Nocardiosis in renal transplant recipients in Kuwait

Abstract

The study stresses a high index of suspicion for nocardiosis in susceptible hosts who present with cutaneous abscess, pulmonary infiltrative lesions, and cerebral manifestations. TMP-SMX in combination with cefuroxime seems to be a highly effective therapy. It does not appear mandatory to reduce or discontinue immunosuppressive therapy during treatment of nocardiosis.

Successful Long-Term Treatment with Linezolid for Disseminated Infection with Multiresistant Nocardia farcinica

“…As in other cases of nocardiosis described in the literature, our transplant patient received intense immunosuppressive treatment and showed a pleural, pericardial, and CNS involvement consistent with a disseminated infection [5,[6][7][8][9]. Treatment with high-dose steroids, a history of cytomegalovirus disease, and high levels of calcineurin inhibitors have all been identified as independent risk factors for Nocardia infection in organ transplant recipients [1].…”

Neurologic Presentations of Renal Diseases

“…20,77,114,115 Opportunistic infections caused by bacteria and mycobacteria such as Nocardia asteroids, Listeria monocytogenes, Mycobacterium tuberculosis, or fungi such as Cryptococcus neoformans, Aspergillus fumigatus, or Paracoccidioides cause meningitis, encephalitis, myelitis, or brain abscess. 7,19 Protozoa infection by Toxoplasma gondii and Trypanosoma cruzi (Chagas disease) may cause meningoencephalitis. 116,117 JC virus causes progressive multifocal leukoencephalopathy (dementia, ataxia, visual and focal deficits, and maybe vegetative state).…”

“…b-Lactams structurally resemble bicuculline, an epileptogenic g-aminobutyric acid antagonist. 3,[18][19][20] …”

Opportunistic infections (noncytomegalovirus) in live related renal transplant recipients

“…[17] Different nocardia species have been associated with human disease. Nocardia was diagnosed in 6 of 513 (1.2%) renal transplant recipients in Kuwait;[18] comorbid conditions were diabetes mellitus in three patients, viral hepatitis in two patients, neutropenia in one patient. Five patients responded well during treatment with trimethoprim-sulfamethoxazole alone or in combination with cefuroxime.…”

“…Five patients responded well during treatment with trimethoprim-sulfamethoxazole alone or in combination with cefuroxime. [18] Imipenem, ceftrioxone, cefotaxime, meropenem, amikacin, minocycline, ampiccillin, and amoxicillin or clavulonicacid have been shown to be efficacious alone or in combination with trimethoprim + sulfamethoxazole. Cerebral abscess, if not responsive to antimicrobial therapy, should be treated surgically.…”