Nocardia elegans infection: a case report and literature review

Abstract

A case of disseminated nocardiosis caused by Nocardia elegans in a 72-year-old man with rheumatoid arthritis, treated with tacrolimus and prednisolone, is reported herein. The patient had impaired vision and was diagnosed with endophthalmitis and an abdominal skin abscess. He was started on trimethoprim-sulfamethoxazole treatment, followed by cefepime. The patient was then switched to a combination of imipenem-cilastatin and minocycline. Although the patient survived as a result of surgery and prolonged antibiotic treatment, he eventually lost vision after the infection became resistant to antibiotic treatment. Molecular analysis of samples from the abscess and vitreous fluid confirmed the extremely rare pathogen N. elegans, which accounts for only 0.3-0.6% of infections caused by Nocardia species. This organism is almost always associated with pulmonary infection, and disseminated infections are rare. As with previously reported norcardial infections, the current case was treated successfully with trimethoprim-sulfamethoxazole, carbapenems, and aminoglycosides. However, the clinical characteristics of this organism remain unclear. Further studies are therefore required to develop more effective treatment protocols for disseminated nocardiosis caused by this problematic pathogen.

Fulminant Nocardiosis Due to a Multidrug-Resistant Isolate in a 12-Year-Old Immunocompetent Child

“…N africana was discovered in 2001 in Sudan in 8 patients with lung disease, 27 and N elegans has been isolated in sputum, skin abscess, and vitreous fluid. 28,29 The species found here is also close to N aobensis, which was discovered in Japan in 2004 from 5 pulmonary isolates. 30 In this case report, we highlight that empirical treatment strategy can be inactive because of antimicrobial resistance.…”

“…Our strain showed a drug resistance pattern similar to N elegans and N aobensis. 29,30 However, unlike N aobensis and N elegans, our strain was resistant to all β-lactams, aminoglycosides, and quinolones except for moxifloxacin, which represents a characteristic feature of our strain. The strain was susceptible only to sulfamethoxazole/trimethoprim, linezolid, tigecyclin, and moxifloxacin.…”

Specificity Influences in (1→3)-β-d-Glucan-Supported Diagnosis of Invasive Fungal Disease

“…In contrast to bacterial species not observed to directly produce BDG, circulating BDG derived from invasive Nocardia infections has been definitively demonstrated in a series of independent case reports. Elevated BDG titers were reported in infections caused by multiple species of Nocardia including N.abscessus, N. elegans, N. farcinica, and N. nova [110,111]. Additional evaluation to verify the presence of BDG involving the culturing of clinical isolates of N. asteroides, N. neocalidoniensis, and N. cyriacgeorgica, as well as the control species Staphylococcus aureus and Escherichia coli, and the semi-purification of the post-growth culture broth supernatants was conducted.…”

The Role of Systemic Antimicrobials in the Treatment of Endophthalmitis: A Review and an International Perspective

“…This agent does achieve therapeutic levels in the vitreous following oral administration [1]. Oral administration of trimethoprim-sulfamethoxazole as adjunctive therapy has been reported in the treatment of endogenous endophthalmitis with subretinal abscess due to Nocardia [23,24], MRSA [25], and other organisms. Risks associated with trimethoprim-sulfamethoxazole include nausea, vomiting, peripheral neuritis, Stevens-Johnson syndrome, and toxic epidermal necrolysis.…”