Pleuropulmonary nocardiosis due to Nocardia otitidiscaviarum in a debilitated host

Abstract

Nocardia otitidiscaviarum is a rare cause of pulmonary nocardiosis. We present a case of pulmonary nocardiosis with pleural involvement in an adolescent with rheumatic heart disease and congestive cardiac failure presenting with right lower lobe consolidation and pleural effusion. Direct gram-stain of pleural fluid showed pus cells with Gram-positive filamentous branching bacilli. Empiric treatment with parenteral ceftriaxone and supportive therapy for cardiac failure was initiated. Pleural fluid culture yielded growth of N. otitidiscaviarum at 72 h. Antibiotic susceptibility testing showed resistance to cephalosporins. The patient expired due to congestive cardiac failure on the 5th day.

A case report: Nocardia otitidiscaviarum bacteraemia in a patient with metastatic lung adenocarcinoma

“…Infection by N.otitidiscaviarum is rare compared with other species of Nocardia and rarely causes infection in humans, even in immunocompromised patients. [20][21][22] An attempt should be made to perform the antimicrobial susceptibility for each isolate too. N.otitidiscaviarum tends to be resistant to trimethoprim-sulfamethoxazole, but it is usually sensitive to amikacin and minocycline.…”

Fatal pulmonary infection by trimethoprim-sulfamethoxazole resistant Nocardia otitidiscaviarum: report of two cases and review

“…The Pubmed and Google scholar database was searched with 'Nocardia otitidiscaviarum', 'lung infection', 'pulmonary' and 'pneumonia' and 23 cases have been reported [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], which are presented in Table 3. Sixteen cases were male and seven were female patients.…”

“…Both patients had normal renal and liver functions. Most cases of N. otitidiscaviarum recover after long term treatment (6-12 months) but there have been reports of mortality especially in case of severe and disseminated disease [19,20,22,24,29]. Only five of the fifteen pulmonary cases reviewed were fatal including four patients who were immunocompromised.…”