A case of systemic nocardiosis in systemic vasculitis and a review of the literature

Sirisena, Dinesh; Swedan, L Al; Jayne, David; Chakravarty, Kuntal

doi:10.11622/smedj.2013098

Cited by 10 publications

(7 citation statements)

References 17 publications

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“…The low specificity of the clinical condition as well as the array of radiological images produced by Nocardia make the diagnosis difficult and the condition is often incorrectly interpreted as pneumonia caused by more common agents ( Table 1) [3][4][5][6][7][8] . The diagnosis was difficult because the techniques for identifying the agent were not available in the hospital's laboratory and the blood cultures had to be sent to a specialized centre [10,[15][16][17] .…”

Section: Discussionmentioning

confidence: 99%

“…Nocardiosis is an uncommon infection caused by Gram-positive aerobic bacteria belonging to the genus Nocardia [3,4] . The diagnosis is a challenge because of its non-specific presentation and imaging findings suggesting a broad spectrum of differential diagnoses ( Table 1), making microbiological testing important and sometimes difficult [5][6][7][8] . Recent identification of a species-specific glycoprotein antigen by ELISA allowed detection of antibodies against the antigen in 91% of cases studied.…”

Section: Introductionmentioning

confidence: 99%

“…The optimum therapy for nocardiosis is still unclear as no prospective randomized study has determined the most effective therapy. The choice of antimicrobials is based on cumulative experience, investigations in animal models and profiles of in vitro antimicrobial activity [3][4]6,15,16]. The incidence of nocardial infections is believed to be increasing worldwide as a result of a growing immunocompromised population and improved isolation methods and molecular identification [15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

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Nocardia cyriacigeorgica and Aspergillus Co-infection in a Patient with Giant-cell Arteritis

Gomes

Feria

Costa

et al. 2019

European Journal of Case Reports in Internal Medicine

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Immunosuppressed patients are at greater risk of unusual infections. The authors present the case of a woman with giant-cell arteritis, on oral steroids, who developed cavitating pneumonia due to co-infection with Aspergillus and Nocardia. Reports of such co-infection are rare in the literature. This case highlights the importance of considering rare pathogens in immunosuppressed patients who present with nonspecific symptoms, as well as the impact of such pathogens on clinical management. Another important issue is the need for prophylaxis against Nocardia spp. in immunocompromised patients. LEARNING POINTS • In patients with vasculitis on systemic corticosteroid therapy or other immunosuppressive treatment, suspicion of uncommon infectionshould increase in parallel with the cumulative dose of these drugs. • Obtaining an accurate diagnosis and early treatment is essential, but can be very challenging.• Regular prophylactic therapy should be considered. However, more research is needed to determine whether higher doses of TMP/SMX would provide adequate coverage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Nocardia cyriacigeorgica and Aspergillus Co-infection in a Patient with Giant-cell Arteritis

Gomes

Feria

Costa

et al. 2019

European Journal of Case Reports in Internal Medicine

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“…The mortality rate is 31% which is much greater than that of other agents that can cause cerebral abscesses being less than 10% 10 . The presence of simultaneous lung and brain abscesses has been documented as a reliable indication of an underlying nocardia infection 11 . Central nervous system (CNS) involvement with disseminated nocardiosis results in up to a 55% mortality rate in immunocompromised patients 12 .…”

Section: Discussionmentioning

confidence: 99%

A complicated case of an immunocompetent patient with disseminated nocardiosis

Cooper

Said

Popp

et al. 2014

Infectious Disease Reports

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Nocardia species are aerobic, gram positive filamentous branching bacteria that have the potential to cause localized or disseminated infection. Nocardiosis is a rare disease that usually affects immunocompromised patients and presents as either pulmonary, cutaneous or disseminated nocardiosis. Forty-two year-old hispanic male presented to our care with bilateral lower extremity weakness, frontal headache, subjective fever, nausea, and vomiting. Brain computed tomography (CT) revealed multiple hyperdense lesions with vasogenic edema in the frontal, parietal and left temporal lobes. Chest CT demonstrated bilateral cavitary nodules in the lung and right hilar lymphadenopathy. Brain magnetic resonance imaging revealed multiple bilateral supratentorial and infratentorial rim enhancing lesions involving the subcortical gray-white matter interface with vasogenic edema. Patient was started on empiric therapy for unknown infectious etiology with no response. He eventually expired and autopsy findings revealed a right hilar lung abscess and multiple brain abscesses. Microscopic and culture findings from tissue sample during autopsy revealed nocardia wallacei species with multidrug resistance. The cause of death was stated as systemic nocadiosis (nocardia pneumonitis and encephalitis). The presence of simultaneous lung and brain abscesses is a reliable indication of an underlying Nocardia infection. An increased awareness of the various presentations of nocardiosis and a high index of clinical suspicion can help in a rapid diagnosis and improve survival in an otherwise fatal disease. This case highlights the importance of obtaining a tissue biopsy for definitive diagnosis on the initial presentation when an infectious process is considered in the differential diagnosis and early treatment can be initiated.

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“…The use of surgery in the management of nocardiosis depends on the site and extent of the infection. In extraneural disease, indications for aspiration, drainage, or excision of abscesses are similar to those for other chronic bacterial infections 10,50,51. Therapeutic aspiration is generally inadequate in patients with thick-walled multiloculated abscesses containing free-flowing pus and in patients with mycetomas.…”

Section: Discussionmentioning

confidence: 99%

Soil-acquired cutaneous nocardiosis on the forearm of a healthy male contracted in a swamp in rural eastern Virginia

Palmieri¹,

Santo²,

Johnson³

2014

IMCRJ

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A 45-year-old man complained of pain and swelling on his right wrist after receiving a scratch while playing paintball in a swampy area of eastern Virginia. Two weeks later, he noticed a pimple-like lesion developing, which quickly grew in size and then ulcerated. Because of the severity of his condition, the patient was taken to the emergency room where surgical drainage of the abscess was carried out and the pus was sent for culture and sensitivity testing. Enlarged and tender lymph nodes were palpable going up the arm and surrounding the right axillary area. Three days following culture of pus from his lesion, colonies of Nocardia brasiliensis were isolated. He was successfully treated with an extended regimen of trimethoprim-sulfamethoxazole. Because of its low incidence, nocardiosis is usually not considered in the initial diagnosis. The rapidity with which his infection developed from a pimple-like lesion into an extensive ulcerated area, the involvement of his lymphatic system, the extended time needed to successfully treat his infection, and the potential for infection to rapidly disseminate, reinforces the necessity for laboratory identification and immediate treatment of severe pyogenic cutaneous lesions.

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A case of systemic nocardiosis in systemic vasculitis and a review of the literature

Cited by 10 publications

References 17 publications

Nocardia cyriacigeorgica and Aspergillus Co-infection in a Patient with Giant-cell Arteritis

Nocardia cyriacigeorgica and Aspergillus Co-infection in a Patient with Giant-cell Arteritis

A complicated case of an immunocompetent patient with disseminated nocardiosis

Soil-acquired cutaneous nocardiosis on the forearm of a healthy male contracted in a swamp in rural eastern Virginia

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