Acute primary cutaneous Nocardia asteroides infection in a patient with systemic lupus erythematosus. Case report

Lopes, Jorge O.; Silva, Cristina B.; Kmohan, Cláudio; Oliveira, L. T. O.; Forno, Nara Lúcia Frasson Dal; Pereira, Cleonice C. S.

doi:10.1590/s0036-46651995000600014

Cited by 4 publications

(1 citation statement)

References 10 publications

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“…Mycetomas cases caused by Nocardia sp. have been described in São Paulo and other cities [41], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75].…”

Section: Discussionmentioning

confidence: 99%

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

et al. 2013

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Background Nocardia sp. causes a variety of clinical presentations. The incidence of nocardiosis varies geographically according to several factors, such as the prevalence of HIV infections, transplants, neoplastic and rheumatic diseases, as well as climate, socio-economic conditions and laboratory procedures for Nocardia detection and identification. In Brazil the paucity of clinical reports of Nocardia infections suggests that this genus may be underestimated as a cause of human diseases and/or either neglected or misidentified in laboratory specimens. Accurate identification of Nocardia species has become increasingly important for clinical and epidemiological investigations. In this study, seven clinical Nocardia isolates were identified by multilocus sequence analysis (MLSA) and their antimicrobial susceptibility was also determined. Most Nocardia isolates were associated to pulmonary disease.Methodology/Principal FindingsThe majority of Brazilian human isolates in cases reported in literature were identified as Nocardia sp. Molecular characterization was used for species identification of Nocardia nova, Nocardia cyriacigeorgica, Nocardia asiatica and Nocardia exalbida/gamkensis. Data indicated that molecular analysis provided a different Nocardia speciation than the initial biochemical identification for most Brazilian isolates. All Nocardia isolates showed susceptibility to trimethoprim-sulfamethoxazole, the antimicrobial of choice in the treatment nocardiosis. N. nova isolated from different clinical specimens from one patient showed identical antimicrobial susceptibility patterns and two distinct clones.Conclusions/SignificanceAlthough Brazil is the world's fifth-largest country in terms of land mass and population, pulmonary, extrapulmonary and systemic forms of nocardiosis were reported in only 6 of the 26 Brazilian states from 1970 to 2013. A least 33.8% of these 46 cases of nocardiosis proved fatal. Interestingly, coinfection by two clones may occur in patients presenting nocardiosis. Nocardia infection may be more common throughout the Brazilian territory and in other developing tropical countries than is currently recognized and MLSA should be used more extensively as an effective method for Nocardia identification.

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“…Mycetomas cases caused by Nocardia sp. have been described in São Paulo and other cities [41], [66], [67], [68], [69], [70], [71], [72], [73], [74], [75].…”

Section: Discussionmentioning

confidence: 99%

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

et al. 2013

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Gram-Positive Bacteria

Grossman

Fox

Kovarik

et al. 2011

Cutaneous Manifestations of Infection in the Immunocompromised Host

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Systemic Nocardiosis in a Splenectomized Patient with Systemic Lupus Erythematosus

Moitra

Auckland

Cawley

et al. 2003

JCR: Journal of Clinical Rheumatology

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A splenectomized patient with systemic lupus erythematosus, who had previously been treated with high doses of corticosteroids, presented with headaches and symptoms of a respiratory tract infection. A magnetic resonance imaging scan of the brain revealed a ring-enhancing lesion, and Nocardia asteroides was isolated from a stereotactic biopsy specimen. After adverse reactions to a number of antibiotics, infection control was finally achieved by the new oxazolidinone drug, linezolid. Nocardiosis should be considered as a differential diagnosis in all immunocompromised patients who develop an obscure infection; delay in diagnosis and subsequent initiation of appropriate treatment often results in a fatal outcome. Linezolid is a new option for the treatment of nocardiosis and is effective when given orally.

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Acute primary cutaneous Nocardia asteroides infection in a patient with systemic lupus erythematosus. Case report

Cited by 4 publications

References 10 publications

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

Gram-Positive Bacteria

Systemic Nocardiosis in a Splenectomized Patient with Systemic Lupus Erythematosus

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