Nocardia

10/08/01 (Shang)

Question: What are aspects of pulmonary nocardia infection?

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[Link Directly to Fulltext Article in OVID]

Unique Identifier: 98381519 / PubMed Identifier: 9715730

Authors: Kontoyiannis DP. Ruoff K. Hooper DC.

Institution: Infectious Disease Division, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Abstract: Bacteremic nocardiosis is reported rarely. We discuss 4 recent cases seen at our institution and 32 other cases described in the English literature. We found that patients with bacteremic nocardiosis were similar in presentation, risk factors, course, and therapeutic outcome to nonbacteremic patients with nocardiosis. The presence of endovascular foreign bodies appeared to be the only unique risk factor associated with bacteremic illness. Seeding of the central nervous system appeared to be relatively uncommon. Thirty percent of patients with nocardemia had concomitant bacteremia with other pathogens, mostly Gram-negative organisms. Nocardia grew in a variety of growth media, and the median incubation time to detection was 4 days. Fifty percent of patients with Nocardia bacteremia died. Positive blood cultures were a preterminal finding in the fatal, acute cases and occurred relatively early in the subacute, nonfatal cases. Poor outcome seemed to correlate with acute onset of nocardiosis (duration less than 1 month), late identification of nocardemia, involvement of more than 2 sites, and the lack of treatment with a sulfonamide-containing regimen. [References: 52]

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Unique Identifier: 97373761 / PubMed Identifier: 9230244

Authors: Menendez R. Cordero PJ. Santos M. Gobernado M. Marco V.

Institution: Pneumology Service, University Hospital La Fe, Valencia, Spain.

Abstract: Pulmonary nocardiosis (PN) is an infrequent and severe infection due to Nocardia spp., microorganisms that may behave both as opportunists and as primary pathogens. The aim of this study and review was to evaluate the clinical features, evolution and prognostic factors of PN. The study group comprised 10 consecutive patients with pulmonary nocardiosis acquired in a community setting, diagnosed and followed in a tertiary teaching hospital. Chronic obstructive pulmonary disease (COPD), neoplastic disease and human immunodeficiency virus (HIV) infection were the most frequent predisposing factors. Four patients were receiving corticosteroid treatment. Clinical course was chronic and diagnosis was delayed 3 weeks or more in seven of the patients. Lobar or multilobar condensation was the most frequent radiographic pattern. Antimicrobial susceptibility testing showed: 100% sensitivity for amikacin; 83% for imipenem; 71% for cefotaxime; and 71% for trimethoprim-sulphamethoxazole. The disease remained localized in the lung in five cases, with a trend toward chronicity in one with bronchiectasis. In the other five, the disease disseminated, affecting subcutaneous tissue, the central nervous system and the kidney. Three patients died, one with disseminated disease and two who were receiving corticosteroid therapy. The following conclusions were reached: 1) pulmonary nocardiosis is difficult to diagnose, diagnosis is frequently delayed and a high level of suspicion is, thus, required in patients with underlying diseases or chronic corticosteroid therapy; 2) there is frequent dissemination and high mortality; and 3) antimicrobial combinations with proven synergy, such as imipenem and amikacin, are recommended for initial therapy. [References: 28]

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Unique Identifier: 97333498 / PubMed Identifier: 9189658

Authors: Threlkeld SC. Hooper DC.

Institution: Infectious Disease Unit, Harvard Medical School, Massachusetts General Hospital, Boston, USA.

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Unique Identifier: 95146183 / PubMed Identifier: 7843819

Authors: Long PF.

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Unique Identifier: 95132909 / PubMed Identifier: 7831543

Authors: Marrie TJ.

Institution: Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.

Abstract: There are nine species of Nocardia. Nocardia asteroides accounts for 80% of infections caused by this organism in man. N brasiliensis causes 3% to 9% of these infections, and N farcinica is being recognized with increasing frequency. We present three cases of Nocardia pneumonia two of which were caused by N asteroides and one was caused by N farcinica. These cases illustrate the diverse nature of nocardiosis and show that sometimes it is difficult to determine whether the Nocardia was community- or nosocomially-acquired. [References: 32]

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Unique Identifier: 93017057 / PubMed Identifier: 1401217

Authors: Coker RJ. Bignardi G. Horner P. Savage M. Cook T. Tomlinson D. Weber J.

Institution: Department of Genitourinary Medicine, St Mary's Hospital, London.

Abstract: A case of Nocardia asteroides pneumonia was diagnosed after death in a patient with AIDS. Six sputum cultures and one bronchoalveolar lavage fluid contained no pathogens, and no growth was obtained from one pleural fluid aspirate. None of these specimens was incubated for more than two days. Extended incubation for mycobacteria also failed to help in the diagnosis. N asteroides was isolated from pus taken from the lung cavity during the post mortem examination. It is suggested that if nocardiosis enters the differential diagnosis all specimens should be cultured for at least two weeks and the use of selective media be considered. This case highlights the need for clinicians to maintain a high index of suspicion for this pathogen.

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Unique Identifier: 90168274 / PubMed Identifier: 2696621

Authors: Telzak EE. Hii J. Polsky B. Kiehn TE. Armstrong D.

Institution: Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021.

Abstract: A case of Nocardia asteroides pneumonia in a patient with the acquired immunodeficiency syndrome who was intolerant of sulfadiazine is described. On cefuroxime, the patient had a complete resolution of his Nocardia pneumonia. Disk-diffusion and broth microdilution antibiotic susceptibility testing (MIC less than or equal to 2 micrograms/ml) strongly supported the use of cefuroxime as treatment in this patient. Susceptibility testing with newer cephalosporins should be considered for all significant Nocardia isolates.