Pulmonary nocardiosis and scrub typhus in an immunocompromised host

Princess, Isabella; Ebenezer, Roy; Ramakrishnan, Nagarajan; Nandini, S

doi:10.4103/jgid.jgid_105_17

Cited by 6 publications

(8 citation statements)

References 16 publications

(21 reference statements)

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“…It has been previously reported that 15% of scrub typhus cases had coinfection with other diseases [53]. Identifying coinfections is an important challenge for clinicians, as some are treatable diseases such as influenza, malaria, leptospirosis, typhoid or melioidosis [54][55][56][57][58][59][60][61][62][63]. Others have described severe manifestation in scrub typhus co-infected with dengue and other viral infections [64][65][66][67][68].…”

Section: Discussionmentioning

confidence: 99%

Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives

et al. 2021

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Scrub typhus is a neglected tropical disease predominantly occurring in Asia. The causative agent is a bacterium transmitted by the larval stage of mites found in rural vegetation in endemic regions. Cases of scrub typhus frequently present as acute undifferentiated febrile illness, and without early diagnosis and treatment, the disease can develop fatal complications. We retrospectively reviewed de-identified data from a 23-year-old woman who presented to an emergency department with complaints of worsening abdominal pain. On presentation, she appeared jaundiced and toxic-looking. Other positive findings on abdominal examination were a positive Murphey’s sign, abdominal guarding and hepatosplenomegaly. Magnetic resonance cholangiopancreatography demonstrated acalculous cholecystitis. Additional findings included eschar on the medial aspect of the left thigh with inguinal regional lymphadenopathy. Further, positive results were obtained for immunoglobulins M and G, confirming scrub typhus. The workup for other infectious causes of acute acalculous cholecystitis (AAC) detected antibodies against human herpesvirus 4 (Epstein–Barr virus), suggesting an alternative cause of AAC. Whether that represented re-activation of the Epstein–Barr virus could not be determined. As other reports have described acute acalculous cholecystitis in adult scrub typhus patients, we recommend doxycycline to treat acute acalculous cholecystitis in endemic regions while awaiting serological confirmation.

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Section: Discussionmentioning

confidence: 99%

Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives

et al. 2021

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…The median age at the time of presentation was 58 years (range 14-85 years). Nine of the twenty-three reported cases had associated chronic pulmonary diseases including bronchial asthma, chronic obstructive pulmonary disease (COPD), tuberculosis at the time of infection [19,20,23,25,29,30,31,37]. Thirteen of these twenty-three cases were reported in immunocompromised patients.…”

Section: Discussionmentioning

confidence: 99%

“…Thirteen of these twenty-three cases were reported in immunocompromised patients. Corticosteroid therapy was identified as a risk factor for N. otitidiscaviarum in seven of the thirteen immunocompromised cases [19,20,23,26,28,29,31]. In the other six reports, post-renal transplant [10], Cushing's disease [33], HIV-AIDS (acquired immunodeficiency syndrome) [34,37] and rheumatic heart disease [29] were identified as the cause of immunodeficiency.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Saksena

Rynga

Rajan

et al. 2020

J Infect Dev Ctries

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Introduction: Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients. Methodology: Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France). Conclusion: Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically ill patients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis.

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Disseminated life threatening Nocardia otitidiscaviarum infection in a young female with newly diagnosed systemic lupus erythematosus, case report and review of literature

Parengal

Alebbi

Hamed

et al. 2021

IDCases

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Infection due to Nocardia is reported mainly in immunocompromised patients. It usually presents as a pulmonary or disseminated disease with a predilection for the brain. Infections are a rare etiology of intracranial vascular aneurysms. Herein we report a case of disseminated Nocardia otitidiscaviarum ( N . otitidiscaviarum ) in a young female newly diagnosed with systemic lupus erythematosus (SLE) complicated by the development of an infectious intracranial aneurysm. To the best of our knowledge this is the fourth case of nocardial infection-related intracranial aneurysm and the second case of N. otitidiscaviarum infection to be reported in a patient with systemic lupus erythematosus. Features of previously reported N. otitidiscaviarum related intracranial aneurysm are reviewed.

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Pulmonary nocardiosis and scrub typhus in an immunocompromised host

Cited by 6 publications

References 16 publications

Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives

Acalculous Cholecystitis in a Young Adult with Scrub Typhus: A Case Report and Epidemiology of Scrub Typhus in the Maldives

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

Disseminated life threatening Nocardia otitidiscaviarum infection in a young female with newly diagnosed systemic lupus erythematosus, case report and review of literature

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