Case Report: A Severe and Multi-Site Nocardia farcinica Infection Rapidly and Precisely Identified by Metagenomic Next-Generation Sequencing

Zhang

et al. 2022

Front. Public Health

Nocardia endophthalmitis is a relatively uncommon form of endophthalmitis seen in clinical patients. In general, Nocardia endophthalmitis tends to carry a poor prognosis. Here, we report a 3-year-old child who was admitted to the hospital due to a rupture of the left eye. The suturing and anterior chamber formation were performed immediately. Approximately, 16 days after the operation, massive whitish plump and tufted exudates gathered in the pupil area and at the bottom of the anterior chamber, and the child was diagnosed with endophthalmitis. The infection was initially considered to be caused by fungal pathogens for that the hyphae and spores were observed in the smear. However, the isolate obtained after 4 days of culturation was identified as actinomycetes using MALDI–TOF. We further classified it as Nocardia huaxiensis by next-generation sequencing (NGS) based on the MinION platform. Amikacin and sulfamethoxazole tablets were used to control the infection and the ocular inflammation subsided gradually. Intraocular lens (IOL) implantation is planned to be performed at an appropriate future time to improve his vision. Nocardia endophthalmitis is rare and usually caused by ocular trauma or surgery. In conclusion, Nocardia huaxiensis should be considered as an emerging pathogen and deserves more attention.

Section: Discussionmentioning

confidence: 99%

Case Report: First Case of Endophthalmitis Caused by an Emerging Pathogen: Nocardia huaxiensis

Zhang

et al. 2022

Front. Public Health

“…Isolation and culture are the principal methods for diagnosis of nocardiosis 21 . At present, isolation of Nocardia on common or selective media usually takes 2-7 days, which causes a delay in diagnosis 22,23 . Some Nocardia strains even need between 1-4 weeks to generate available results, because they require strict culture conditions and have a slow growth rate at 35°C in standard culture medium; the presence of normal ora or treatment with antimicrobial therapy would also affect Nocardia culture 11,13,14,24,25 .…”

Section: Discussionmentioning

confidence: 99%

The Clinical Characteristic and Management of patients with nocardiosis in a tertiary hospital in China

Wang

Jian

et al. 2022

Preprint

Background: Nocardiosis is an uncommon opportunistic bacterial infection caused by Nocardia spp., and its incidence has increased significantly in recent years. This study aimed to summarize the clinical characteristics and management of nocardiosis to provide a reference for clinical diagnosis and treatment.Methods : This retrospective study was conducted based on the medical records of nocardiosis patients between January 2015 and December 2021 in a tertiary hospital in China.Results: Overall, 44 patients with nocardiosis were included in this analysis including 26 males and 18 females with a mean age of 50.4 ± 13.2 years. Connective tissue disease (CTD) was the most common underlying disease (16/44). Twenty-six patients were given immunosuppressive therapy. The most frequent infection sites were the lungs (17/44) and skin and soft tissue (8/44). Common symptoms included cough (23/44), expectoration (18/44), fever (15/44), and subcutaneous abscesses (15/44). Average microbiology laboratory detection time was 4.8 days. Twenty-nine patients were managed only with antimicrobial treatment, and 14 patients received both antimicrobial and surgical therapies. Trimethoprim-sulfamethoxazole (TMP-SMX) was the most commonly used antibiotic (31/44). Thirty-five patients were cured or improved, 6 patients were discharged from the hospital due to poor prognosis, and 1 patient died.Conclusion : Clinicians should be alert to immunocompromised patients, especially those with CTD, and tend to pulmonary or cutaneous infections. Smear microscopic examination and prolonged culture time may aid Nocardia identification. Patients with nocardiosis can be treated with antimicrobials or surgical therapy. TMP-SMX remains the mainstay treatment, and its early and prompt use may improve nocardiosis outcome.

“…5 Jiao et al has described use of Next-Generation Sequencing and its clinical use. 24 Relapses and multiple episodes have been known to occur in cases of nocardiosis, especially in patients with underlying immunosuppression. In a study on 132 patients of nocardiosis, 4 patients had at least 2 episodes at the same or different sites over a gap of 6-26 months with similar or different Nocardia isolates.…”

Section: Discussionmentioning

confidence: 99%

A case report: Nocardia otitidiscaviarum bacteraemia in a patient with metastatic lung adenocarcinoma

Shah

Thakkar²,

Goyle³

et al. 2022

IJMMTD

A 73 years old male patient, was admitted with fever, cough and generalised weakness since two to three days. He was diagnosed to have metastatic adenocarcinoma of lung 3 months back and was on chemotherapy. His blood culture grew The patient succumbed to the disease and various other comorbidities that had led to multi-organ failure. Incidence of bacteraemia due to nocardia and the associated common species in India is not known yet. It is imperative to widen the scope of the laboratory and to use diverse laboratory tools for accurate and rapid diagnosis of rare and unconventional pathogens.