Purulent Pericarditis and Cardiac Tamponade Caused by &lt;i&gt;Nocardia farcinica&lt;/i&gt; in a Nephrotic Syndrome Patient

Sirijatuphat, Rujipas; Niltwat, Sorachat; Tiangtam, Orathai; Tungsubutra, Wiwun

doi:10.2169/internalmedicine.52.0453

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…Eleven sporadic glomerular disease cases with nocardiosis have ever been reported in the literature. All these eleven patients accepted immunosuppressive agents for kidney disease; pulmonary infection was the most common; 45% of patients accepted trimethoprim-sulfamethoxazole treatment; and only two patients died [31][32][33][34]. Here, we comprehensively reviewed the manifestations of and treatments for nocardiosis in 7 glomerular disease patients who received glucocorticoids alone or combined with immunosuppressive agents.…”

Section: Discussionmentioning

confidence: 99%

Nocardiosis in glomerular disease patients with immunosuppressive therapy

et al. 2020

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Background Glomerular disease patients have a high risk of infection, which contributes to the progression of disease per se and mortality, especially in those with long-term use of glucocorticoids and (or) immunosuppressive agents. Cases of sporadic nocardiosis have been reported in glomerular disease patients, and this observation was conducted to comprehensively understand the manifestations of and treatments for nocardiosis, which is commonly misdiagnosed as pneumonia or tuberculosis or even as lung cancer or metastatic tumors in glomerular disease patients. Methods We reviewed the demographic characteristics, laboratory abnormalities, radiological features, and treatments of 7 patients with nocardiosis and glomerular disease receiving steroids and immunosuppression therapy at the nephrology department of the Second Xiangya Hospital between 2012 and 2019. Results It was found that all 7 patients had been receiving methylprednisolone for renal disease at a median dose of 20 mg per day and a median duration of 4 months before developing nocardiosis. There were 4 males and 3 females, and the median age was 52.14 years. All 7 patients had hypoalbuminemia at the time of admission. In addition, various cystic abscesses in the subcutaneous tissue, with or without lung and brain involvement, were observed in these patients. Encouragingly, body temperatures returned to normal, and subcutaneous abscesses diminished or disappeared with compound sulfamethoxazole treatment alone or in combination with linezolid, imipenem and mezlocillin/sulbactam. Conclusions It was shown that multisite abscesses, including subcutaneous, pulmonary and cerebral abscesses, were the common manifestations of nocardiosis in glomerular disease patients. Sulfonamide was the first-line antibiotic therapy for nocardiosis, and combinations of other antibiotics were also needed in some serious cases.

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Section: Discussionmentioning

confidence: 99%

Nocardiosis in glomerular disease patients with immunosuppressive therapy

et al. 2020

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“…Pulmonary disease is the most common presentation of Nocardia in immunosuppressed patients and approximately one-third of affected patients have a disseminated disease ( Ambrosioni et al, 2010 ; Kandi, 2015 ; Scorey and Daniel, 2016 ). Infection of traumatic wounds produces chronic inflammation that may lead to fistulas, abscesses, cellulitis, ulcerations, and mycetoma ( Smego and Gallis, 1984 ; Salinas-Carmona, 2000 ; Salinas-Carmona et al, 2009 ), and may extend into muscles, bones, the brain, kidneys, the prostate, cornea, heart, and adjacent organs ( De Nardo et al, 2013 ; Sirijatuphat et al, 2013 ; Kumar et al, 2014 ; Park et al, 2014 ; Sharma and O’Hagan, 2016 ). Nocordia infection of the central nervous system may be acquired by cutaneous or respiratory routes ( Smego and Gallis, 1984 ; Beaman and Beaman, 1994 ; Inamadar and Palit, 2003 ; Zakaria et al, 2008 ; Chen et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Cloning, Expression, Invasion, and Immunological Reactivity of a Mammalian Cell Entry Protein Encoded by the mce1 Operon of Nocardia farcinica

Tan

Hou

et al. 2017

Front. Microbiol.

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Bacterial mammalian cell entry (Mce) proteins have been implicated in pathogen invasion of mammalian host cells. The aim of this study was to examine the invasion-conferring ability of mce1E operon-encoded proteins, in vivo expression of Mce1E in cells from infected mice and rabbits, and Mce1E immunogenicity. Nocardia farcinica mce1E was cloned into pet30a(+) vectors, expressed in Escherichia coli, and purified. Invasion assays, transmission electron microscopy (TEM), immunoblots, and enzyme-linked immunosorbent assay (ELISA) detection of cytokines were conducted. TEM confirmed the invasion of HeLa cells by Mce1E-coated beads. The antigenicity of E. coli-expressed recombinant Mce1E was confirmed in immunoblots with sera from N. farcinica-infected mouse and rabbit sera. Co-incubation of Mce1E with splenocytes of N. farcinica-infected mice demonstrated upregulation of interferon (IFN-γ), but not interleukin (IL)-4 or IL-10, in the cultural supernatant. These findings demonstrate that Mce1E may facilitate N. farcinica interactions with and invasion of mammalian cells. Notably, Mce1E are expressed and elicited antibody responses in mice and rabbits during infection. Besides, it may play a role in cell-mediated immune reactions and cause host inflammation responses to N. farcinica infection.

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“…Very rarely, Nocardia can lead to purulent pericarditis requiring surgical drainage [9]. There are several subspecies of Nocardia known to cause disease in humans; around 80% of respiratory infections and disseminated infections are caused by N. asteroides [5,8,10]. However, N. farcinica has a higher propensity for dissemination due to its higher virulence and proneness to antibiotic resistance [7,10].…”

Section: Discussionmentioning

confidence: 99%

“…Nocardiosis is rare and can present as acute bronchopneumonia, cutaneous pustules, or disseminated disease [2-3]. Nocardia pericarditis is very uncommon, with only a few documented cases due to Nocardia farcinica ( N. farcinica ) [4-5]. The majority of N. farcinica infections occur in immunocompromised patients [6-8].…”

Section: Introductionmentioning

confidence: 99%

A Rare Presentation of Nocardia pericarditis Leading to Cardiac Tamponade in an Immunocompetent Patient

Faircloth

Troy

2019

Cureus

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Nocardia can cause isolated disease in many parts of the body including the brain, skin, and lungs. It is also capable of causing disseminated disease. In almost all cases, Nocardia infections occur in immunocompromised hosts with depressed cell-mediated functions. We present a case of disseminated Nocardia farcinica leading to pericardial effusion and tamponade in an immunocompetent host with the only risk factor being heavy alcohol intake. Treatment relies on an accurate diagnosis. This case presentation highlights the importance of considering Nocardia infections in an alcoholic patient with a worsening clinical picture.

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Purulent Pericarditis and Cardiac Tamponade Caused by <i>Nocardia farcinica</i> in a Nephrotic Syndrome Patient

Cited by 7 publications

References 22 publications

Nocardiosis in glomerular disease patients with immunosuppressive therapy

Nocardiosis in glomerular disease patients with immunosuppressive therapy

Cloning, Expression, Invasion, and Immunological Reactivity of a Mammalian Cell Entry Protein Encoded by the mce1 Operon of Nocardia farcinica

A Rare Presentation of Nocardia pericarditis Leading to Cardiac Tamponade in an Immunocompetent Patient

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