Nocardiosis in patients with nephrotic syndrome: a retrospective analysis of 11 cases and a literature review

Guo, Juan; Li, Shijun; Xu, Shutian; Jiang, Ling; Gao, Erzhi; Liu, Zhihong

doi:10.1007/s11255-020-02415-z

Cited by 8 publications

(8 citation statements)

References 18 publications

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“…The laboratory test results were available in all 27 patients and showed that most patients had positive hs-CRP and approximately 20% of patients had positive PCT. Similarly, Guo et al reported that most patients with nocardiosis had an elevated CRP level, whereas PCT levels were normal or slightly elevated [28]. These results suggest some typical indicators of Nocardia infection and increasing PCT levels may indicate a severe infection.…”

Section: Discussionmentioning

confidence: 83%

Clinical Nocardia species: Identification, clinical characteristics, and antimicrobial susceptibility in Shandong, China

Qian

Mou

et al. 2020

Bosn J of Basic Med Sci

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Nocardia is a pathogen responsible for a variety of clinical infections. Here, we aimed to investigate the species distribution, clinical manifestations, and antimicrobial susceptibility of Nocardia species in two tertiary general hospitals over 3 years in China. In this retrospective study, a total of 27 Nocardia species were isolated from 27 individuals between January 2017 and December 2019. Nocardia isolates were identified to species level by mass spectrometry and 16S rRNA PCR sequencing. Clinical data were collected from medical records. Antimicrobial susceptibility was determined by standard Broth microdilution method. The 27 patients with Nocardia infection included 12 males and 15 females with a mean age of 60.11 years. Among 27 Nocardia isolates, 7 species were identified, with the most common species being N. otitidiscaviarum (40.7%). The antimicrobial susceptibility profiles varied between different Nocardia species. Notably, all Nocardia isolates were linezolid susceptible. Majority of Nocardia isolates were collected from a department of respiratory medicine (55.56%) and sputum specimen (44.44%). Pulmonary region was the most involved body site (70.37%), followed by skin (7.4%) and pleural cavity (7.4%). Most patients with Nocardia infection needed combination antibiotic therapy. Two deaths were reported during the treatment period and 24 patients achieved improvement after antibiotic therapy. The clinical manifestations of Nocardia infection and antimicrobial susceptibility profiles varied with diverse Nocardia species. Thus, the accurate identification of these species is crucial for the diagnosis and the selection of antibiotic treatment.

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Section: Discussionmentioning

confidence: 83%

Clinical Nocardia species: Identification, clinical characteristics, and antimicrobial susceptibility in Shandong, China

Qian

Mou

et al. 2020

Bosn J of Basic Med Sci

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“…Nocardia infection of the spinal cord is rare and is typical in this case. Subcutaneous, soft tissue is a common invasive site, and abscess is the main manifestation [ 20 ]. Pathological tissue can be easily obtained through ultrasound and puncture.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Nocardia farcinica involves the spinal cord: a case report and review of the literature

Zhang

et al. 2021

BMC Infect Dis

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Background Nocardia is a relatively rare opportunistic pathogenic bacteria group, commonly seen in patients with immunocompromised or defective immune system. It can affect multiple organs of the body and cause disseminated infection, among which most occurs in the lung, secondly in the nervous system, soft tissues, rare in the spinal cord and pituitary. No case has been reported involving lung, spinal cord, skin and pituitary gland at the same time. Case presentation We report a 55-year-old female with Nocardia infection involving the lung, skin, spinal cord, and pituitary gland. The patient underwent a full set of imaging examinations and showed typical imaging findings. Chest computed tomography (CT) showed multiple nodules with cavities in the lungs. The magnetic resonance imaging (MRI) of the vertebral body showed abnormal signal of the entire spinal cord with cavity formation and ring enhancement. The subcutaneous nodules of the abdomen were punctured under ultrasound. Through the etiological tissue culture of subcutaneous nodules and the second generation sequencing of cerebrospinal fluid, the diagnosis was finally confirmed. Conclusion Disseminated Nocardiosis is an uncommon disease. This article will report a rare case of disseminated Nocardiosis simultaneously involving the lung, spinal cord, subcutaneous soft tissue and pituitary gland, especially with neuropathy as the initial symptom. Imaging is helpful for the early diagnosis of the disease and pathological and microbiological examinations are helpful for its confirming.

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“…Nocardia infection in NS patients was first described in 1962 by Kerbel NC ( Kerbel, 1962 ). Only a few case reports of Nocardia infection in NS patients are available up to now, and the two latest single-center literature reviews were published in 2020 ( Guo et al., 2020 ; Han et al., 2020 ). However, there are hardly any multicenter retrospective reviews.…”

Section: Introductionmentioning

confidence: 99%

Nocardia Infection in Nephrotic Syndrome Patients: Three Case Studies and A Systematic Literature Review

Cheng

Wang

Yuan

et al. 2022

Front. Cell. Infect. Microbiol.

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ObjectiveThe multicenter literature review and case studies of 3 patients were undertaken to provide an updated understanding of nocardiosis, an opportunistic bacterial infection affecting immunosuppressed nephrotic syndrome (NS) patients receiving long-term glucocorticoid and immunosuppressant treatment. The results provided clinical and microbiological data to assist physicians in managing nocardiosis patients.MethodsThree cases between 2017 and 2018 from a single center were reported. Additionally, a systematic review of multicenter cases described in the NCBI PubMed, Web of Science, and Embase in English between January 1, 2001 and May 10, 2021 was conducted.ResultsThis study described three cases of Nocardia infection in NS patients. The systematic literature review identified 24 cases with sufficient individual patient data. A total of 27 cases extracted from the literature review showed that most patients were > 50 years of age and 70.4% were male. Furthermore, the glucocorticoid or corticosteroid mean dose was 30.9 ± 13.7 mg per day. The average time between hormone therapy and Nocardia infection was 8.5 ± 9.7 months. Pulmonary (85.2%) and skin (44.4%) infections were the most common manifestations in NS patients, with disseminated infections in 77.8% of patients. Nodule/masses and consolidations were the major radiological manifestations. Most patients showed elevated inflammatory biomarkers levels, including white blood cell counts, neutrophils percentage, and C-reactive protein. Twenty-five patients received trimethoprim-sulfamethoxazole monotherapy (18.5%) or trimethoprim-sulfamethoxazole-based multidrug therapy (74.1%), and the remaining two patients (7.4%) received biapenem monotherapy. All patients, except the two who were lost to follow-up, survived without relapse after antibiotic therapy.ConclusionsNephrotic syndrome patients are at high risk of Nocardia infection even if receiving low-dose glucocorticoid during the maintenance therapy. The most common manifestations of nocardiosis in NS patients include abnormal lungs revealing nodules and consolidations, skin and subcutaneous abscesses. The NS patients have a high rate of disseminated and cutaneous infections but a low mortality rate. Accurate and prompt microbiological diagnosis is critical for early treatment, besides the combination of appropriate antibiotic therapy and surgical drainage when needed for an improved prognosis.

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Nocardiosis in patients with nephrotic syndrome: a retrospective analysis of 11 cases and a literature review

Cited by 8 publications

References 18 publications

Clinical Nocardia species: Identification, clinical characteristics, and antimicrobial susceptibility in Shandong, China

Clinical Nocardia species: Identification, clinical characteristics, and antimicrobial susceptibility in Shandong, China

Disseminated Nocardia farcinica involves the spinal cord: a case report and review of the literature

Nocardia Infection in Nephrotic Syndrome Patients: Three Case Studies and A Systematic Literature Review

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