Successful treatment of pulmonary Nocardia farcinica infection with linezolid: case report and literature review

Abstract

Nocardia infection is rare but potentially fatal. Therapy of Nocardia infection remains difficult. Linezolid, a novel oxazolidinone antibiotic, has proven to be effective, but clinical data are limited. Here we describe a case of a 45-year-old man with pulmonary N. farcinica infection following a liver transplantation. The initial therapy was trimethoprim-sulfamethoxazole, which showed no effect. According to susceptibility test, linezolid was administered with clearly improving the patient's condition. The treatment was stopped for anemia as drug related adverse event, and the therapy lasted for as long as 5 months. At the end of treatment clinical cure was confirmed and anemia reversed after discontinuation of linezolid. We also analyzed the clinical data of previously published reports by literature review, focusing on the efficacy and safety of linezolid treatment for Nocardia infection.

Efficacy and Safety of Linezolid in Treating Gram-Positive Bacterial Infection in the Elderly: A Retrospective Study

“…Therefore, the cross-resistance between linezolid and other protein synthesis inhibitors is very uncommon, and linezolid induced drug resistance in bacteria is seldom reported. Consequently, linezolid has become the recommended choice for the treatment of hospital and community acquired infection [11]. However, the use of linezolid in the elderly with hospital and community acquired infection is seldom reported, and its efficacy and safety in these patients are not clear.…”

Systemic Nocardia brasiliensis infection in a patient with systemic lupus erythematosus: successful diagnosis and therapy

“…The infectious route was indefinite because N. brasiliensis might be a common natural inhabitant of the soil or a saprophyte feeding on a host. Based on previous reports, pulmonary was disseminated most frequently . Our case first presented signs and symptoms of lung infection, followed by the development of skin rashes over her trunk and extremities, so we would assume the infection started in the lungs and disseminated to cutaneous and subcutaneous tissue by blood circulation.…”

“…The duration of therapy for disseminated nocardiosis is indefinite; previous reports in the literature recommended six months to one year . Justiniano et al .…”

“…These organisms can cause systemic infectious disease. Pulmonary involvement has been the most common clinical manifestation, followed by the central nervous system, cutaneous or subcutaneous tissue, and kidney . Nocardia asteroides is the major pathogen that causes systemic nocardiosis.…”

“…Nocardia asteroides is the major pathogen that causes systemic nocardiosis. Nocardia brasiliensis , N. otitidiscaviarum , and N. farcinica are also pathogenic species for humans . There have been several cases of nocardiosis reported in mainland China since the first case in 1964 .…”