Successful treatment of pulmonary nocardiosis with fluoroquinolone in bronchial asthma and bronchiectasis

Sadamatsu, Hironori; Takahashi, Koichiro; Tashiro, Hiroki; Komiya, Kazutoshi; Nakamura, Tomomi; Sueoka‐Aragane, Naoko

doi:10.1002/rcr2.229

Cited by 10 publications

(9 citation statements)

References 9 publications

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“…The major clinical symptoms of human nocardiosis include lymphadenitis, lymphangitis, encephalitis, pneumonia, and cutaneous tissue lesions (Condas et al, 2015). Despite its infrequency, pulmonary nocardiosis is clinically severe (Sadamatsu et al, 2017). Recently, nocardiosis has been described as isolated cases and case series in lungs and other sites of immunocompetent patients, representing 33%-56% of total cases.…”

Section: Introductionmentioning

confidence: 99%

Detection of Nocardia by 16S Ribosomal RNA Gene PCR and Metagenomic Next-Generation Sequencing (mNGS)

Ding

Wei

et al. 2022

Front. Cell. Infect. Microbiol.

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In this study, the aim was to investigate the discriminatory power of molecular diagnostics based on mNGS and traditional 16S ribosomal RNA PCR among Nocardia species. A total of fourteen clinical isolates from patients with positive Nocardia cultures and clinical evidence were included between January 2017 and June 2020 in HeNan Provincial People’s Hospital. DNA extraction and 16S rRNA PCR were performed on positive cultures, and pathogens were detected by mNGS in these same samples directly. Among the 14 Nocardia isolates, four species were identified, and N. cyriacigeorgica (8 cases) is the most common species. Twelve of the 14 Nocardia spp. isolates were identified by the two methods, while two strains of N. cyriacigeorgica were not identified by mNGS. All tested isolates showed susceptibility to trimethoprim-sulfamethoxazole (SXT), amikacin and linezolid. Apart from Nocardia species, other pathogens such as Acinetobacter baumannii, Klebsiella pneumonia, Aspergillus, Enterococcus faecalis, Human herpesvirus, etc., were detected from the same clinical samples by mNGS. However, these different pathogens were considered as colonization or contamination. We found that it is essential to accurately identify species for determining antibiotic sensitivity and, consequently, choosing antibiotic treatment. 16S rRNA PCR was useful for identification of nocardial infection among species, while this technique needs the clinicians to make the pre-considerations of nocardiosis. However, mNGS may be a putative tool for rapid and accurate detection and identification of Nocardia, beneficial for applications of antimicrobial drugs and timely adjustments of medication.

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Section: Introductionmentioning

confidence: 99%

Detection of Nocardia by 16S Ribosomal RNA Gene PCR and Metagenomic Next-Generation Sequencing (mNGS)

Ding

Wei

et al. 2022

Front. Cell. Infect. Microbiol.

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“…The Pubmed and Google scholar database was searched with 'Nocardia otitidiscaviarum', 'lung infection', 'pulmonary' and 'pneumonia' and 23 cases have been reported [19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37], which are presented in Table 3. Sixteen cases were male and seven were female patients.…”

Section: Discussionmentioning

confidence: 99%

“…The median age at the time of presentation was 58 years (range 14-85 years). Nine of the twenty-three reported cases had associated chronic pulmonary diseases including bronchial asthma, chronic obstructive pulmonary disease (COPD), tuberculosis at the time of infection [19,20,23,25,29,30,31,37]. Thirteen of these twenty-three cases were reported in immunocompromised patients.…”

Section: Discussionmentioning

confidence: 99%

“…Thirteen of these twenty-three cases were reported in immunocompromised patients. Corticosteroid therapy was identified as a risk factor for N. otitidiscaviarum in seven of the thirteen immunocompromised cases [19,20,23,26,28,29,31]. In the other six reports, post-renal transplant [10], Cushing's disease [33], HIV-AIDS (acquired immunodeficiency syndrome) [34,37] and rheumatic heart disease [29] were identified as the cause of immunodeficiency.…”

Section: Discussionmentioning

confidence: 99%

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Fatal pulmonary infection by trimethoprim-sulfamethoxazole resistant Nocardia otitidiscaviarum: report of two cases and review

Saksena

Rynga

Rajan

et al. 2020

J Infect Dev Ctries

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Introduction: Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients. Methodology: Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France). Conclusion: Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically ill patients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis.

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“…There are few documented cases of pulmonary nocardiosis affecting adult immunocompetent patients,7–9 and they are mostly associated with pulmonary chronic disease (such as bronchiectasis, chronic obstructive pulmonary disease or asthma) 10–13. There are also reports of previously healthy children having nocardiosis associated with pneumonia and pleural effusion, central nervous system infection and septic arthritis 14–17…”

Section: Discussionmentioning

confidence: 99%

Nocardialung abscess in an immunocompetent adolescent

Soares¹,

Reis-Melo

Ferraz

et al. 2019

BMJ Case Rep

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The authors report a case of a lung abscess caused by Nocardia sp. in a previously healthy adolescent. A 17-year-old young man presented with tonsillitis that did not respond to β-lactamic antibiotic, dyspnoea and thoracic pain. The X-ray revealed a cavitation in the right pulmonary upper lobe. He was admitted and completed a 14-day empirical antimicrobial therapy for a pulmonar abscess, although no clinical recovery was observed. He then underwent pulmonary biopsy of the lesion and PCR analysis of the collected pulmonary tissue, which revealed the presence of Nocardia. This case emphasises the importance of considering nocardiosis in the differential diagnosis of a lung abscess, particularly if no response to empirical therapy is obtained.

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Successful treatment of pulmonary nocardiosis with fluoroquinolone in bronchial asthma and bronchiectasis

Cited by 10 publications

References 9 publications

Detection of Nocardia by 16S Ribosomal RNA Gene PCR and Metagenomic Next-Generation Sequencing (mNGS)

Detection of Nocardia by 16S Ribosomal RNA Gene PCR and Metagenomic Next-Generation Sequencing (mNGS)

Fatal pulmonary infection by trimethoprim-sulfamethoxazole resistant Nocardia otitidiscaviarum: report of two cases and review

Nocardialung abscess in an immunocompetent adolescent

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