Infections Due to Nocardia transvalensis: Clinical Spectrum and Antimicrobial Therapy

Abstract

Nocardia transvalensis, a rare Nocardia species, has previously been recognized as a cause of actinomycotic mycetoma. In a retrospective review of N. transvalensis isolates referred to the Centers for Disease Control (Atlanta) during the period January 1981 through January 1990, we identified 15 patient isolates. Four N. transvalensis isolates originated from one Australian reference laboratory; one patient's isolate that was identified by the Australian laboratory but that was not received at the Centers for Disease Control was also included in our study. A review of the cases of these 16 patients found that N. transvalensis caused infection in 10 patients and colonization in two patients. Six (75%) of eight patients with primary pulmonary or disseminated N. transvalensis infections had an underlying immunologic disorder or were receiving immunosuppressive therapy; three patients with disseminated infection died. All nine infected patients for whom specific antimicrobial therapy was prescribed received trimethoprim-sulfamethoxazole. Results of in vitro antimicrobial susceptibility tests of 11 N. transvalensis isolates revealed increased antimicrobial resistance to amikacin and other drugs when compared with that of other Nocardia species. Severely immunocompromised patients are predisposed to N. transvalensis pneumonia or disseminated infection, and the lung may be the portal of entry.

The medically important aerobic actinomycetes: epidemiology and microbiology

“…asteroides is the most common cause of primary pulmonary nocardiosis: this species has been estimated to cause at least 80% of cases (43). Rarely, other species, in particular, N. brasiliensis (551), have also been implicated in causing pulmonary disease in both immunocompromised and nonimmunocompromised patients (101,382).…”

“…identified as causing invasive pulmonary and cutaneous infections. Patients with disseminated and potentially fatal N. brasiliensis (551), N. otitidiscaviarum (75,101), N. transvalensis (29,382,384), N.…”

Nocardia wallacei sp. nov. and Nocardia blacklockiae sp. nov., Human Pathogens and Members of the “ Nocardia transvalensis Complex”

“…N. transvalensis has since been found to be an uncommon but significant pathogen capable of causing disseminated infections, particularly in immunocompromised patients. In 1992, McNeil et al reported on the recovery of N. transvalensis from 16 patients from Australia, Canada, Nigeria, Spain, and the United States, 10 of whom had clinical and/or histopathologic evidence of infection (16). Of these patients with proven pulmonary or disseminated infection, six had definable underlying immunosuppressive conditions.…”

Nocardia transvalensis/wallacei hindfoot actinomycetoma

“…Diseases that are caused by N. transvalensis include mycetomas, localized ocular infections, and primary pulmonary infection. N. transvalensis is now understood to cause life-threatening, invasive, and disseminated infections in severely immunocompromised patients [6] . Primary cutaneous disease usually occurs in immunocompetent hosts unlike other forms of nocardiosis.…”

“…PCR-based methodologies have been shown to offer clear-cut advantages over traditional methods for the isolation of N. transvalensis complex that are difficult to recognize by conventional methods and present potential chemotherapeutic complications arising from their inherent resistance to aminoglycosides and amikacin in particular [6,[21][22][23] . Patients will benefit from optimal drug selection, particularly when primary drug resistance is noted and an alternative drug therapy is needed [24] .…”