Vascular Nosocomial <i>Nocardia farcinica</i> Infection After Arterial Stenting in an Immunocompetent Patient

Vuotto, Fanny; Faure, Karine; Queyre, V; Dessein, Rodrigue; Pasquet, A.; Lambert, Marc; Haulon, Stéphan; Bérégi, J.P.; Guery, Benoît; Hatron, P.Y.

doi:10.1155/2011/216873

Cited by 7 publications

(6 citation statements)

References 4 publications

(7 reference statements)

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“…Pulmonary and disseminated nocardiosis have also been recently reported in immunocompetent patients in different countries [33], [57], [58], [59]. Although frequent in India, cases of keratitis are relatively rare in another countries [60], [61].…”

Section: Discussionmentioning

confidence: 98%

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

et al. 2013

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Background Nocardia sp. causes a variety of clinical presentations. The incidence of nocardiosis varies geographically according to several factors, such as the prevalence of HIV infections, transplants, neoplastic and rheumatic diseases, as well as climate, socio-economic conditions and laboratory procedures for Nocardia detection and identification. In Brazil the paucity of clinical reports of Nocardia infections suggests that this genus may be underestimated as a cause of human diseases and/or either neglected or misidentified in laboratory specimens. Accurate identification of Nocardia species has become increasingly important for clinical and epidemiological investigations. In this study, seven clinical Nocardia isolates were identified by multilocus sequence analysis (MLSA) and their antimicrobial susceptibility was also determined. Most Nocardia isolates were associated to pulmonary disease.Methodology/Principal FindingsThe majority of Brazilian human isolates in cases reported in literature were identified as Nocardia sp. Molecular characterization was used for species identification of Nocardia nova, Nocardia cyriacigeorgica, Nocardia asiatica and Nocardia exalbida/gamkensis. Data indicated that molecular analysis provided a different Nocardia speciation than the initial biochemical identification for most Brazilian isolates. All Nocardia isolates showed susceptibility to trimethoprim-sulfamethoxazole, the antimicrobial of choice in the treatment nocardiosis. N. nova isolated from different clinical specimens from one patient showed identical antimicrobial susceptibility patterns and two distinct clones.Conclusions/SignificanceAlthough Brazil is the world's fifth-largest country in terms of land mass and population, pulmonary, extrapulmonary and systemic forms of nocardiosis were reported in only 6 of the 26 Brazilian states from 1970 to 2013. A least 33.8% of these 46 cases of nocardiosis proved fatal. Interestingly, coinfection by two clones may occur in patients presenting nocardiosis. Nocardia infection may be more common throughout the Brazilian territory and in other developing tropical countries than is currently recognized and MLSA should be used more extensively as an effective method for Nocardia identification.

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Section: Discussionmentioning

confidence: 98%

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

et al. 2013

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“…N. farcinica is an aerobic, gram-positive, filamentous, ubiquitous, soilborne, and weakly acid-fast bacteria [3, 4]. N. farcinica infections are usually acquired by direct inhalation of contaminated particles from soil or water; however, these infections are also reported to occur after traumatic injury [5, 6]. Misdiagnosis and mistreatment of N. farcinica infection can cause severe damage and even death, because Nocardia species can disseminate and are resistant to antibiotics.…”

Section: Discussionmentioning

confidence: 99%

Orbital and intracranial Nocardia farcinica infection caused by trauma to the orbit: a case report

Wang

et al. 2019

BMC Infect Dis

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BackgroundLocalized `and disseminated Nocardia farcinica infection is frequently reported in immunocompromised patients. However, orbital nocardiosis is rare, and, to our knowledge, traumatic orbital nocardiosis that affects the brain has never been described. Here, we report a case of traumatic orbital and intracranial N. farcinica infection in an immunocompetent patient.Case presentationA 35-year-old man, who was immunocompetent, to the best of our knowledge and as per the absence of immunodeficiency symptoms, with orbital trauma caused by the penetration of a rotten bamboo branch developed lesions in the orbit and brain. Subsequently, he underwent debridement and received broad-spectrum antibiotic therapy, but orbital infection occurred, with drainage of pus through the sinus tract. The patient then underwent endoscope-assisted local debridement. Bacterial culture of the sinusal pus was positive for N. farcinica, and a combined intracranial infection had developed. The disease was treated effectively by trimethoprim-sulfamethoxazole and ceftriaxone sodium therapy. The patient remained infection free and without complications at the 14-month follow-up.ConclusionsTraumatic orbital and intracranial infection caused by N. farcinica is a rare infectious disease, and atypical presentations easily lead to misdiagnosis. When a patient presents with an atypical orbital infection that is unresponsive to empirical broad-spectrum antibiotics, along with suspicious neurologic symptoms, Nocardia infection should be considered. Identification by bacterial culture is the gold standard. Complete local debridement and appropriate antibiotic treatment are keys to the treatment of the disease.

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“…Nosocomial outbreaks have been reported, most frequently in immunocompromised, but also immunocompetent patients intra-operatively exposed to N. farcinica. Contamination of arterial stent, prosthesis, or heart/ liver transplantation units transmission via health care workers has been documented, posing the question of intensified handwashing regimen, correct barriers use (gloves, gowns), and environment cleaning [41,42]. Some species are more associated with distinct type of human infections, thus the modality of infection and risk factors might be different, considering if the skin has been directly contaminated or by the blood stream dissemination.…”

Section: Source Of Infection and Risks Factorsmentioning

confidence: 99%

“…iv. Infection at site of surgery is increasingly reported, from biopsy to major procedures, such as open heart sternotomy, vascular prosthesis and central venous catheters insertion [41,42,58,59]. Severe postoperative wound infections are conditioned by the virulence of the strain, but also affinity to medical material, and resistance to common antibiotic prophylactic regimen.…”

Section: Considering the Necessity Of A Port Of Entry Main Risks Facmentioning

confidence: 99%

“…Animal models and in vitro data attest imipenem and amikacin superior activity compared with TMP-SMZ and also synergistic effects combing the 3 drugs, but parenteral administration requires hospital settings or expensive out-patient facilities, not affordable for long-term treatment. Limited activity in vitro is suggested for fluoroquinolones, although clinical experiences found it successful in long-term combinations regimens [8,42]. Thus, clinician's decisions should be guided by the single patient conditions:…”

Section: Therapymentioning

confidence: 99%

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Cutaneous Nocardiosis

Atzori¹

2014

SOJ Microbiol Infect Dis

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Open Access Review Article cutaneous inoculation. Primary cutaneous nocardiosis is more common, with incidence rates ranging from 5% to 24% in various countries like India, UK, and Spain [10-12]. A major problem is correct identification, as clinical presentation is not peculiar as well as histological findings, suggestive of an infective process, but not able to detect the microorganisms, unless a tissue culture has been performed and Gram stained. The laboratory should be advised of the clinical suspicion, as Nocardia is a slow-growing bacterium, and cultures are often discarded when no growth is seen within 48 hours, or obscured by rapidly growing bacteria [1]. Once the Nocardiosis is presumed, speciation might take 1-3 weeks, and each strain has individual antibiotic susceptibility pattern, conditioning empiric treatment and possible fatal course. Newer molecular technologies promise to provide rapid and accurate identification [13], but first of all have revolutionized taxonomy, and we have to face with currently more than 30 species. Clinical relevance has been determined for about seventeen species [14,15] in respect to the 4 pathogens identified by traditional hydrolysis patterns: N. asteroides, N. brasiliensis, N. otitidiscaviarum, and N. transvalensis. Distinct serotypes and biotypes might share the same antibiotic susceptibility profile [8,13-18]. In western Europe and USA, the term "N.asteroides complex" is frequently used, failing to differentiate the strain cluster (N.asteroides sensu strictu) from N. cyriacigeorgica, N. farcinica, N. nova, N. abscessus, Nocardia brasiliensis, which is the second most common isolates in the majority of countries [14,16], differs from N.pseudobrasiliensis in mycolic acid pattern, adenine decomposition, nitrate reduction, and antimicrobial agent susceptibilities [18] For all these issues, clinical management and treatment of patients with nocardial disease remain a challenge. This review characterizes the cutaneous manifestations and related risk factors, to suggest clues in clinical diagnosis, raise physicians alert to avoid delayed recognition and address the correct assessments. Skin manifestations From a general health perspective, cutaneous nocardiosis (CN) traditionally occurs with 3 main patterns: (1) actinomycetoma, (2) lymphocutaneous (sporotrichoid) infection, (3) superficial skin infection (Table 1). Some classification adds a distinct 4 th pattern, corresponding to the secondary skin

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Vascular Nosocomial Nocardia farcinica Infection After Arterial Stenting in an Immunocompetent Patient

Cited by 7 publications

References 4 publications

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

Molecular Identification of Nocardia Isolates from Clinical Samples and an Overview of Human Nocardiosis in Brazil

Orbital and intracranial Nocardia farcinica infection caused by trauma to the orbit: a case report

Cutaneous Nocardiosis

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