Disseminated Cutaneous Nocardia Brasiliensis Infection

Abstract

Nocardia brasiliensis is an uncommon pathogen in the United States despite its presence in soil samples. It is most frequently seen in patients who are immunosuppressed, but can occur in the immunocompetent host also. Usually in a healthy host the infection is localized to one area of the body. Disseminated infection was diagnosed in a healthy child who recovered fully after initiation of oral sulfonamide therapy. We suspect that the source was soil to which the patient was exposed during a family camping trip. Nocardia asteroides is the most frequent cause of nocardial infections in North America. These infections are unusual in healthy individuals, occurring more often in immunologically compromised hosts. They are usually acquired by a pulmonary route and may disseminate widely, most commonly to the central nervous system and skin. Nocardia brasiliensis, when it does occur in the United States, usually causes a chronic cutaneous and subcutaneous infection manifesting itself as mycetoma, abscess, or ulcer. We saw acute suppurative lymphocutaneous Nocardia brasiliensis infection in an otherwise healthy 2-year-old boy.

Isolation and Characterization of Medically Important Aerobic Actinomycetes in Soil of Iran (2006 - 2007)

“…This Nocardia species produces infection most frequently in immunocompromised patients, but it can cause cutaneous and disseminated infection in immunocompetent patients too [30]. A review of actinomycetomas cases from 1972 to 2005 in Iran demonstrated that N. brasiliensis has been the cause of 86.6% of the cases, which have mostly been associated with tropical environments [7].…”

Nocardia species: host-parasite relationships

“…Thus, when lesions are found at two or more locations within the body, the infection is defined as systemic or disseminated nocardiosis. Any anatomic location can be involved, but the most common sites that become infected during dissemination include the CNS, cutaneous and subcutaneous tissues, eyes (especially the retina), kidneys, joints, bone, and heart (22,26,36,51,105,107,122,135,144,149,156,159,176,191,218,220,251,253,254,260,263,304,352,375,391,392,423,454,459,466,478,479,503,520,522,525,538,540,566,569,585,589,601,631,708,719,731,734).…”

“…There are reports of Nocardia spp. colonizing airway passages without inducing disease; however, on the basis of studies with animal models, these should probably be interpreted as representing subclinical infections rather than simple colonization (37, 59-61, 64, 67, 69-71, 74, 82, 89, 122, 203, 253, 254, 388, 566, 734 (18,38,186,198,203,237,247,253,254,393,395,478,486,506,527,623,703,734 [303,311,702], wood splinter [180], traumatic accident [352,378], bullet wound [283,463,468], insect bite [156,277], or animal bite [429]). Thus, when lesions are found at two or more locations within the body, the infection is defined as systemic or disseminated nocardiosis.…”

Skin Infections

“…It is ubiquitous and can be isolated from soil, water, and organic matter. [132][133][134] Other clinically relevant species are Nocardia farcinica and Nocardia nova. [132][133][134] Other clinically relevant species are Nocardia farcinica and Nocardia nova.…”

“…The disease is confined to Latin America, with endemic areas in Brazil, Argentina, Colombia, and Venezuela. 132 The acute/subacute form usually affects children, teenagers, and young adults and is also called "juvenile type." However, after this age, the incidence increases progressively in males.…”