Nocardia farcinica lung infection in a patient with cystic fibrosis: a case report

Abstract

IntroductionRespiratory tract infections are the major causes of morbidity and mortality in patients with cystic fibrosis. Nocardia are rarely implicated in these infections and few reports of the involvement of this species are found in the literature.Case presentationWe describe a case of lung infection followed by chronic colonization of trimethoprim and sulfamethoxazole resistant Nocardia farcinica in a patient with cystic fibrosis. The chronic colonization of this uncommon bacterium in patients with cystic fibrosis was proved using a newly developed real-time polymerase chain reaction assay, which indicates that this bacterium, despite treatment, is difficult to eradicate.ConclusionOur case report confirms that this organism can be recovered in persons with cystic fibrosis. Its eradication is necessary especially if the patient is to undergo lung transplantation.

Pulmonary Nocardiosis Misdiagnosed as Tuberculosis

“…is opportunistic pathogens of immune compromised patients [9,10]. No source of infection could be detected in the current case as Nocardia are found in environment worldwide in fresh and salt water and soil type, dusts and fecal deposit of animal [11]. We report a case of pulmonary nocardiosis misdiagnosed initially as pulmonary tuberculosis because in most of the cases the chest radiogtraphy is pleomorphic and non-specific but consolidation and cavitary lesion are common [12,13], so the case was managed for along 15 months with anti T.B.…”

“…In study published by Bittar et al [11] showed Nocardia farcinica in a 15 year old Caucasian boy with cystic fibrosis.…”

A 58-Year-Old Female with Progressive Cough and Right Shoulder Pain

“…Finally, all isolates were susceptible to amikacin [10]. For patients with life-threatening infection, it seems prudent to initiate therapy with two or three drugs with the aim of switching to oral monotherapy when the patient's condition is stable and the results of in vitro studies are available [11]. …”

“…Combination therapy with imipenem and cefotaxime, amikacin and TMP/SMX, imipenem and TMP/SMX, amikacin and cefotaxime, or amikacin and imipenem was shown to be superior to single-agent therapy [11]. Some experts are of the opinion that combination of imipenem with amikacin should be started as the first-line therapy for cerebral and pulmonary nocardiosis [1].…”

A French multicentric study and review of pulmonary Nocardia spp. in cystic fibrosis patients

“…Similarly, a prolonged isolation of Nocardia in sputa must be taken into account and potentially treated despite stable clinical status. Finally, patients with particular clinical status (lung transplantation or strong immunosuppressive regimen or may be repeated corticoid treatment) must be treated because such conditions are known to induce nocardiosis [29].…”