DisseminatedNocardia farcinica: Literature Review and Fatal Outcome in an Immunocompetent Patient

Abstract

Trimethoprim-sulfamethoxazole typically is the first-line therapy for N. farcinica; treatment with amikacin and imipenem-cilastatin is used less often (7% of patients). Despite aggressive therapy, we observed that the death rate (39%) associated with N. farcinica in recent publications was eight percentage points higher than reported in a review from 2000.

Nocardia Mastoiditis in an Immunocompromised Patient

“…Diagnosis of this pathogen requires proof of the organism in tissue, cultures, or both. As cultures may take five or more days to identify nocardia, newer techniques, such as 16 sRNA amplification, that allow quicker identification are helpful in distinguishing nocardia species from one another to allow timely initiation of appropriate antimicrobial therapy [2].…”

“…Of the 67 cases of Nocardia farcinica infections reported from 2000-2012, almost 60% were found to affect the lungs [2]. Up to half of pulmonary nocardiosis cases have involvement outside the lungs, and approximately 20% of patients present only with extrapulmonary disease [1].…”

“…Rarely, bacteremia due to nocardia can occur [1]. It has been reported that Nocardia asteroides can cause mastoiditis in an HIV-infected patient [4], however, reports of N. farcinica causing disease, in particular mastoiditis, remain rare [2]. Reported cases of nocardia causing mastoiditis can be found in Table 1.…”

“…Nocardia farcinica has a more unique drug susceptibility pattern owing to this species being more virulent, with a mortality rate of more than 30%. Of the 67 cases reported between 2000-2012, 25 (37%) of those patients died [2]. N. farcinica has been shown to have remarkable resistance to most beta-lactams and aminoglycosides, excluding amikacin (to which all isolates have been reported as susceptible) [1,5].…”

“…One such species, Nocardia farcinica, is more virulent and has a unique antibiotic susceptibility pattern compared to other nocardia species [1]. Recognized as one of the least frequently encountered clinically important species of nocardia, only 67 cases were reported from 2000-2012 [2]. These characteristics create challenges for initiating appropriate treatment of nocardia infections.…”