Infection Caused by Nocardia farcinica : Case Report and Review

Abstract

Nocardia farcinica is a rare Nocardia species causing localised and disseminated infections. A case of Nocardia farcinica infection is presented, and 52 cases previously reported in the literature are reviewed. The hosts usually had predisposing conditions (85%), and acquired the infection through the respiratory tract or skin; the infection then often spread to the brain, kidney, joints, bones and eyes. Pulmonary or pleural infections (43%), brain abscesses (30%) and wound infections (15%) which failed to respond to conventional antimicrobial therapy were the more frequent forms of infection. Nocardia farcinica was frequently isolated from pus (100% of samples), bronchial secretions (41%) and biopsy specimens (63%), but isolation from blood and urine, as in the case presented here, is rare. Antibiotic therapy was adequate in 61% of the patients in whom it was specified, the agents most frequently given being trimethoprim-sulfamethoxazole (54%), amikacin combined with imipenem (7%) and amoxicillin-clavulanate (7%). The high mortality (31%) can be attributed to the severe underlying diseases present, difficulties encountered in identifying the pathogen, inappropriate therapy and late initiation of therapy. Although an infrequent pathogen, Nocardia farcinica should be kept in mind as a cause of infection especially in immunosuppressed patients with indolent infections not responding to third-generation cephalosporins.

Fatal cases of disseminated nocardiosis: challenges to physicians and clinical microbiologists – Case report

“…The majority of patients were male and had one or more predisposing factors, and the lung was the most common primary site of infection. The mortality rate was 41.7%; similarly, poor outcome associated with N. farcinica was previously reported by Torres et al [9]. General treatment recommendations for nocardiosis are difficult to establish due to the lack of controlled trials and variable in vitro antibiotic susceptibility patterns [6].…”

Cytological diagnosis of pulmonary nocardiosis in an immunocompromised patient

“…However, now this species has been reported from paediatric population. [4] In the case presented here we have isolated…”

“…Pleomorphic and non-speciÞ c radiological manifestations further complicate the diagnosis. [4] Sputum examination, bronchoalveolar lavage, chest ultrasound and CT guided Þ ne needle aspiration cytology offer a simple means of procuring material for diagnostic evaluation. [2] In these specimens, Nocardia spp.…”

Primary Nocardia farcinica Brain Abscess With Secondary Relapsing Meningitis in an Immunocompromised Patient

“…Nocardia spp. are difficult to culture, grow slowly and their growth may be contaminated by faster growing species, delaying the start of the appropriate antibiotic treatment [4,7]. Prolonged course of oral antimicrobials (> 12 months) is considered necessary to prevent relapses [8].…”