Rhodococcus equi causing bacteraemia and pneumonia in a pulmonary transplant patient

Rhodococcus equi pulmonary infection in a pancreas‐alone transplant recipient: consequence of intense immunosuppression

“…A total of 18 cases of R. equi infection in solid organ transplant recipients were identified by a literature search using Medline (1966–2000, all languages)(4–21). Ten of these cases were in renal transplant recipients (4–13), three liver transplant recipients (14–16), three heart transplant recipients (18–20), one lung transplant recipient (17), and one kidney‐pancreas transplant recipient (21).…”

“…A total of 18 cases of R. equi infection in solid organ transplant recipients were identified by a literature search using Medline (1966–2000, all languages)(4–21). Ten of these cases were in renal transplant recipients (4–13), three liver transplant recipients (14–16), three heart transplant recipients (18–20), one lung transplant recipient (17), and one kidney‐pancreas transplant recipient (21). Rhodococcus equi pneumonia was the most common clinical presentation (13/18, 72%), followed by vertebral infection (2/18, 10%), osteomyelitis (1/18, 6%), pericarditis (1/18, 6%) and subcutaneous abscess (1/18, 6%) (4–22).…”

“…Ten of these cases were in renal transplant recipients (4–13), three liver transplant recipients (14–16), three heart transplant recipients (18–20), one lung transplant recipient (17), and one kidney‐pancreas transplant recipient (21). Rhodococcus equi pneumonia was the most common clinical presentation (13/18, 72%), followed by vertebral infection (2/18, 10%), osteomyelitis (1/18, 6%), pericarditis (1/18, 6%) and subcutaneous abscess (1/18, 6%) (4–22). From the available data, 2 patients died (11%), 4 patients had relapse of the infection (22%), 11 patients had documented cure (61%), and the outcome of one patient (heart transplant recipient) was not reported.…”

“…The treatment of R. equi has not been well‐established and is based on case reports and antibiotic sensitivity testing. The antibiotics that have been used successfully in solid organ transplant patients with R. equi infection include vancomycin, ciprofloxacin, rifampin, macrolides (erythromycin, clarithromycin), ceftriaxone and imipenem/cilastatin (4–21). There is no evidence to suggest that anti‐ Pneumocystis prophylaxis with sulfamethoxazole/trimethoprim confers any protection against the development of R. equi infection.…”

“…Solid organ transplant recipients may be at risk for R. equi infection because of impaired cell‐mediated immunity owing to immunosuppression directed against T and B lymphocytes. Rhodococcus equi infection in renal, liver, heart, and kidney–pancreas transplant recipients has previously been reported (4–21). We report a case of a pancreas‐alone transplant recipient who developed R. equi pneumonia after receiving multiple courses of anti‐T lymphocyte therapy for the treatment of recurrent acute pancreas allograft rejection.…”