Risk Factors, Clinical Characteristics, and Outcome of Nocardia Infection in Organ Transplant Recipients: A Matched Case-Control Study

Peleg, Anton Y.; Husain, Shahid; Qureshi, Zubair A.; Silveira, Fernanda P.; Sarumi, Molade; Shutt, Kathleen A.; Kwak, Eun Jeong; Paterson, David L.

doi:10.1086/514340

Cited by 354 publications

(413 citation statements)

References 32 publications

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“…The lung is the major organ primarily affected, accounting for 60-70 % of all human nocardiosis (Minero et al, 2009). Mortality due to nocardiosis ranges from 40 to 80 % depending on the immune status of the patient and intervention therapy (Knollmann et al, 2000;Martínez Tomás et al, 2007;Minero et al, 2009;Peleg et al, 2007;Zeidman et al, 1995). Nocardia spp.…”

Section: Discussionmentioning

confidence: 99%

Molecular identification of clinical Nocardia isolates from India

Rudramurthy

Honnavar

Kaur

et al. 2015

Journal of Medical Microbiology

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The epidemiology of nocardiosis is evolving with increasing number of Nocardia spp. causing human infection. In recent years, molecular techniques have been used to identify Nocardia spp. There are limited data available on the spectrum of Nocardia spp. isolated from clinical samples in India. Here, a molecular study was carried on 30 clinical isolates maintained in our National Culture Collection to evaluate the techniques used for identifying the agents. The isolates were identified by sequencing two promising genes: the 16S rRNA gene and hsp65. Both hsp65 and the 16S rRNA gene could reliably identify 90 % of Nocardia isolates, i.e. N. farcinica, N. cyriacigeorgica, N. brasiliensis, N. otitidiscaviarum, N. amamiensis and N. pneumoniae. The mean percentage dissimilarity of sequence identification was higher using the hsp65 gene (4 %, range 0-7.9 %) compared with the 16S rRNA gene (2.3 %, range 0-8.9 %). Two isolates that showed ambiguous results in both the short segment of the 16S rRNA gene and hsp65 sequences could be resolved by sequencing a larger fragment (,1000 bp) of the 16S rRNA gene. Both of these isolates were identified as N. beijingensis with similarities of 99.8 and 100 % compared with the standard strain. Genotyping of N. cyriacigeorgica strains was performed using hsp65 gene sequences and compared with previously described genotypes. Our N. cyriacigeorgica isolates belonged to genotype 1 (n54) and genotype 2 (n52). The present study highlights a wide spectrum of Nocardia spp. in India and emphasizes the need for molecular techniques for identification to the species level.

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Section: Discussionmentioning

confidence: 99%

Molecular identification of clinical Nocardia isolates from India

Rudramurthy

Honnavar

Kaur

et al. 2015

Journal of Medical Microbiology

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“…A higher incidence of vascular and hepatic artery thrombosis has also been reported in a few studies of li ver transplant recipients with CMV disease, and this effect is postulated to result from infection of the vascular endothelial cells [18,19] . The immunomodulatory effects of CMV have been suggested to account for a higher predis position to develop infections due to other opportunistic infections including fungi, other viruses, and bacteria such as Nocardia sp [20,21] . CMVinfected transplant recipients are also more likely to develop EpsteinBarr virus associated posttransplant lymphoproliferative disorders (PTLD), or develop coinfections with other viruses such as the human herpesviruses HHV6 and HHV7 [20,22] .…”

Section: Indirect CMV Effectsmentioning

confidence: 99%

Current concepts on cytomegalovirus infection after liver transplantation

Lee

Razonable

2010

WJH

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Cytomegalovirus (CMV) is the most common viral pathogen that negatively impacts on the outcome of liver transplantation. CMV cause febrile illness often accompanied by bone marrow suppression, and in some cases, invades tissues including the transplanted allograft. In addition, CMV has been significantly asso ciated with an increased predisposition to allograft rejection, accelerated hepatitis C recurrence, and other opportunistic infections, as well as reduced overall pa tient and allograft survival. To negate the adverse effects of CMV on outcome, its prevention, whether through antiviral prophylaxis or preemptive therapy, is regarded as an essential component to the medical management of liver transplant patients. Two recent guidelines have suggested that antiviral prophylaxis or preemptive therapy are similarly effective in preventing CMV disease in modest-risk CMV-seropositive liver trans plant recipients, while antiviral prophylaxis is the preferred strategy over preemptive therapy for the preven tion of CMV disease in high-risk recipients [CMV-seronegative recipients of liver allografts from CMV-seropositive donors (D+/R-)]. However, antiviral prophylaxis has only delayed the onset of CMV disease in many CMV D+/R-liver transplant recipients, and at least in one study, such occurrence of late-onset primary CMV disease was significantly associated with increased mortality after liver transplantation. Therefore, optimized strategies for prevention are needed, and aggressive treatment of CMV infection and disease should be pursued. The standard treatment of CMV disease consists of intravenous ganciclovir or oral valganciclovir, and if feasible, one should also reduce the degree of immunosuppression. In one recent controlled clinical trial, val ganciclovir was found to be as effective and safe as intravenous ganciclovir for the treatment of mild to mo derate CMV disease in solid organ (including liver) tran splant recipients. In this article, the authors review the current state and the future perspectives of prevention and treatment of CMV disease after liver transplantation.

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“…The risk of Nocardia infection is significantly increased in immunocompromised patients, and GC are an independent risk factor for nocardiosis (28,29). Lung infections caused by Nocardia can manifest as single or multiple lung nodules, reticulonodular infiltrates, lobar consolidations with or without cavitation, and pleural effusions (30,31).…”

Section: Discussionmentioning

confidence: 99%