Cutaneous nocardiosis with discharging sinus clinically mimicking tuberculosis diagnosed by cytology

Nocardiosis is primarily a pulmonary infection commonly seen in immunocompromised individuals. However, lymphocutaneous nocardiosis is observed in immunocompetent individuals often after trauma. The clinical and cytomorphological features of lymphocutaneous nocardiosis closely mimic the most common infections in India such as tuberculosis and mycetoma (very common cutaneous infection with discharging sinus). As it is crucial to differentiate nocardiosis from tuberculosis, to avoid unnecessary antitubercular treatment, special stains like modified Ziehl–Neelsen stain and Gram stain can be employed to differentiate the morphology of Nocardia from tuberculosis. Fine‐needle cytology from these cutaneous lesions helps in yielding adequate material for rapid and accurate diagnosis of immediate specific antibiotic treatment. We report a rare case that presented with clinical diagnosis of tuberculosis but turned out to be nocardiosis on cytomorphology with simple and most feasible fine‐needle aspiration method of tissue diagnosis and scrape cytology.     

Infected Aortic Graft

A case of infected aortic graft after abdominal aorta aneurysm resection is reported and a short review of this potential lethal complication is given.     

Nocardia asteroides Necrotizing Scleritis Associated with Subtenon Triamcinolone Acetonide Injection

Purpose: To report a case of Nocardia asteroides infection after subtenon triamcinolone acetonide injection. Design: Case report. Results: An 80-year old female received a subtenon triamcinolone acetonide injection for postcataract surgery cystoid macular edema. Shortly after, the patient developed a chronic red eye that progressed to a fulminant necrotizing scleritis. Eventual scleral biopsy revealed Nocardia asteroides infection, which improved after 5 months of systemic antibiotic therapy. Conclusions: Subtenon triamcinolone acetonide injection should be recognized as a cause of serious infectious scleritis.     

Epidemiology and in vitro antimicrobial susceptibility of aerobic Actinomycetales in a clinical setting

IntroductionThe incidence of infections caused by aerobic actinomycetes is increasing. Recent changes in taxonomy and the variability in susceptibility patterns among species make necessary a proper identification and antibiotic susceptibility testing.Material and methodsFifty-three strains of aerobic actinomycetes were identified by MALDI-TOF MS using the VITEK MS Mycobacterium/Nocardia kit (bioMérieux, France) in a tertiary hospital in Spain during a six-year period. Antimicrobial susceptibility testing of the isolates was performed using the Sensititre Rapmycoi microdilution panel (Thermo Fisher Scientific, Massachusetts, USA).ResultsForty strains of Nocardia spp. were identified in the study, being N. farcinica and N. cyriacigeorgica the most prevalent ones. All isolates were susceptible to linezolid and the resistance to amikacin was only observed in one isolate of Gordonia sputi. Resistance to cotrimoxazole was only found in five isolates.ConclusionsRoutine identification and antimicrobial susceptibility testing of aerobic actinomycetes is advisable for an efficient identification of species and effective treatment.     

Pneumocystis jirovecii pneumonia is rare in renal transplant recipients receiving only one month of prophylaxis

Prophylaxis against Pneumocystis jirovecii pneumonia (PCP) is recommended for at least 4–12 months after solid organ transplant. In our center, renal transplant recipients receive only 1 month of post‐transplant trimethoprim–sulfamethoxazole, which also may provide limited protection against Nocardia. We identified only 4 PCP cases and 4 Nocardia cases in 1352 patients receiving renal and renal‐pancreas transplant from 2003 to 2009 at the University of Michigan Health System. Two PCP cases were identified <1 year after transplant, and 2 PCP cases were identified >1 year after transplant (gross attack rate 4/1352, 0.3%). Two Nocardia cases were identified <1 year after transplant, and 2 cases were identified >1 year after transplant. All identified cases received induction therapy (7 of 8 with anti‐thymocyte globulin), whereas about one‐half of all renal transplant patients received induction therapy at our institution. No patient was treated for rejection within 6 months of PCP; 2 of 4 patients with PCP had recent cytomegalovirus infection. All patients with PCP and 3 of 4 patients with Nocardia survived. The benefits of prolonged PCP prophylaxis should be weighed against the adverse events associated with prolonged use of antimicrobials.     

Nocardia Brain Abscess in a Liver Transplant Recipient

Nocardia brain abscess is rare. We report on a unique case of N. farcinica brain abscess in a liver transplant recipient, following Aspergillus fumigatus pneumonia. A 43-year-old liver transplant recipient presented with altered mentality at 2 months after A. fumigates pneumonia. He was successfully treated with surgical removal and antibiotic therapy with trimethoprim-sulfamethoxazole and ceftriaxone.     

Cutaneous Nocardia brasiliensis infection in an immunocompetent host after ovarian cystectomy: A case study.

Nocardia brasiliensis is a rare human pathogen that is usually associated with localised cutaneous infections. We report a case of primary cutaneous Nocardia brasiliensis infection causing delayed wound healing that developed after ovarian cystectomy in an otherwise healthy 32-year-old woman. The patient was initially treated with cotrimoxazole, however due to intolerance intravenous amikacin was given and gradually the wound healed. The diagnosis was confirmed by demonstrating the causative organism in exudates, and cultures. Early diagnosis as well as early institution of chemotherapy is effective in most patients, and antimicrobial susceptibility testing of the isolate should be performed to identify the best treatment options.     

星型奴卡氏菌肺炎

目的提高对肺奴卡氏菌感染的临床认识。方法报道一例星型奴卡氏菌肺炎,结合国内文献报道的临床资料进行分析。结果星型奴卡氏菌肺炎常发生在农民,有泥土接触史,患者常有免疫功能低下,发热、咳嗽、咯血、气促等临床表现,胸片表现为肺炎、肺脓肿、空洞、胸腔积液等,治疗以磺胺为首选。结论对不明原因发热、咳嗽、气促、咯血的患者,特别是有免疫功能低下,长期服用激素的情况时,要注意星型奴卡氏菌肺炎感染的可能。     

Nocardia farcinica pericarditis after kidney transplantation despite prophylaxis

Abstract: A deceased-donor kidney transplant recipient developed purulent pericarditis caused by Nocardia despite trimethoprim–sulfamethoxazole (TMP–SMX) prophylaxis for Pneumocystis jirovecii . She was treated empirically with ceftriaxone and amikacin and subsequently underwent sternotomy with drainage of an intrapericardial abscess. Culture and susceptibility data demonstrated Nocardia farcinica , which was susceptible to SMX and amikacin, although resistant to ceftriaxone. Nocardia asteroides , the more common human pathogen, is generally susceptible to third-generation cephalosporins and TMP–SMX. N. farcinica is rare in the United States, more virulent and resistant than N. asteroides , and is more likely to cause disseminated disease. Successful therapy of disseminated Nocardia infections is dependent upon choice of appropriate empiric antibiotics in addition to surgical drainage of purulent fluid collections. TMP–SMX prophylaxis may not be sufficient to prevent infections due to Nocardia species in all immunosuppressed transplant recipients. Here, a rare complication of this unusual pathogen is discussed.     

A Case of Disseminated Nocardiosis Secondary to the Skin Nodules in an Elderly Woman

Nocardiosis refers to a locally invasive or disseminated infection associated with the Nocardia species. Most infections enter through the respiratory tract and then disseminate systemically. Rarely can a primary nocardial infection of the skin spread to contiguous structures or disseminate to other internal organs in immunocompromised hosts. We describe a 70-year-old woman who suffered from recurrent nodular skin lesions on her right hand, forearm and elbow following inoculation of a traumatic injury. Analysis of the purulent exudates obtained from the nodule revealed Nocardia species. After 20 days, a chest X-ray showed newly developed multiple nodules in both lungs. The diagnosis of systemic nocardiosis was established, and we treated this case with trimethoprim-sulfamethoxazole.