Pulmonary Nocardiosis with Aspergillosis in a patient with COPD: A rare co-infection

Meena, Durga Shankar; Kumar, Deepak; Garg, Mahendra Kumar; Yadav, Prakrati; Sharma, Anuradha; Abhishek, Kumar S; Garg, Pawan Kumar; Pamnani, Jaya

doi:10.1016/j.idcr.2020.e00766

Cited by 9 publications

(6 citation statements)

References 15 publications

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“…Limited studies have been reported from India regarding pulmonary nocardiosis, and most of them are case reports [1,3,8,[15][16][17][18][19]. From the western part of India, these only a few cases have been reported [20][21]. This study primarily focuses on clinical and radiological features of pulmonary nocardiosis to increase awareness in community clinicians.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features, Radiological Findings, and Treatment Outcomes in Patients with Pulmonary Nocardiosis: A Retrospective Analysis

Yadav¹,

Kumar²,

Meena³

et al. 2021

Cureus

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IntroductionLack of specific clinical features makes the diagnosis of pulmonary nocardiosis difficult. A high index of suspicion is required for diagnosis especially in cohorts with pre-existing risk factors. This study aimed to study the clinical and radiological characteristics and outcomes in patients with pulmonary nocardiosis. MethodsThis was a retrospective observational study. Data of confirmed cases with pulmonary nocardiosis were collected from a digital patient management system. ResultsA total of eight cases of pulmonary nocardiosis were included. The mean age of patients was 50 ± 14.3 years with a female preponderance (62.5%). The most common co-morbidity was chronic lung disease (37.5%). The common clinical feature of pulmonary nocardiosis was cough with expectoration (50%) and the mean duration of symptoms was 18 days. The common radiological (CT thorax) findings were consolidation, bronchiectasis, mediastinal lymphadenopathy, and nodularity (50% each). One patient had an extension of pulmonary disease in the chest wall. Microbiological detection of Nocardia spp. was done in sputum samples (50%) and in bronchoalveolar lavage (BAL) samples (50%). Culture was positive in two BAL samples. Intravenous empirical antibiotics in combination with oral trimethoprim-sulfamethoxazole double standard (15 mg/kg trimethoprim) were started at the time of diagnosis. Ceftriaxone and amikacin were commonly used antimicrobials. ConclusionNocardia spp. commonly causes disease in patients with pre-existing chronic disease. A high index of suspicion is required in patients with subacute to chronic respiratory symptoms, raised inflammatory markers, and the absence of common respiratory pathogens in evaluation.

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Section: Discussionmentioning

confidence: 99%

Clinical Features, Radiological Findings, and Treatment Outcomes in Patients with Pulmonary Nocardiosis: A Retrospective Analysis

Yadav¹,

Kumar²,

Meena³

et al. 2021

Cureus

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“…Meena et al reported a case of pulmonary tuberculosis complicated by Nocardia infection in a 46-year-old woman with COPD. This infection can be easily misdiagnosed because the clinical features are non-specific, and all pathogens are difficult to culture ( 7 ). However, there is no relevant literature report on mixed pulmonary infection of Nocardia, M. tuberculosis , Aspergillus, and cytomegalovirus infection in China and abroad.…”

Section: Discussionmentioning

confidence: 99%

“…As an emerging pathogen diagnostic method, mNGS has excelled in the clinical diagnosis of a variety of infectious diseases. It has an ability to detect pathogens in samples This infection can be easily misdiagnosed because the clinical features are non-specific, and all pathogens are difficult to culture (7). However, there is no relevant literature report on mixed pulmonary infection of Nocardia, M. tuberculosis, Aspergillus, and cytomegalovirus infection in China and abroad.…”

Section: Discussionmentioning

confidence: 99%

A case report on mixed pulmonary infection of Nocardia nova, Mycobacterium tuberculosis, and Aspergillus fumigatus based on metagenomic next-generation sequencing

HaiMing

Han³

et al. 2022

Front. Public Health

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BackgroundPulmonary infection is one of the common complications of long-term use of glucocorticoids. Severe infections not only increase the length of hospital stay and treatment costs but also cause progression or recurrence of the primary disease.Case descriptionHerein, we reported a case of mixed pulmonary infection secondary to glucocorticoid use. Rare pathogens such as Nocardia nova, Mycobacterium tuberculosis, Aspergillus fumigatus, and cytomegalovirus were detected by metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid and lung puncture tissue. Combining the results of conventional pathogen detection and clinical symptoms, the patient was diagnosed with mixed pulmonary infection by multiple pathogens. After timely targeted medication, the patient was finally discharged with a good prognosis.ConclusionTo our knowledge, this is the first case report on mixed pulmonary infection with pathogens including Nocardia nova, Mycobacterium tuberculosis, Aspergillus fumigatus, and human cytomegalovirus. As a new clinical diagnostic method, mNGS has great advantages in diagnosis of diseases such as mixed infections.

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“…[1][2]12 Meanwhile, co-infection with Nocardia farcinica and Aspergillus flavus in the lung is rare, severe and even fatal. [13][14][15] Furthermore, physicians have relatively insufficient experience in its treatment. 10 Thus, early diagnosis and appropriate antibiotic therapy are necessary for a favorable prognosis.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Nocardiosis with Pulmonary Fungus and Secondary Epilepsy: A Case Report

Wu¹,

Liu²

2022

IDR

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Disseminated nocardiosis is a rare, life-threatening disease that usually found in immunocompromised patients, and Nocardia farcinica is one of the most common causative pathogens. The difficulty in identifying the bacterium and the delay in initiating appropriate therapy often influence the prognosis of patients with disseminated nocardiosis. Here, we present a rare case of disseminated nocardiosis in a 61-year-old female with pulmonary fungus and secondary epilepsy. She received targeted antibiotic therapy and showed a great recovery in clinical symptoms and radiological signs. Disseminated nocardiosis can be easily overlooked due to the absence of characteristic symptoms and limitations of clinical examinations. Given the variability in antibiotic susceptibility patterns, the management of disseminated nocardiosis must be individualized. Therefore, early diagnosis and targeted antibiotic treatment are critical for the prognosis of disseminated nocardiosis.

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Pulmonary Nocardiosis with Aspergillosis in a patient with COPD: A rare co-infection

Cited by 9 publications

References 15 publications

Clinical Features, Radiological Findings, and Treatment Outcomes in Patients with Pulmonary Nocardiosis: A Retrospective Analysis

Clinical Features, Radiological Findings, and Treatment Outcomes in Patients with Pulmonary Nocardiosis: A Retrospective Analysis

A case report on mixed pulmonary infection of Nocardia nova, Mycobacterium tuberculosis, and Aspergillus fumigatus based on metagenomic next-generation sequencing

Disseminated Nocardiosis with Pulmonary Fungus and Secondary Epilepsy: A Case Report

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