Recent experiences with nocardial infections

Rosett, Walter; Hodges, Glenn R.

doi:10.1097/00000441-197811000-00004

Cited by 69 publications

(39 citation statements)

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“…Several studies have shown that COPD is the disease most often treated with corticosteroid therapy [10,13,14]. Clinical features were similar to those in previous studies.…”

Section: S S S S S -S -Samikacin S -S S S -S -S S Imipenem S -S -S -Rsupporting

confidence: 83%

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Pulmonary infection with Nocardia species: a report of 10 cases and review

Menéndez

Cordero²,

Santos³

et al. 1997

Eur Respir J

175

109

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Pulmonary nocardiosis (PN) is an infrequent and severe infection due to Nocardia spp., microorganisms that may behave both as opportunists and as primary pathogens. The aim of this study and review was to evaluate the clinical features, evolution and prognostic factors of PN.The study group comprised 10 consecutive patients with pulmonary nocardiosis acquired in a community setting, diagnosed and followed in a tertiary teaching hospital.Chronic obstructive pulmonary disease (COPD), neoplastic disease and human immunodeficiency virus (HIV) infection were the most frequent predisposing factors. Four patients were receiving corticosteroid treatment. Clinical course was chronic and diagnosis was delayed 3 weeks or more in seven of the patients. Lobar or multilobar condensation was the most frequent radiographic pattern. Antimicrobial susceptibility testing showed: 100% sensitivity for amikacin; 83% for imipenem; 71% for cefotaxime; and 71% for trimethoprim-sulphamethoxazole. The disease remained localized in the lung in five cases, with a trend toward chronicity in one with bronchiectasis. In the other five, the disease disseminated, affecting subcutaneous tissue, the central nervous system and the kidney. Three patients died, one with disseminated disease and two who were receiving corticosteroid therapy.The following conclusions were reached: 1) pulmonary nocardiosis is difficult to diagnose, diagnosis is frequently delayed and a high level of suspicion is, thus, required in patients with underlying diseases or chronic corticosteroid therapy; 2) there is frequent dissemination and high mortality; and 3) antimicrobial combinations with proven synergy, such as imipenem and amikacin, are recommended for initial therapy. Eur Respir J 1997; 10: 1542-1546

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“…Several studies have shown that COPD is the disease most often treated with corticosteroid therapy [10,13,14]. Clinical features were similar to those in previous studies.…”

Section: S S S S S -S -Samikacin S -S S S -S -S S Imipenem S -S -S -Rsupporting

confidence: 83%

“…Respiratory colonization can occur, and in a compromised host it can progress to tissue invasion and dissemination [8,9]. ROSETT and HODGES [10] isolated Nocardia spp. from respiratory secretions in 36 patients, 19 of whom were free of disease.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary infection with Nocardia species: a report of 10 cases and review

Menéndez

Cordero²,

Santos³

et al. 1997

Eur Respir J

175

109

View full text Add to dashboard Cite

show abstract

“…Thus, when lesions are found at two or more locations within the body, the infection is defined as systemic or disseminated nocardiosis. Any anatomic location can be involved, but the most common sites that become infected during dissemination include the CNS, cutaneous and subcutaneous tissues, eyes (especially the retina), kidneys, joints, bone, and heart (22,26,36,51,105,107,122,135,144,149,156,159,176,191,218,220,251,253,254,260,263,304,352,375,391,392,423,454,459,466,478,479,503,520,522,525,538,540,566,569,585,589,601,631,708,719,731,734).…”

Section: Pulmonary Nocardiosismentioning

confidence: 99%

Nocardia species: host-parasite relationships

1994

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The nocardiae are bacteria belonging to the aerobic actinomycetes. They are an important part of the normal soil microflora worldwide. The type species, Nocardia asteroides, and N. brasiliensis, N. farcinica, N. otitidiscaviarum, N. nova, and N. transvalensis cause a variety of diseases in both normal and immunocompromised humans and animals. The mechanisms of pathogenesis are complex, not fully understood, and include the capacity to evade or neutralize the myriad microbicidal activities of the host. The relative virulence of N. asteroides correlates with the ability to inhibit phagosome-lysosome fusion in phagocytes; to neutralize phagosomal acidification; to detoxify the microbicidal products of oxidative metabolism; to modify phagocyte function; to grow within phagocytic cells; and to attach to, penetrate, and grow within host cells. Both activated macrophages and immunologically specific T lymphocytes constitute the major mechanisms for host resistance to nocardial infection, whereas B lymphocytes and humoral immunity do not appear to be as important in protecting the host. Thus, the nocardiae are facultative intracellular pathogens that can persist within the host, probably in a cryptic form (L-form), for life. Silent invasion of brain cells by some Nocardia strains can induce neurodegeneration in experimental animals; however, the role of nocardiae in neurodegenerative diseases in humans needs to be investigated.

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“…from the respiratory tract and skin, in addition to signs of sepsis in the patient, include direct visualization of the microorganism on a Gram-stained smear, pure or predominant growth in the culture, and repeated isolation from serial clinical samples (488).…”

Section: Epidemiologic Aspects Of Infection In Humansmentioning

confidence: 99%

The medically important aerobic actinomycetes: epidemiology and microbiology

1994

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The aerobic actinomycetes are soil-inhabiting microorganisms that occur worldwide. In 1888, Nocard first recognized the pathogenic potential of this group of microorganisms. Since then, several aerobic actinomycetes have been a major source of interest for the commercial drug industry and have proved to be extremely useful microorganisms for producing novel antimicrobial agents. They have also been well known as potential veterinary pathogens affecting many different animal species. The medically important aerobic actinomycetes may cause significant morbidity and mortality, in particular in highly susceptible severely immunocompromised patients, including transplant recipients and patients infected with human immunodeficiency virus. However, the diagnosis of these infections may be difficult, and effective antimicrobial therapy may be complicated by antimicrobial resistance. The taxonomy of these microorganisms has been problematic. In recent revisions of their classification, new pathogenic species have been recognized. The development of additional and more reliable diagnostic tests and of a standardized method for antimicrobial susceptibility testing and the application of molecular techniques for the diagnosis and subtyping of these microorganisms are needed to better diagnose and treat infected patients and to identify effective control measures for these unusual pathogens. We review the epidemiology and microbiology of the major medically important aerobic actinomycetes.

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Recent experiences with nocardial infections

Cited by 69 publications

References 0 publications

Pulmonary infection with Nocardia species: a report of 10 cases and review

Pulmonary infection with Nocardia species: a report of 10 cases and review

Nocardia species: host-parasite relationships

The medically important aerobic actinomycetes: epidemiology and microbiology

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