Pulmonary Reinfection by &lt;i&gt;Nocardia&lt;/i&gt; in an Immunocompetent Patient with Bronchiectasis

Tamakoshi, Junko; Kimura, Risa; Takahashi, Kosuke; Saitô, Hiroshi

doi:10.2169/internalmedicine.0531-17

Cited by 5 publications

(3 citation statements)

References 16 publications

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“…Additionally, these isolates showed varying susceptibilities to different antibiotics. Different Nocardia species may have different susceptibility profiles, and this information is crucial for providing adequate antimicrobial therapy as well as investigating the epidemiology of Nocardia infections (Tamakoshi et al, 2018). When Nocardia is isolated from clinical specimens, the species should be identified.…”

Section: Discussionmentioning

confidence: 99%

Detection of Nocardia by 16S Ribosomal RNA Gene PCR and Metagenomic Next-Generation Sequencing (mNGS)

Ding

Wei

et al. 2022

Front. Cell. Infect. Microbiol.

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In this study, the aim was to investigate the discriminatory power of molecular diagnostics based on mNGS and traditional 16S ribosomal RNA PCR among Nocardia species. A total of fourteen clinical isolates from patients with positive Nocardia cultures and clinical evidence were included between January 2017 and June 2020 in HeNan Provincial People’s Hospital. DNA extraction and 16S rRNA PCR were performed on positive cultures, and pathogens were detected by mNGS in these same samples directly. Among the 14 Nocardia isolates, four species were identified, and N. cyriacigeorgica (8 cases) is the most common species. Twelve of the 14 Nocardia spp. isolates were identified by the two methods, while two strains of N. cyriacigeorgica were not identified by mNGS. All tested isolates showed susceptibility to trimethoprim-sulfamethoxazole (SXT), amikacin and linezolid. Apart from Nocardia species, other pathogens such as Acinetobacter baumannii, Klebsiella pneumonia, Aspergillus, Enterococcus faecalis, Human herpesvirus, etc., were detected from the same clinical samples by mNGS. However, these different pathogens were considered as colonization or contamination. We found that it is essential to accurately identify species for determining antibiotic sensitivity and, consequently, choosing antibiotic treatment. 16S rRNA PCR was useful for identification of nocardial infection among species, while this technique needs the clinicians to make the pre-considerations of nocardiosis. However, mNGS may be a putative tool for rapid and accurate detection and identification of Nocardia, beneficial for applications of antimicrobial drugs and timely adjustments of medication.

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Section: Discussionmentioning

confidence: 99%

Detection of Nocardia by 16S Ribosomal RNA Gene PCR and Metagenomic Next-Generation Sequencing (mNGS)

Ding

Wei

et al. 2022

Front. Cell. Infect. Microbiol.

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“…PN occurred in COPD and bronchiectasis patients without any other immunosuppressive factors. 12 PN in bronchiectasis or COPD might be related to the decrease of airway clearance and the local pulmonary immune function which leads to an increased chance of Nocardia colonization in the lower respiratory tract. 13 Patients with COPD and asthma need to inhale glucocorticoids frequently, and even use systemic glucocorticoids for a short time during acute attacks, which might increase the risk of PN.…”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Pulmonary Nocardiosis in Patients with Different Underlying Diseases: A Case Series Study

Zhong¹,

Huang²,

Zhan³

et al. 2022

IDR

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Objective To investigate the clinical features of pulmonary nocardiosis (PN) in patients with different underlying diseases. Methods Clinical, imaging, treatment and prognosis data from patients diagnosed with PN from July 2011 to June 2021 at the First Affiliated Hospital, Zhejiang University School of Medicine were collected and analyzed. According to different underlying diseases, patients were grouped into immunocompromised host (ICH) group and immunocompetent host (ICO) group, and clinical characteristics were compared between the two groups. Results There were 64 patients with PN, including 42 males, aged from 21 to 86 (57.1 ± 15.7) years. The most common clinical manifestations were cough, expectoration, fever. There were 41 cases in the ICH group and 23 cases in the ICO group. There were 11 cases with underlying pulmonary diseases in the ICH group, including 2 cases of bronchiectasis, 4 cases of chronic obstructive pulmonary disease (COPD), etc. There were 11 cases of underlying pulmonary basic diseases in ICO group, including 7 cases of bronchiectasis and COPD, 1 case of bronchiectasis, 1 case of COPD, etc. The proportion of patients with bronchiectasis and COPD in the ICO group was significantly higher (P < 0.05). Extrapulmonary nocardiosis infection occurred in 6 patients of the ICH group. During the period of hospitalization, 87.0% patients in ICO group received SMZ/TMP therapy, 73.2% of patients in ICH group received two drug combination therapy. In the ICH group, mortality at 28 days was 14.6% and 8.7% in the ICO group. Conclusion PN mainly occurred in ICH patients, but also occurred in the ICO cases to a lesser extent, especially in patients with bronchiectasis and/or COPD. Complicated with extrapulmonary infections mainly occurred in ICH population and combination of two antibiotics was often used in ICH group. The case fatality rates were 14.6% in ICH and 8.7% in ICO cases, respectively.

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“…[ 17 ] Nevertheless, antimicrobial susceptibility tests are essential since they may differ among Nocardia species. [ 16 , 17 ] In addition, some authors suggested that brain imaging should be considered in all patients with pulmonary nocardiosis. [ 2 ] Regarding the tools for species identification, 16S ribosomal RNA gene PCR is recommended as a feasible method since the test is rapid, inexpensive, and reliable.…”

Section: Discussionmentioning

confidence: 99%

A rare case of ruptured anterior cerebral artery infected aneurysm with angioinvasion secondary to disseminated Nocardia otitidiscaviarum: A case report and literature review

Duangprasert¹,

Kebboonkird²,

Ratanavinitkul³

et al. 2022

Surgical Neurology International

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Background: The cases of ruptured infected aneurysms secondary to disseminated nocardiosis are exceptionally rare. Therefore, there is no guideline for investigation or optimal treatment. Case Description: A 51-year-old man with immunocompromised status was first presented with pneumonia and cerebral infarction, where the infected aneurysm was ruptured thereafter. Intraoperative findings revealed left anterior cerebral artery thrombosis and occlusion with evidence of angioinvasion along with pus discharge which was later identified with Nocardia otitidiscaviarum. Our case was the first to report on the angioinvasive nature of cerebral nocardiosis, which occurs concurrently with a ruptured infected aneurysm and an unusual presentation that made the diagnosis and treatment challenging. Conclusion: Cerebral nocardiosis may cause ruptured infected aneurysms in patients with risk factors, especially for immunocompromised hosts. Furthermore, Nocardia can present with severe cerebral manifestation due to angioinvasion causing cerebral infarction accompanied by a ruptured infected aneurysm.

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Pulmonary Reinfection by <i>Nocardia</i> in an Immunocompetent Patient with Bronchiectasis

Cited by 5 publications

References 16 publications

Detection of Nocardia by 16S Ribosomal RNA Gene PCR and Metagenomic Next-Generation Sequencing (mNGS)

Detection of Nocardia by 16S Ribosomal RNA Gene PCR and Metagenomic Next-Generation Sequencing (mNGS)

Clinical Features of Pulmonary Nocardiosis in Patients with Different Underlying Diseases: A Case Series Study

A rare case of ruptured anterior cerebral artery infected aneurysm with angioinvasion secondary to disseminated Nocardia otitidiscaviarum: A case report and literature review

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