Human Nocardiosis in Northern Italy from 1982 to 1992

Abstract

We conducted a retrospective survey of nocardiosis in 9 city hospitals in northern Italy from 1982 to 1992. The medical records of 30 patients with documented nocardiosis were reviewed. Microbiological data included morphology, biochemical characteristics, serology and in vitro susceptibility testing. The 29 isolates (1 case was diagnosed on the basis of serological results) were Nocardia asteroides (n = 25) and Nocardia farcinica (n = 4). Predisposing factors including immunosuppression for organ transplant rejection prophylaxis, lung disease (silicotuberculosis and pulmonary fibrosis), solid tumours and hematological malignancies, and AIDS. Three patients had no identified risk factors. 20 cases of pulmonary nocardiosis were observed. Sites of infection in patients without previous pulmonary involvement were: brain abscesses, soft tissues, pericardium, blood, and cerebrospinal fluid. Most strains tested were susceptible to amikacin and imipenem. Resistance to several antimicrobial agents was found, particularly erythromycin, fosfomycin, pefloxacin, sulphonamides and trimethoprim. Antimicrobial chemotherapy included sulphonamides, amikacin, ceftriaxone, imipenem and minocycline. 21 patients survived, although 2 relapsed transiently. Nocardiosis appears to be more common than generally realised by physicians in northern Italy. The local species distribution and disease spectrum are similar to those described elsewhere. Nocardiosis should be part of the differential diagnosis in patients with pulmonary infiltrates or brain abscess, particularly those with predisposing factors.

Nocardia Farcinica Lung Abscess Presenting in the Context of Advanced HIV Infection: Spontaneous Resolution in Response to Highly Active Antiretroviral Therapy Alone

“…Reflecting these modes of acquisition, Nocardia usually presents in patients with HIV as a chronic pneumonia syndrome (75% to 90%) or soft tissue infection (5% to 15%) (3,7,(10)(11)(12). The presentation of Nocardia in HIVinfected patients is similar to patients without HIV, but it is more likely to be associated with extrapulmonary dissemination (7,8,13).…”

“…An alternative to cotrimoxazole must be utilized in the setting of sulfa resistance (common with N otitidiscaviarum), sulfa intolerance and for those patients failing sulfonamide therapy. The combination of imipenem and amikacin has demonstrated good activity clinically, as well as in animal models and in vitro (12,25). Parenteral therapy can generally be stepped down to oral therapy after three to six weeks, once a clinical response has been achieved (25).…”

Infection Due to Nocardia farcinica in a Woman with Chronic Granulomatous Disease

“…the most common primary sites of infection due to N. farcinica Sulfonamides are still the treatment of choice for infections due among 65 cases, but the paranasal sinuses, the oral palate, and the to N. farcinica [2,3]. Good therapeutic results with monotherapy eyes can also be involved [2,3,[5][6][7][8][9]]. Mouse studies demonstrate or various combinations of imipenem, amikacin, amoxicillin plus that N. farcinica is more virulent than N. asteroides [6].…”

“…More clavulanic acid, and minocycline have also been reported [2,3]. patients with N. farcinica infections [2,3,[6][7][8][9] are immunocomCombinations of imipenem and amikacin or cefotaxime and imipromised (70%) than are patients with N. asteroides infections [1].…”

Fatal Pulmonary Nocardia farcinica Infection

“…It has been estimated that between 500 and 1,000 infections with Nocardia species occur yearly in the United States and between 150 and 250 in France (1,2). Because of its controversial status, N. farcinica was not mentioned in the literature for some years, so the relative frequencies of N. farcinica among clinical nocardial isolates are difficult to determine and may vary geographically (2,4,9,12).…”