Nocardia in Solid Organ Transplant Recipients

Clark, Nina M.

doi:10.1111/j.1600-6143.2009.02896.x

Cited by 39 publications

(44 citation statements)

References 112 publications

(338 reference statements)

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“…In patients with pulmonary disease or CNS dissemination, a second parenteral antimicrobial (usually amikacin or imipenem) is typically added to TMP-SMX, and treatment is extended to 12 months or longer. 6,7 Prophylaxis with TMP-SMX, which is usually prescribed to prevent Pneumocystis jirovecii in susceptible hosts, also reduces the incidence of Nocardia. 2,3,6 Nocardia's restricted susceptibility pattern presents a challenge for hospitalists, as TMP-SMX and aminoglycosides are rarely administered empirically for cases of suspected pneumonia or atypical pulmonary infections (other than P. jirovecii).…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Prophylaxis with TMP-SMX, which is usually prescribed to prevent Pneumocystis jirovecii in susceptible hosts, also reduces the incidence of Nocardia. 2,3,6 Nocardia's restricted susceptibility pattern presents a challenge for hospitalists, as TMP-SMX and aminoglycosides are rarely administered empirically for cases of suspected pneumonia or atypical pulmonary infections (other than P. jirovecii). When confronted with the pattern of simultaneous pulmonary and CNS lesions, hospitalists must consider infections (lung abscess, mycobacteria, fungi, Nocardia), malignancies, and autoimmune conditions (sarcoidosis, Wegener's granulomatosis).…”

Section: Discussionmentioning

confidence: 99%

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Overcome by weakness

Krassner

Dhaliwal

Baudendistel

2012

Journal of Hospital Medicine

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Overcome by weakness

Krassner

Dhaliwal

Baudendistel

2012

Journal of Hospital Medicine

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“…can cause severe infections in patients with CGD, usually in the lungs (4). Pulmonary nocardiosis can be either acute or chronic or both (2). Radiographic findings include infiltrates, nodules, cavities, and empyema (2, 4).…”

Section: Case Reportmentioning

confidence: 99%

Imipenem-Resistant Nocardia cyriacigeorgica Infection in a Child with Chronic Granulomatous Disease

Hagerman¹,

Rodríguez-Nava²,

Boiron³

et al. 2011

J Clin Microbiol

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Nocardia spp. can lead to local or disseminated infections, especially in immunocompromised patients. Combination therapy of amikacin and imipenem is commonly used to treat severe nocardial infections. We describe a patient with imipenem-resistant Nocardia cyriacigeorgica, which, to our knowledge, has not been previously reported among isolates of this species. CASE REPORTA 9-year-old boy with an X-linked chronic granulomatous disease (CGD) was admitted in our hospital after a 5-day history of fever (Ͼ39°C), cough, rhinorrhea, vomiting, and loose stools, as well as macroscopic hematuria. His primary care physician had prescribed empirically amoxicillin-clavulanate 3 days prior to admission after finding mildly elevated leukocytosis (17.3 ϫG/liter) and a serum C-reactive protein (CRP) level of 158 mg/liter. The patient had a negative rapid streptococcal test of the throat and a urinalysis showing hematuria and proteinuria. A urine culture was negative. A possible glomerulonephritis without edema or hypertension was suspected, and he was admitted.He had received an allogeneic bone marrow transplantation from his sister at the age of 1 year, with a neutrophil activity of 7% (NADPH oxidase) 2 years prior. Despite this, he never had a serious infection. He was prescribed routine trimethoprimsulfamethoxazole and itraconazole prophylaxis at least 6 months prior to this episode, but his parents admitted bad compliance.On admission, the physical examination revealed that the child was not septic but was febrile at 38.8°C, with a normal physical exam. His white blood cell count was 12.4 ϫG/liter, with 75.5% segmented and 9% nonsegmented neutrophils, hemoglobin at 12.6 mg/dl, platelets at 301,000/mm 3 , CRP at 97 mg/liter, procalcitonin at 0.58 g/liter, and an erythrocyte sedimentation rate of 103 mm/h. Proteinuria was confirmed, with microscopic hematuria and normal glomerular filtration rate. Abdominal ultrasonography was compatible with acute glomerulonephritis. The pediatric nephrologists concluded that this child had a glomerulonephritis of unknown etiology, with a subsequent spontaneous resolution of the proteinuria. Because of the persistent fever in an immunocompromised patient, a chest radiography and computer tomography (CT) scan were requested and showed an opacity in the upper left lobe of the lung. A bronchoalveolar lavage (BAL) was performed, and while the microbiological results were being awaited, an empirical treatment with intravenous amoxicillin-clavulanate was started on hospital day 1. Because of persisting fever, intravenous antibiotics were changed on day 2 to intravenous imipenem (100 mg/kg of body weight/day) and trimethoprim-sulfamethoxazole (15 mg/kg/day of trimethoprim) to cover broadly opportunistic microorganisms. Voriconazole was added on day 3. He rapidly improved clinically after that day.Routine cultures, including those for fungal, viral, and mycobacterial organisms, in the BAL fluid were initially negative. PCR in the BAL fluid for multiple respiratory virus (including adenovirus, entero...

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“…1,3 The best antibiotic therapy has not been well established. Conventional regimens include trimethoprimsulfamethoxazole (TMP-SMX), amikacin, imipenem, cephalosporin, minocycline and so on, but the prognosis remains depressing.…”

mentioning

confidence: 99%

“…Conventional regimens include trimethoprimsulfamethoxazole (TMP-SMX), amikacin, imipenem, cephalosporin, minocycline and so on, but the prognosis remains depressing. 1,3,4 Linezolid has emerged as an attractive drug for Nocardia infection in recent years, but the efficacy, feasibility and safety of linezolid treatment has not been well discussed.…”

mentioning

confidence: 99%

Successful treatment of pulmonary Nocardia farcinica infection with linezolid: case report and literature review

Shen¹,

Wu²,

Geng³

et al. 2011

Braz J Infect Dis

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Nocardia infection is rare but potentially fatal. Therapy of Nocardia infection remains difficult. Linezolid, a novel oxazolidinone antibiotic, has proven to be effective, but clinical data are limited. Here we describe a case of a 45-year-old man with pulmonary N. farcinica infection following a liver transplantation. The initial therapy was trimethoprim-sulfamethoxazole, which showed no effect. According to susceptibility test, linezolid was administered with clearly improving the patient's condition. The treatment was stopped for anemia as drug related adverse event, and the therapy lasted for as long as 5 months. At the end of treatment clinical cure was confirmed and anemia reversed after discontinuation of linezolid. We also analyzed the clinical data of previously published reports by literature review, focusing on the efficacy and safety of linezolid treatment for Nocardia infection.

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Nocardia in Solid Organ Transplant Recipients

Cited by 39 publications

References 112 publications

Overcome by weakness

Overcome by weakness

Imipenem-Resistant Nocardia cyriacigeorgica Infection in a Child with Chronic Granulomatous Disease

Successful treatment of pulmonary Nocardia farcinica infection with linezolid: case report and literature review

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