF Abs should be considered a crucial diagnostic step for nocardiosis patients.
Asunto(s)
Autoanticuerpos , Factor Estimulante de Colonias de Granulocitos y Macrófagos , Nocardiosis , Humanos , Autoanticuerpos/inmunología , Autoanticuerpos/sangre , Factor Estimulante de Colonias de Granulocitos y Macrófagos/inmunología , Nocardiosis/inmunología , Nocardiosis/diagnóstico , Femenino , Masculino , Persona de Mediana Edad , Anciano , Adulto , Proteinosis Alveolar Pulmonar/inmunología , Proteinosis Alveolar Pulmonar/diagnóstico , Cryptococcus gattii/inmunologíaRESUMEN
INTRODUCTION: Nocardiosis is an unusual infection caused by aerobic gram-positive bacteria in the genus Nocardia. Infections resulting from Nocardia species are frequent in immunosuppressive patients. Weakened immune systems caused by human immunodeficiency virus infection, diabetes, cancer, and other conditions such as chronic lung disease, renal failure, etc, are the main risk factors for nocardiosis. Central nervous system (CNS) nocardiosis has been reported to represent ~2% of all and to be present in 15% to 50% of patients with systemic infection. The patient in our case had an isolated CNS nocardiosis caused by Nocardia terpenica infection, a rare reclassified Nocardia pathogen of CNS nocardiosis. CASE: We here present a 54-year-old Chinese male with a fever and headache for 15 days who showed positive meningeal irritation signs. Magnetic resonance imaging showed the right trigone of the lateral ventricular choroid plexitis and diffused leptomeningeal meningitis involving the bilateral cerebral hemisphere, cerebellar hemisphere, and brain stem. The patient was quickly diagnosed with CNS Nocardia infection by next-generation sequencing within 48 hours after admission. Meanwhile, the diagnosis was validated by Nocardia-positive staining in cerebral spinal fluid culturing. The patient was given trimethoprim-sulfamethoxazole, and his symptoms recovered after 3 days. CONCLUSIONS: In this case, the clinical, radiological, and microbiological findings highlight the importance of suspecting Nocardia as the potential pathogen in patients with central nervous system inflammation of doubted immune incompetence. In addition, next-generation sequencing as an effective test is also highly recommended for suspicious CNS infection patients to perform a rapid diagnosis and treatment.
Asunto(s)
Nocardiosis , Nocardia , Humanos , Masculino , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , Nocardiosis/complicaciones , Persona de Mediana Edad , Nocardia/aislamiento & purificación , Imagen por Resonancia Magnética , Antibacterianos/uso terapéutico , Plexo Coroideo/microbiología , Meningitis/microbiología , Meningitis/diagnóstico , Meningitis/etiologíaRESUMEN
RATIONALE: Nocardia infection is commonly regarded as an opportunistic pulmonary pathogen affecting debilitated or immunocompromised individuals. Brain abscesses caused by Nocardia farcinica are rare and pose a diagnostic challenge. Traditional diagnostic techniques for identifying Nocardia species, such as blood culture, microscopy, and pathology, have shown inadequate performance. In the reported case, we applied metagenomic next-generation sequencing (mNGS) to diagnose a case of brain abscess due to N. farcinica. PATIENT CONCERNS: A 66-year-old female developed a brain abscess after sustaining a hand injury. The patient exhibited a gradual change in personality and experienced tremors in her right upper limb for a duration of 1 month. DIAGNOSES: The pathogen responsible for the multiple brain abscesses was identified in the cerebrospinal fluid as N. farcinica through mNGS. INTERVENTIONS: Antibiotic treatment included trimethoprim-sulfamethoxazole, linezolid, amikacin, meropenem, and moxifloxacin. OUTCOMES: The patient's symptoms and signs improved significantly after administration of antibiotics to which the pathogen is known to be sensitive. After 5 months of follow-up, magnetic resonance imaging of the head showed that the abscess was basically cured. The patient lived a normal life with no adverse drug reactions. LESSONS: Nocardia brain infection is characterized by an insidious onset and lacks distinctive clinical and imaging features. mNGS was advantageous for the timely identification and management of Nocardia-associated brain abscess in the present case and obviated the need for invasive brain surgery. Expeditious and precise diagnosis coupled with prompt antibiotic therapy can significantly reduce the mortality rate associated with this condition.
Asunto(s)
Antibacterianos , Absceso Encefálico , Traumatismos de la Mano , Nocardiosis , Nocardia , Humanos , Femenino , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Absceso Encefálico/microbiología , Absceso Encefálico/etiología , Absceso Encefálico/diagnóstico , Nocardia/aislamiento & purificación , Anciano , Antibacterianos/uso terapéutico , Traumatismos de la Mano/complicaciones , Imagen por Resonancia Magnética , Secuenciación de Nucleótidos de Alto RendimientoRESUMEN
INTRODUCTION: Mycetoma is a chronic granulomatous inflammatory disease of the subcutaneous tissue, which affects deep structures and bone. Most cases of actinomycetoma are caused by members of the genus Nocardia. CASE PRESENTATION: Here we report the case of a 43-year-old male who presented a disseminated mycetoma on the forearm, chest and neck, characterized by enlarged and erythematous lesions through which seropurulent material drains, and numerous atrophic scars. Molecular identification was performed by 16S gene amplification and sequencing. Nocardia mexicana was identified with 100% identity. Trimethoprim-sulfamethoxazole, diaminodiphenyl sulfone and amikacin was a successful treatment after 6 months. CONCLUSIONS: Nocardia mexicana is a rare organism that causes mycetoma. We report a case of extensive mycetoma on the forearm with spread to the neck and thorax associated with manipulation of the mouth of a calf.
Asunto(s)
Antibacterianos , Antebrazo , Micetoma , Cuello , Nocardiosis , Nocardia , ARN Ribosómico 16S , Tórax , Humanos , Masculino , Adulto , Nocardia/aislamiento & purificación , Nocardia/genética , Micetoma/microbiología , Micetoma/tratamiento farmacológico , Micetoma/diagnóstico , Nocardiosis/microbiología , Nocardiosis/tratamiento farmacológico , Nocardiosis/diagnóstico , Antebrazo/microbiología , Antebrazo/patología , Tórax/diagnóstico por imagen , Tórax/microbiología , Cuello/patología , Antibacterianos/uso terapéutico , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , ADN Bacteriano/genética , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Amicacina/uso terapéutico , ADN Ribosómico/genética , ADN Ribosómico/químicaRESUMEN
Nocardia paucivorans is a rarely cultured bacteria most commonly found in immunocompromised hosts, and rarely, may result in dissemination across multiple organ systems. Infection and subsequent clinical manifestations are often vague and nonspecific, making timely diagnosis difficult. Due to the infrequency of N. paucivorans infection, no consensus treatment has yet been established. We report a case of an immunocompromised patient with disseminated nocardiosis with infective endocarditis and other extrapulmonary involvement.
Asunto(s)
Huésped Inmunocomprometido , Nocardiosis , Nocardia , Humanos , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , Nocardia/aislamiento & purificación , Masculino , Antibacterianos/uso terapéutico , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/tratamiento farmacológico , Persona de Mediana EdadRESUMEN
Nocardiosis, characterized by poor prognosis and high mortality, is a local or systemic suppurative or granulomatous disease caused by Nocardia that is common in immunosuppressed individuals but rare in populations with normal immune function. This paper described one case of Nocardia gipuzkoensis disseminated infection in a patient with normal immune function by outlining the process of treatment, conducting literature review and by outlining the clinical characteristics, diagnostic criteria and standardized treatments of nocardia disease, in the hope of providing reference for subsequent treatment of rare Nocardia subspecies infections.
Asunto(s)
Nocardiosis , Nocardia , Humanos , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardia/aislamiento & purificación , Masculino , Persona de Mediana Edad , InmunocompetenciaRESUMEN
Nocardiosis demonstrates a temporal categorization that includes acute, subacute, and chronic stages alongside distinct typical localizations such as pulmonary, cutaneous, and disseminated forms. Disseminated nocardiosis, commonly caused by Nocardia asteroides, N. brasiliensis, and N. farcinica, continues to result in substantial morbidity and mortality. Herein, we report a life-threatening disseminated nocardiosis caused by Nocardia otitidiscaviarum in a patient with minimal change disease. This study emphasizes the difficulty in the diagnosis and treatment of unknown infections in clinical settings and highlights the important role played by laboratories in solving infectious diseases caused by rare pathogens.
Asunto(s)
Antibacterianos , Nocardiosis , Nocardia , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , Humanos , Nocardia/aislamiento & purificación , Antibacterianos/uso terapéutico , Masculino , Resultado del Tratamiento , Persona de Mediana EdadRESUMEN
RATIONALE: Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated motor sensory peripheral neuropathy that is rare in clinical practice. This treatment method aims to suppress potential immunopathology. Nocardiosis is a rare, destructive, opportunistic disease. We report a case of failed treatment of CIDP combined with pulmonary nocardiosis, and for the first time, we link these 2 diseases together. PATIENT CONCERNS: A 65-year-old man developed symmetrical limb weakness. Four months later, he was diagnosed with CIDP and started receiving glucocorticoid (GC) treatment. The disease progressed slowly and was treated with mycophenolate mofetil (MMF) in combination. He did not follow the doctor requirements for monthly follow-up visits, and the preventive medication for sulfamethoxazole/trimethoprim was not strictly implemented. Two months after the combination therapy, the patient developed fever, coughing and sputum production, as well as fatigue and poor appetite. Based on imaging and etiological results, he was diagnosed with pulmonary nocardiosis. DIAGNOSES: Chronic inflammatory demyelinating polyneuropathy, pulmonary nocardiosis. INTERVENTIONS: After treatment with antibiotics, the patient lung infection temporarily improved. However, the patient CIDP condition progressed, limb weakness worsened, respiratory muscle involvement occurred, and intravenous immunoglobulin (IVIG) was administered. However, there was no significant improvement in the condition, and the patient died. OUTCOMES: In this report, we present a case of a patient with CIDP and pulmonary nocardiosis. It is worth noting that in order to avoid the progression and recurrence of CIDP, we did not stop using related therapeutic drugs during the treatment process, the patient had repeatedly refused to use IVIG. Despite this, the patient condition worsened when lung inflammation improved, leading to persistent respiratory failure and ultimately death. Treatment contradictions, medication issues, and patient compliance issues reflected in this case are worth considering. LESSONS: For patients with CIDP receiving immunosuppressive therapy, attention should be paid to the occurrence and severity of Nocardia infection. Therefore, early detection and treatment are necessary. We need to pay attention to the compliance of patients with prophylactic use of antibiotics, strengthen the follow-up, and urge them to return to their appointments on time.
Asunto(s)
Nocardiosis , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante , Humanos , Masculino , Anciano , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardiosis/complicaciones , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/tratamiento farmacológico , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/diagnóstico , Polirradiculoneuropatía Crónica Inflamatoria Desmielinizante/complicaciones , Antibacterianos/uso terapéutico , Inmunoglobulinas Intravenosas/uso terapéuticoRESUMEN
Nocardia pyomyositis in immunocompetent patients is a rare occurrence. The diagnosis may be missed or delayed with the risk of progressive infection and suboptimal or inappropriate treatment. We present the case of a 48-year-old immunocompetent firefighter diagnosed with pyomyositis caused by Nocardia brasiliensis acquired by direct skin inoculation from gardening activity. The patient developed a painful swelling on his right forearm that rapidly progressed proximally and deeper into the underlying muscle layer. Ultrasound imaging of his right forearm showed a 7-mm subcutaneous fluid collection with surrounding edema. Microbiologic analysis of the draining pus was confirmed to be N brasiliensis by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) Mass Spectrometry. After incision and drainage deep to the muscle layer to evacuate the abscess and a few ineffective antibiotic options, the patient was treated with intravenous ceftriaxone and oral linezolid for 6 weeks. He was then de-escalated to oral moxifloxacin for an additional 4 months to complete a total antibiotic treatment duration of 6 months. The wound healed satisfactorily and was completely closed by the fourth month of antibiotic therapy. Six months after discontinuation of antibiotics, the patient continued to do well with complete resolution of the infection. In this article, we discussed the risk factors for Nocardia in immunocompetent settings, the occupational risks for Nocardia in our index patient, and the challenges encountered with diagnosis and treatment. Nocardia should be included in the differential diagnosis of cutaneous infections, particularly if there is no improvement of "cellulitis" with traditional antimicrobial regimens and the infection extends into the deeper muscle tissues.
Asunto(s)
Antibacterianos , Jardinería , Inmunocompetencia , Nocardiosis , Nocardia , Piomiositis , Humanos , Masculino , Persona de Mediana Edad , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardia/aislamiento & purificación , Antibacterianos/uso terapéutico , Piomiositis/tratamiento farmacológico , Piomiositis/diagnóstico , Piomiositis/microbiología , Ceftriaxona/uso terapéutico , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Drenaje , Moxifloxacino/uso terapéutico , Moxifloxacino/administración & dosificación , Linezolid/uso terapéuticoRESUMEN
We introduce the case of a male patient in his 60s who was admitted to our emergency department with a persisting sore throat for the last 3 weeks and dysphagia. Fibre-endoscopic evaluation revealed an asymmetry at the base of the tongue. In combination with elevated white cell count and C reactive protein, a computerized tomography showed a superinfected thyroglossal duct cyst. Intravenous antibiotics were initiated, and the patient was taken to the operating room for cervicotomy. The microbiological swab taken intraoperatively detected Nocardia paucivorans Additional imaging revealed disseminated nocardiosis with cerebral and pulmonary manifestations.The patient was treated with oral trimethoprim/sulfamethoxazole and, over time, showed complete remission of central nervous system lesions and improvement of pulmonary involvement. Following this, the treatment was stopped 8 months after the initial diagnosis. In this report, we discuss treatment standards and outcomes of nocardiosis based on our management strategies of our patient.
Asunto(s)
Antibacterianos , Nocardiosis , Quiste Tirogloso , Combinación Trimetoprim y Sulfametoxazol , Humanos , Masculino , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardiosis/complicaciones , Quiste Tirogloso/diagnóstico , Persona de Mediana Edad , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Diagnóstico Diferencial , Tomografía Computarizada por Rayos X , Nocardia/aislamiento & purificaciónRESUMEN
BACKGROUND: Nocardia is an ubiquitous soil organism. As an opportunistic pathogen, inhalation and skin inoculation are the most common routes of infection. Lungs and skin are the most frequent sites of nocardiosis. Testis is a highly unusual location for nocardiosis. CASE PRESENTATION: We report the case of an immunocompromised 75-year-old-man admitted for fever of unknown origin. He presented with skin lesions after gardening and was first suspected of Mediterranean spotted fever, but he did not respond to doxycycline. Then, physical examination revealed new left scrotal swelling that was compatible with a diagnosis of epididymo-orchitis. The patient's condition did not improve despite empirical antibiotic treatment with the onset of necrotic scrotal abscesses requiring surgery. Nocardia brasiliensis yielded from the removed testis culture. High-dose trimethoprim-sulfamethoxazole and ceftriaxone were started. Multiple micro-abscesses were found in the brain and spinal cord on imaging studies. After 6 weeks of dual antibiotic therapy for disseminated nocardiosis, slight regression of the brain abscesses was observed. The patient was discharged after a 6-month course of antibiotics and remained relapse-free at that time of writing these lines. Trimethoprim-sulfamethoxazole alone is meant to be pursued for 6 months thereafter. We undertook a literature review on previously reported cases of genitourinary and urological nocardiosis; to date, only 36 cases have been published with predominately involvement of kidney, prostate and testis. CONCLUSIONS: To the best of our knowledge, this is the first case of Nocardia brasiliensis simultaneously infecting skin, testis, brain and spinal cord in an immunocompromised patient. Knowledge on uncommon forms of nocardiosis remains scarce. This case report highlights the difficulty of diagnosing atypical nocardiosis and the importance of prompt bacteriological sampling in case of empirical antibiotics failure.
Asunto(s)
Antibacterianos , Fiebre de Origen Desconocido , Nocardiosis , Nocardia , Humanos , Masculino , Nocardiosis/diagnóstico , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , Anciano , Antibacterianos/uso terapéutico , Nocardia/aislamiento & purificación , Fiebre de Origen Desconocido/etiología , Fiebre de Origen Desconocido/microbiología , Huésped Inmunocomprometido , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Testículo/microbiología , Testículo/patología , Orquitis/microbiología , Orquitis/tratamiento farmacológico , Orquitis/diagnósticoRESUMEN
In this article we report a case of disseminated nocardiosis caused by Nocardia otitidiscaviarum in an immunocompetent patient with chronic obstructive pulmonary disease (COPD) who complained of a cough, followed by skin and intracranial lesions. On metagenomic next-generation sequencing (mNGS) technology of respiratory samples (bronchoalveolar lavage fluid, BALF) Nocardia otitidiscaviarum was identified. The patient was treated with therapy combined with a low dose of TMP-SMX and imipenem cilastatin sodium and had a favorable outcome. The timely diagnosis of Nocardia with the help of mNGS technology and early rational treatment of TMP-SMX can help improve the prognosis.
Asunto(s)
Antibacterianos , Líquido del Lavado Bronquioalveolar , Nocardiosis , Nocardia , Humanos , Nocardiosis/diagnóstico , Nocardiosis/microbiología , Nocardiosis/tratamiento farmacológico , Nocardia/aislamiento & purificación , Nocardia/genética , Antibacterianos/uso terapéutico , Líquido del Lavado Bronquioalveolar/microbiología , Masculino , Secuenciación de Nucleótidos de Alto Rendimiento , Anciano , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Combinación Cilastatina e Imipenem/uso terapéutico , Resultado del Tratamiento , MetagenómicaRESUMEN
Nocardiosis is an opportunistic infection that affects both immunocompromised as well as immunocompetent patients. The main infections occur as soft tissue and lung infections although they might disseminate to various organs. This is a case study aimed to reflect the severity of the disease and the patient's risk factors associated with the infection. A sputum sample was collected from tuberculosis (TB) suspects for culture. Nocardia-like colonies were isolated, purified, and sent to BGI Company (Hongkong, China). Standard forward sequencing of 16S rRNA was done by ABI Genetic Analyzer (Applied Biosystems). Sequence alignment and nucleotide basic local alignment search tool (BLAST) were done using National Center for Bioinformatics (NCBI) Nucleotide BLAST. Biochemical identification to the colonies was done using an automation system (BD Phoenix™) to confirm the identification. Nocardia paucivorans was identified from the TB suspect. Risk factors were identified as extensive contact to dust, absence of primary care units with complete facilities, and old age. Since the infection of the lungs caused by Nocardia might be similar to pulmonary TB, this case report highlights the importance of accurate diagnosis and identification procedures to differentiate between the two.
Asunto(s)
Nocardiosis , Nocardia , ARN Ribosómico 16S , Esputo , Humanos , Nocardiosis/microbiología , Nocardiosis/diagnóstico , Nocardia/aislamiento & purificación , Nocardia/genética , Masculino , Resultado Fatal , Esputo/microbiología , ARN Ribosómico 16S/genética , Persona de Mediana Edad , Infecciones del Sistema Respiratorio/microbiología , Infecciones del Sistema Respiratorio/diagnóstico , Oro , Factores de Riesgo , Tuberculosis Pulmonar/microbiología , Tuberculosis Pulmonar/diagnósticoRESUMEN
A case is presented of a 64-year-old male patient who was admitted because of delirium, jaundice, a pattern of cholestasis in the liver profile and a right lung mass in the context of a constitutional syndrome and weight loss in the last eight months. The lung mass was punctured and the culture of the obtained material developed white colonies, identified by mass spectrometry (MALDI-TOF) as Nocardia cyriacigeorgica. Regarding the clinical diagnosis, it was considered as systemic lupus erythematosus (SLE), on the basis of fulfilling 8 criteria according to SLICC 2012 group, and 24 points according to EULAR/ACR 2019. The liver biopsy showed a mixt cellular infiltrate in portal spaces, with absence of interphase hepatitis and presence of peripheral ductular reaction. These findings were interpreted as liver compromise relate to SLE. Delirium was also considered as a neurological manifestation related to SLE on the basis of ruling out other causes. After being treated with antibiotics and documenting a reduction in the size of the lung mass he received cyclophosphamide in intravenous pulses, achieving normalization of his liver profile and his state of consciousness, and a progressively weight recovering. A year after he was in good health. The report of this case is justified because of the rare presenting form of late onset SLE, as well as the concomitant pulmonary nocardiosis in the absence of previous immunosuppressant treatment.
Se presenta el caso de un varón de 64 años que fue internado por delirium asociado a ictericia con patrón de colestasis en el hepatograma, y una masa en el pulmón derecho en el contexto de pérdida de peso y síndrome constitucional de 8 meses de evolución. Se realizó punción de la masa pulmonar cuyo cultivo desarrolló colonias blanquecinas identificadas como Nocardia cyriacigeorgica por espectrometría de masas (MALDI-TOF MS). Se llegó al diagnóstico de lupus eritematosos sistémico (LES) por presentar 8 de los criterios de acuerdo con el grupo SLICC 2012 y 24 puntos de acuerdo a los criterios EULAR/ACR 2019. La biopsia hepática mostró leve y variable infiltrado inflamatorio mixto en espacios porta, con ausencia de hepatitis de interfase y presencia de reacción ductular periférica. Se interpretaron estos hallazgos como vinculados a hepatopatía por LES. El delirium fue interpretado como afectación neurológica por LES en base al descarte de otras enfermedades. Recibió tratamiento antibiótico y tras constatarse reducción del tamaño de la masa pulmonar se administraron pulsos de ciclofosfamida intravenosa. Evolucionó favorablemente, con normalización del hepatograma y el estado de conciencia, y recuperación del peso en forma progresiva. Al año se lo encontró en buen estado de salud. Justifica el reporte del caso la rara forma de presentación del LES de comienzo tardío, así como la nocardiosis pulmonar concomitante sin tratamiento inmunosupresor previo.
Asunto(s)
Colestasis , Delirio , Lupus Eritematoso Sistémico , Nocardiosis , Humanos , Masculino , Persona de Mediana Edad , Lupus Eritematoso Sistémico/complicaciones , Nocardiosis/diagnóstico , Nocardiosis/complicaciones , Delirio/etiología , Colestasis/etiología , Enfermedades Pulmonares/microbiologíaAsunto(s)
COVID-19 , Trasplante de Riñón , Nocardiosis , Combinación Trimetoprim y Sulfametoxazol , Humanos , Trasplante de Riñón/efectos adversos , COVID-19/epidemiología , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Nocardiosis/tratamiento farmacológico , Nocardiosis/diagnóstico , Nocardiosis/epidemiología , Nocardiosis/inmunología , SARS-CoV-2 , Masculino , Persona de Mediana Edad , Femenino , Receptores de Trasplantes , Antibacterianos/uso terapéutico , Inmunosupresores/efectos adversosRESUMEN
Nocardia is a gram-positive bacillus with the microscopic appearance of branching hyphae and is mainly distributed in the soil. Nocardiosis more frequently occurs in immunosuppressed patients. Since nocardiosis has a high mortality rate, immediate diagnosis and treatment are needed. We report the first case of pulmonary nocardiosis caused by Nocardia pseudobrasiliensis after liver transplantation. A 58-year-old woman underwent living-donor transplantation for primary biliary cholangitis. Seven months after transplantation, she came to our hospital complaining of fever and anorexia. Computed tomography of the lungs showed a 45 mm large nodule affecting the upper lobe of the left lung. We started administering empiric antibiotics and tapering immunosuppression, but the patient's condition gradually worsened, and lung lesions increased. On the fifth day after hospitalization, bacteria developed from sputum cultures were identified as N. pseudobrasiliensis by matrix-assisted laser desorption ionization time of flight mass spectrometry. We started treatment with trimethoprim-sulfamethoxazole. The patient's clinical symptoms and laboratory data improved quickly. After one month of hospitalization, this patient was discharged. Then, the lung lesion almost vanished. Ten years after her transplant, the patient is alive with a well-functioning graft.
Asunto(s)
Trasplante de Hígado , Nocardiosis , Nocardia , Humanos , Nocardiosis/tratamiento farmacológico , Nocardiosis/microbiología , Nocardiosis/diagnóstico , Femenino , Persona de Mediana Edad , Trasplante de Hígado/efectos adversos , Nocardia/aislamiento & purificación , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Antibacterianos/uso terapéutico , Huésped Inmunocomprometido , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
We report the case of a female patient in her late 20s who visited the clinic with concerns about poor vision, redness, watering and a burning sensation in her left eye 2 weeks after undergoing a small incision lenticule extraction. She had no history of systemic illness or immunosuppressed status. On slit lamp examination, she was found to have corneal stromal infiltrates in the interface at multiple locations. Given the clinical diagnosis of microbial keratitis, corneal scraping of the interface infiltrate was performed and sent for microbiological examination revealing gram-positive, thin, beaded filaments that were acid-fast positive and later identified by growth in culture media as Nocardia species. This case was managed successfully with the use of topical amikacin and systemic trimethoprim-sulfamethoxazole with complete resolution of infection.