Lymphocutaneous type of nocardiosis caused by <i> Nocardia brasiliensis</i>: A case report and review of primary cutaneous nocardiosis caused by <i> N. brasiliensis</i> reported in Japan

Fukuda, Hidetsugu; Saotome, Atsuko; Usami, Nao; Urushibata, Osamu; Mukai, Hiroyuki

doi:10.1111/j.1346-8138.2008.00482.x

Cited by 38 publications

(28 citation statements)

References 4 publications

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“…Agricultural work represents an important risk factor, with N. brasiliensis being the most common infecting species. Chronic cutaneous infections evolving over months to years may result in a mycetoma (actinomycetoma) [3,[10][11][12].…”

Section: Epidemiology Pathogenesis and Risk Factorsmentioning

confidence: 99%

Nocardiosis: Updated Clinical Review and Experience at a Tertiary Center

2010

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Nocardiosis is a rare opportunistic disease that affects mainly patients with deficient cell-mediated immunity, such as those with acquired immunodeficiency syndrome (AIDS) or transplant recipients. Pulmonary disease is the most common presentation in immunosuppressed patients and approximately one-third have a disseminated disease. Primary cutaneous nocardiosis is more frequently observed in immunocompetent patients with direct inoculation of the organism through professional exposure. The diagnosis can be challenging, as signs and symptoms are not specific and a high index of clinical of suspicion is necessary. Although gram stain, modified acid-fast stain, and cultures remain as the standard diagnostic tools, novel molecular techniques have changed the taxonomy of these organisms and, in some instances, have facilitated their identification. The disease has a marked tendency to recur and a high morbidity and mortality rate in immunosuppressed patients. Treatment is usually prolonged and an associated antibiotic treatment is preferred for severe disease. Although sulfonamides in combination with other antibiotics are still the treatment of choice, other associations such as imipenem plus amikacin are preferred in some centers. Linezolid is a useful alternative therapeutic agent due to its oral availability and activity against most of the isolates studied. Twenty-eight cases of nocardiosis were diagnosed at our center between January 1989 and April 2009. We report the epidemiologic characteristics of Nocardia spp. observed in our institution and discuss the risk factors, clinical features, diagnosis, and management of the disease.

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Section: Epidemiology Pathogenesis and Risk Factorsmentioning

confidence: 99%

Nocardiosis: Updated Clinical Review and Experience at a Tertiary Center

2010

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“…14 Primary cutaneous nocardiosis can present as lymphocutaneus syndrome, superficial skin infection (pustules, pyroderma, abscess, ulcers, granulomas, or cellulitis), sialoadenitis, and mycetoma. 8,15–18 The most common cause of primary cutaneous nocardiosis is N. brasiliensis . 10 Direct inoculation through the skin is the main route for infection of N. brasiliensis , while direct inhalation of contaminated particles containing this bacterium may also occur.…”

Section: Discussionmentioning

confidence: 99%

Primary Cutaneous Nocardiosis in a Patient With Nephrotic Syndrome

Chen

Tang

et al. 2016

Medicine

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Nocardia infection is not common in clinical practice and most cases occur as an opportunistic infection in immunocompromised patients.We report a case of primary cutaneous nocardiosis characterized by multiple subcutaneous abscesses due to Nocardia brasiliensis in a patient with nephrotic syndrome undergoing long-term corticosteroid therapy. The patient was diagnosed with nephrotic syndrome 9 months ago, and mesangial proliferative glomerulonephritis was confirmed by renal biopsy. Subsequently, his renal disease was stable under low-dose methylprednisolone (8 mg/d). All of the pus cultures, which were aspirated from 5 different complete abscesses, presented Nocardia. Gene sequencing confirmed that they were all N. brasiliensis. The patient was cured by surgical drainage and a combination of linezolid and Trimethoprim-Sulfamethoxazole.The case highlights that even during the period of maintenance therapy with low-dose corticosteroid agents, an opportunistic infection still could occur in patients with nephrotic syndrome.

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“…6 Lymphocutaneous nocardiosis consists of an acute primary cellulitis with lymphangitic spread and causes lymphadenitis. 7,8 Medical treatment of cutaneous nocardia infections is largely empiric and based on experience with treatment of invasive disease. Historically, oral TMP-SMX has been used for treatment of nocardiosis, with minocycline as an alternative.…”

Section: Discussionmentioning

confidence: 99%

Primary Cutaneous Nocardiosis in a Heart Transplant Patient: A Case Report

Devaraj¹,

Rodriguez²,

Hess³

et al. 2010

TMF

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A 38-year-old female with history of longstanding non-ischemic cardiomyopathy underwent orthotopic heart transplantation (OHT). Her past medical history was significant for factor V leiden and methylenetetrahydrofolate reductase (MTHFR) heterozygous deficiencies with chronic pulmonary embolism, sickle cell trait, atrial flutter, type 2 diabetes mellitus, and hypertension. The patient had a long and complicated course post-transplantation. Immediately after OHT, she was noted to have donor-specific human leukocyte antigen (HLA) antibodies treated with 5 cycles of plasmapheresis. On further biopsies it was noted that she had acute cellular rejection requiring pulse-dose parenteral steroids on multiple occasions. Her immunosuppression therapy consisted of tacrolimus, mycophenolate and prednisone. Six months post-transplant she was noted to have a spontaneous 4cm right calf muscle hematoma based on lower extremity ultrasound that was felt to be due to her underlying hematologic disease. At 7 months post-transplant the patient was hospitalized twice. The first admission was for multifocal necrotizing pneumonia. Although sputum cultures were non-diagnostic, the patient improved with 2 weeks of antibiotic treatment. The second admission occurred after a routine right heart catheterization that showed hemodynamic parameters concerning for rejection. At that time, the patient received empiric parenteral pulse steroids while waiting for final pathology results; these were negative for rejection and the patient's immunosupressants were continued at previous doses.The newest hospitalization was 8 months post-transplant, when she was admitted with a chief complaint of worsened right-sided calf pain for a month. On physical exam the patient was noticed to have an area of warmth, induration and palpable tenderness. Patient denied any other symptoms, and specifically denied fevers, chills, respiratory symptoms or trauma. Imaging studies on admission included a lower extremity ultrasound that showed the hematoma had increased in size to 9 cm from previous study 2 months prior. Lab studies to assess any acute hematologic cause of recurrent spontaneous hematoma were negative. The differential diagnosis on admission included a leg abscess; however the absence of fever, leukocytosis and loculations made it seem unlikely. A calf MRI performed 4 days later showed the collection had increased to 13 cm. It was complex but still compatible with hematoma, although superimposed infection could not be ruled out. At this point it was decided for the patient to undergo an ultrasound guided fluid aspiration for diagnostic and therapeutic purpose, given the patient's continuing pain and rate of growth. Fluid aspiration yielded 50 cc of pus. Broad spectrum antibiotics were started, and that evening the patient went to the operating room for an incision and drainage. The following day the wound culture grew a modified acid fast gram positive bacilli (by modified Kinyoun method) that immediately raised the concern for infection with nocardia speci...

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Lymphocutaneous type of nocardiosis caused by Nocardia brasiliensis: A case report and review of primary cutaneous nocardiosis caused by N. brasiliensis reported in Japan

Cited by 38 publications

References 4 publications

Nocardiosis: Updated Clinical Review and Experience at a Tertiary Center

Nocardiosis: Updated Clinical Review and Experience at a Tertiary Center

Primary Cutaneous Nocardiosis in a Patient With Nephrotic Syndrome

Primary Cutaneous Nocardiosis in a Heart Transplant Patient: A Case Report

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