Nocardia farcinica pneumoniae in chronic obstructive pulmonary disease patient

Nocardia farcinica is an infrequent infection that usually appears in patients with predisposing conditions, especially in immunosuppressed patients, although it has also been found in healthy individuals. Its importance as a new pathogen has been recognized only in recent years. Mainly, it affects the lung, indistinguishable from other types of pneumonia in the clinical and radiological characteristics. The main reason for detection is therapeutic failure.     

First case of Nocardia nova spinal abscess in an immunocompetent patient

Nocardia are a group of aerobic actinomycetes that are filamentous gram-positive, weakly acid-fast, and cause opportunistic infection in immunocompromised patients. Primary Nocardia infection mostly involves lung, skin and less commonly, the central nervous system (CNS). Among Nocardia CNS infections, spinal infection is extremely rare. We describe the first case of a spinal abscess caused by Nocardia nova in an immunocompetent patient who experienced a penetrating facial injury six months earlier. Nocardia species were isolated from intradural spinal abscesses and identified by 16S rRNA, hsp65 and secA1 sequence analyses. Surgical excision and treatment with amikacin, cefotaxime, and oral erythromycin was successful.     

Potential nosocomial disseminated infection due to Nocardia asteroides after a prosthesis insertion in an immunocompetent patient

Nocardia infections are rare and usually occurred in immunocompromised patients with systemic dissemination from a lung infection. We report a case of an immunocompetent patient in whom Nocardia asteroides had cause psoas and cerebral abcess without pulmonary infection, a short period after a hip prosthesis insertion. The clinical history is highly suggestive of a hospital-acquired infection.     

Case report of disseminated nocardiosis complicated in an elderly person with pneumoconiosis

Nocardia is typically regarded as an opportunistic infection, with pulmonary nocardiosis frequently disseminated to organs hematogenous by, and nearly half of these cases resulting in complicated nocardia brain abscess. Disseminated nocardia has a dismal prognosis with high mortality, and should be checked for multiple organs including the brain when nocardiosis is diagnosed. We describe the successful treatment of nocardia brain abscesses in an immunocompetent older people with pneumoconiosis by combining trimethoprim-sulfamethoxazole and ciprofloxacin. Patients had no history of fever, headache, or respiratory symptoms such as cough, or sputum until the acute hemiplegia episode. Nocardia infection is not as rare as generally assumed and should be considered as a possibility in the elderly due to its high mortality.     

Nocardia transvalensis infection in an immunocompetent patient reported from Turkey

Pulmonary nocardiosis is a rare infection mostly occurs in patients with immunosuppressive conditions. We report an immunocompetent case of pulmonary Nocardia transvalensis from Turkey, presented with bilateral pneumonia and bronchial dilatation treated six months with trimethoprim-sulfamethoxazole.     

Nocardia endocarditis in a native mitral valve

Nocardiosis is an opportunistic infection that usually arises in immunodepressed patients. Cases in immunocompetent patients are uncommon. We report a 53-year-old woman diagnosed as having Nocardia sp. endocarditis in a native mitral valve, which required valve replacement.     

Disseminated nocardiosis due to unusual species: two case reports

Pulmonary nocardiosis is the major clinical manifestation of human nocardiosis and disseminated infection can be seen in immunocompromised patients. N. asteroides is the predominant pathogen associated with disseminated diseases. We report 2 cases of pulmonary nocardiosis admitted with disseminated infection, caused by rare species of Nocardia: Nocardia transvalensis and Nocardia cyriacigeorgica.     

Disseminated Nocardia otitidiscaviarum infection in a woman with sickle cell anemia and end-stage renal disease

Nocardia otitidiscaviarum is an uncommon human pathogen and a rare cause of pulmonary infection and bacteremia. We report a case of N. otitidiscaviarum bacteremia and pulmonary infection in a patient with end-stage renal disease (chronic kidney disease, stage 5) and sickle cell anemia. The epidemiology, pathogenesis, and treatment of Nocardia infections are discussed.     

Cryptosporidium and cryptosporidiosis

Cryptosporidium is a newly recognized human pathogen associated with severe enteritis and, perhaps, cholecystitis in immunocompromised patients, particularly those with the acquired immunodeficiency syndrome, and significant, though self-limited, diarrheal illness in the immunocompetent host. As more physicians look for this pathogen, the number of reported cases of cryptosporidiosis continues to increase. Although the prevalence of cryptosporidiosis in humans is not yet known, recent studies suggest that it is a common cause of diarrhea worldwide, particularly in young children. The pathogenic mechanisms by which Cryptosporidium causes enteritis and the factors of human host defense essential for eradication of this parasite have not been delineated. Acid-fast staining of stool is a quick and reliable way of diagnosing cryptosporidiosis. Although a vast array of therapeutic agents has been tried for this disease, there is currently no known effective therapy for cryptosporidial infection.     

Nocardial infection as a complication of AIDS: report of six cases and review

Nocardiosis has been increasingly recognized as a serious infection among persons who otherwise appear healthy and among those with underlying chronic disease, neoplasms, and immunosuppression. Nocardial infection as a complication of AIDS has been reported infrequently. Six patients with AIDS and nocardiosis were identified at one New York City hospital from January 1980 through March 1989. Sites of nocardial infection in these patients included the lungs, brain, esophagus, and suprarenal and paraspinal masses. Mycobacteria, fungi, viruses, and bacteria other than Nocardia species caused concomitant infections in three patients. Three patients died of nocardiosis. Because of such factors as the growth properties of Nocardia species, the presence of other organisms, the common use of sulfonamides for treatment of patients with AIDS, and a low index of suspicion among physicians, the incidence of nocardiosis as a complication of AIDS may possibly be underreported. Early recognition of nocardial infection may lead to an improved prognosis.     

Pulmonary nocardiosis due to Nocardia otitidiscaviarum in an immunocompetent host- a rare case report

Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients. We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever, cough with scanty sputum, hemoptysis, left sided chest pain and exertional dyspnea for two weeks. There was no past history of tuberculosis, diabetes mellitus or steroid therapy. Chest X-ray showed homogenous peripherally based opacity in the left upper zone. Bronchoscopy was done and brushing sent for culture, which showed colonies with features of Nocardia species after 48 hours. Further phenotypic characterization revealed it to be Nocardia otitidiscaviarum. Patient was treated with cotrimaxazole for six months after which complete recovery was evidenced symptomatically and radiologically. We report this case to emphasize the fact that among the Nocardia species, Nocardia otitidiscaviarum as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals.     

A case of an immunocompetent young man obtaining community-acquired disseminated Nocardia brasiliensis

Nocardiosis is a rare but severe pyogenic or granulomatous disease and caused by Nocardia that mainly infects immunocompromised patients. We report here a case of an immunocompetent 24-year-old male student with community-acquired pneumonia with asymptomatic disseminated cerebral abscess by Brasiliensis nocardiosis. The patient was fully recovered after receiving optimized antimicrobial therapy without relapse. This case suggests the health professionals such as the physicians of pulmonary, infection, neurology department and et al should always think about unusual cause of community acquired pneumonia, even in immunocompetent patients and when having pulmonary nocardiosis we should do a radiological neurological work up, even with the absence of neurological finding or symptom.     

MULTIPLE PULMONARY NODULES CAUSED BY Corynebacterium striatum IN AN IMMUNOCOMPETENT PATIENT

Nondiphtherial corynebacteria are ubiquitous in nature and commonly colonize the skin and mucous membranes of humans, however they rarely account for clinical infection. We present the first reported case of multiple pulmonary nodules caused by Corynebacterium striatum. The infection occurred in a 72-year-old immunocompetent female, and the diagnosis was obtained by Gram''s stain and culture of lung biopsy. C. striatum should be recognized as a potential pathogen in both immunocompromised and normal hosts in the appropriate circumstances.     

Pulmonary nocardiosis during immunosuppressive therapy for idiopathic pulmonary fibrosis

Nocardiosis is a subacute or chronic suppurative infection caused by Nocardia species. Although it is more common in immunocompromised hosts, idiopathic pulmonary fibrosis (IPF) has not been recognized as a predisposing factor for nocardial infection. We report a case of IPF, in which pulmonary nocardiosis developed during treatment with prednisolone and cyclophosphamide. The risk of pulmonary nocardiosis may be increased in cases of IPF on immunosuppressive therapy. Since IPF often accompanies lung carcinoma, it is important to correctly differentiate nocardiosis from carcinoma.     

Infections due to Nocardia transvalensis: clinical spectrum and antimicrobial therapy.

Nocardia transvalensis, a rare Nocardia species, has previously been recognized as a cause of actinomycotic mycetoma. In a retrospective review of N. transvalensis isolates referred to the Centers for Disease Control (Atlanta) during the period January 1981 through January 1990, we identified 15 patient isolates. Four N. transvalensis isolates originated from one Australian reference laboratory; one patient's isolate that was identified by the Australian laboratory but that was not received at the Centers for Disease Control was also included in our study. A review of the cases of these 16 patients found that N. transvalensis caused infection in 10 patients and colonization in two patients. Six (75%) of eight patients with primary pulmonary or disseminated N. transvalensis infections had an underlying immunologic disorder or were receiving immunosuppressive therapy; three patients with disseminated infection died. All nine infected patients for whom specific antimicrobial therapy was prescribed received trimethoprim-sulfamethoxazole. Results of in vitro antimicrobial susceptibility tests of 11 N. transvalensis isolates revealed increased antimicrobial resistance to amikacin and other drugs when compared with that of other Nocardia species. Severely immunocompromised patients are predisposed to N. transvalensis pneumonia or disseminated infection, and the lung may be the portal of entry.     

Pulmonary nocardiosis: risk factors, clinical features, diagnosis and prognosis

PURPOSE OF REVIEW: Pulmonary infection by Nocardia spp. has been recognized for the past 100 years. The number of cases of pulmonary nocardiosis reported in the literature is increasing, and in some cases, a diagnosis is reached even postmortem. This increase is partly due to the growing number of patients with depressed cellular immunity. The diagnosis of this infection, which has a high rate of mortality, is usually delayed, due to a nonspecific clinical-radiological presentation and the difficulties in cultivating the bacteria. This review analyzes the current situation, in order to better understand this infection and enhance awareness and clinical suspicion that would lead to further specific microbiological studies and treatment. RECENT FINDINGS: The number of case series in the literature is increasing. This development may be due to an absolute increase in the number of immunocompromised patients, but also to improvements in laboratory techniques and molecular methods to detect nocardiosis. SUMMARY: It is important to keep in mind, and suspect the presence of pulmonary nocardiosis in the immunodepressed patients with clinical pulmonary infection. Furthermore, the laboratory should be notified when Nocardia is suspected in a clinical specimen so that measures can be taken to optimize recognition and recovery of the organism.     

Late presentation of Cryptococcus gattii meningitis in a traveller to Vancouver Island: A case report

Since 1999, Cryptococcus gattii has been identified as a primary pathogen on Vancouver Island in British Columbia, and it has resulted in infection of both people and animals living in that area. A previously healthy 45-year-old female resident of Alberta developed C gattii infection 11 months after travelling to an endemic region of Vancouver Island. A case of an immunocompetent patient, with an atypically long incubation time, who presented with subacute meningitis secondary to disseminated pulmonary cryptococcosis is presented. The present report highlights the need for clinical vigilance in treating patients presenting with atypical pulmonary infections or meningitis who have been holiday travellers to endemic areas of Vancouver Island.     

Immunoblotting and enzyme linked-immunosorbent assay for diagnosis of toxoplasma infection in HIV Thai patients

Toxoplasma gondii has been recognized as an important cause of morbidity and mortality among immunocompromised persons. The diagnosis of T. gondii infection is most often based on serological tests results. Serological diagnosis can be limited in AIDS patients because of depressed antibody responses. Fifty serum samples were used in this study to investigate serological evidence of toxoplasmosis in HIV positive Thai patients by Platelia kit, the commercial enzyme-linked immunosorbent assay (ELISA) in which the membrane protein p-30 is the predominant antigen and immunoblot technique (IB). Sera of HIV positive Thai patients with Toxoplasma infection recognized the same antigenic component, the 32 kDa antigenic band, as is recognized by Toxoplasma positive sera from immunocompetent patients and it may represent a specific marker for diagnosis of Toxoplasma infection in HIV positive Thai patients.     

Acute focal bacterial nephritis due to methicillin-resistant Staphylococcus aureus in an immunocompetent adult

Acute focal bacterial nephritis (AFBN) is a rare, acute focal infection of the renal parenchyma without liquefaction. The pathogenesis is thought to be due to hematogenous infection or ascending infection from the lower urinary tract. Escherichia coli has been the major pathogen isolated in prior cases, but other Gram-negative enteric pathogens and Staphylococcus aureus have been reported as well. It is well described in children and adults with diabetes and organ transplantation, but has not been previously reported in healthy adults. We report a case of an immunocompetent adult female who presented with a methicillin-resistant Staphylococcus aureus bacteremia after a skin and soft tissue infection that resulted in AFBN.