A 20-Year Experience with Nocardiosis in Solid Organ Transplant (SOT) Recipients in the Southwestern United States: A Single-center Study

Majeed, Aneela; Beatty, Norman; Ahmad, Iftikhar; Mushtaq, Adeela; Gaynor, Pryce; Kim, Jeeyong C; Márquez, José Luis; Mora, Francisco; Georgescu, Anca Meda; Zangeneh, Tirdad T.

doi:10.1093/ofid/ofx163.1899

Cited by 14 publications

(49 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Single organ transplantation (SOT) was the most common risk factor in this cohort. This confirms the data from most recent reports, showing the occurrence of PN in 1.3% to 3.5% of all SOT recipients (Poonyagariyagorn et al, 2008;Peleg et al, 2007;Hemmersbach-Miller et al, 2018;Majeed et al, 2018). PN may also occur in immunocompetent patients, mainly those with a pulmonary comorbidity, especially COPD (Chen et al, 2013;Hui et al, 2003;Chen et al, 2014;Kurahara et al, 2014;Martinez Tomas et al, 2007).…”

Section: Discussionsupporting

confidence: 88%

Pulmonary nocardiosis in Western Europe—Clinical evaluation of 43 patients and population-based estimates of hospitalization rates

Ott

Meier

Kolditz

et al. 2019

International Journal of Infectious Diseases

View full text Add to dashboard Cite

Background: Pulmonary nocardiosis (PN) is an uncommon but potentially life-threatening infection. Most of our knowledge on PN is derived from case reports and small case series. Increasing incidence rates of PN have been reported recently. The aim of this study was to describe the clinical course of and risk factors for PN in four Western European countries and to estimate population-based annual hospitalization rates. Methods: This was a retrospective evaluation (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) of the clinical course of and risk factors for PN in patients at 11 hospitals in four European countries (Germany, Austria, Switzerland, and the Netherlands). Population-based estimates of hospitalization rates for PN in Germany (2005 to 2011) were calculated using official German nationwide diagnosis-related groups (DRG) hospital statistics. Results: Forty-three patients fulfilled stringent criteria for proven (n = 8) and probable (n = 35) PN; seven had extrapulmonary dissemination. For these 43 patients, the major risk factors for PN were immunocompromising (83.7%) and/or pulmonary (58.1%; as only comorbidity in 27.9%) comorbidities. The median duration of PN targeted therapy was 12 weeks. Distinctive patterns of resistance were observed (imipenem susceptibility: Nocardia farcinica 33.3%; Nocardia asteroides 66.7%). The overall mortality rate was 18.9% (50% in disseminated PN). Over time, annual PN hospitalization rates remained unchanged at around 0.04/ 100 000, with the highest rate among men aged 75-84 years (0.24/100 000). Conclusions: PN is a rare, but potentially life-threatening disease, and mainly affects immunocompromised elderly males. Overall, annual hospitalization rates remained stable between 2005 and 2011.

show abstract

Section: Discussionsupporting

confidence: 88%

Pulmonary nocardiosis in Western Europe—Clinical evaluation of 43 patients and population-based estimates of hospitalization rates

Ott

Meier

Kolditz

et al. 2019

International Journal of Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…11 With regards to prophylaxis, TMP-SMX for PJP in SOT recipients has not been consistently shown to prevent breakthrough nocardiosis, presumably due to its usage only 2-3 times per week unlike daily. [15][16][17] Our patient was on prophylaxis since the transplant and yet acquired the disease.…”

Section: Discussionmentioning

confidence: 94%

“…There have been epidemiological descriptions of clusters of outbreaks around construction areas, 14 and hospital wards. Among SOT recipients, the incidence of nocardiosis ranges from 0.04% to 3.5%, 15,16 with the highest frequency in recipients of lung (3.5%), followed by recipients of heart (2.5%), intestine (1.3%), kidney (0.2%), and liver (0.1%) transplants. 17 As per a retrospective European study, nocardiosis occurred at a median of 17.5 (range, 2-244) months after transplant.…”

Section: Discussionmentioning

confidence: 99%

Isolated abdominal nocardiosis in a pediatric renal transplant recipient

Acharya

Amin

Rajderkar

et al. 2019

Pediatric Transplantation

View full text Add to dashboard Cite

Nocardia infection after RT is uncommon. The most common modes of exposure are inhalation of dust containing nocardia or contaminated soil/water and surgical instruments. Isolated abdominal nocardiosis following RT has not been reported. We report an 11‐year‐old female who developed nocardia abscesses of the abdomen post‐RT. ESRD was secondary to FSGS and she had received multiple immunosuppressive agents prior to transplant. Induction immunosuppression consisted of thymoglobulin and maintenance was with tacrolimus, mycophenolate, and prednisone. There were construction activities in the hospital ward during her hospital stay. Due to immediate recurrence of FSGS in the allograft, she received plasma exchange, rituximab, and IVIG. Anti‐infective prophylaxis consisted of TMP‐SMX, valganciclovir, and nystatin. She developed multiple loculated fluid collections in the abdomen 6 weeks later. Histology of lesions demonstrated suppurative caseating granulomatous inflammation and the AFB culture showed Nocardia farcinica. With the reduction of immunosuppressive agents along with usage of TMP‐SMX, imipenem‐cilastatin, and linezolid, she had a partial recovery after 9 months with persistent small abscesses but remained asymptomatic clinically. There was no evidence of nocardia infection in lungs and brain. Repeat AFB culture from the lesions was negative. Allograft function remained stable throughout. She remains on oral TMP‐SMX therapy. We postulated that she could have acquired nocardia either from the contaminated air particles in the hospital from the construction activities or reactivation of nocardia from prior colonization. Nocardia infection should be suspected in immunocompromised patients with unexplained fever and abdominal pain.

show abstract

“…Historical data suggest that the use of daily TMP‐SMX for the prevention of P jiroveci pneumonia has a protective effect against Nocardia infection in solid organ transplant recipients . However, more recent reports show an increasing number of TMP‐SMX–susceptible Nocardia infections in patients receiving TMP‐SMX, leading some to speculate that the doses effective for the prevention of P jiroveci (80/400 mg) are insufficient for the prevention of Nocardia . Five patients in our series had breakthrough Nocardia infection while on double‐strength (160/800 mg daily) TMP‐SMX prophylaxis, suggesting similarly to Majeed et al that this dose is also insufficient for prophylaxis.…”

Section: Discussionmentioning

confidence: 99%

“…However, more recent reports show an increasing number of TMP‐SMX–susceptible Nocardia infections in patients receiving TMP‐SMX, leading some to speculate that the doses effective for the prevention of P jiroveci (80/400 mg) are insufficient for the prevention of Nocardia . Five patients in our series had breakthrough Nocardia infection while on double‐strength (160/800 mg daily) TMP‐SMX prophylaxis, suggesting similarly to Majeed et al that this dose is also insufficient for prophylaxis. Three of these patients with breakthrough Nocardia infections had susceptibilities available, all fortunately confirming TMP‐SMX retained susceptibility.…”

Section: Discussionmentioning

confidence: 99%

Nocardia infection in kidney transplant recipients: A single‐center experience

Matchett

Djamali

Mandelbrot

et al. 2019

Transplant Infectious Dis

View full text Add to dashboard Cite

Background: Data on Nocardia infection in kidney transplant patients remain limited. Methods: A chart review of patients with a history of kidney transplant and one positive culture for Nocardia between 1999 and 2019 was performed. Results: Ten patients (0.1%) had a Nocardia infection. Eight were deceased donor kidney transplant recipients, and the mean age at the time of transplant was 56.0 ± 14.5 years. Nocardia infection occurred at a median of 12 months (range, 6-102) after transplant with half of the cases within 1 year. Breakthrough Nocardia infection occurred in five patients receiving daily double-strength (160/800 mg) TMP-SMX as prophylaxis. Half of the patients had comorbid CMV infection at diagnosis.The most common site involved was the lung. TMP-SMX was the most frequently used antimicrobial agent for treating Nocardia infection (9 of 10); it was administered as single-drug therapy (4 of 10) or as combination therapy with other antimicrobials (5 of 10). Overall mortality was 60% with 30% attributable mortality within a mean of 3.3 ± 7.7 weeks after a diagnosis of Nocardia.Discussion: TMP-SMX prophylaxis did not appear to protect against Nocardia but did appear to be associated with less severe disease. Overall outcomes remain poor, and infection can occur outside the traditional window.

show abstract

A 20-Year Experience with Nocardiosis in Solid Organ Transplant (SOT) Recipients in the Southwestern United States: A Single-center Study

Cited by 14 publications

References 0 publications

Pulmonary nocardiosis in Western Europe—Clinical evaluation of 43 patients and population-based estimates of hospitalization rates

Pulmonary nocardiosis in Western Europe—Clinical evaluation of 43 patients and population-based estimates of hospitalization rates

Isolated abdominal nocardiosis in a pediatric renal transplant recipient

Nocardia infection in kidney transplant recipients: A single‐center experience

Contact Info

Product

Resources

About