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.     

Chest wall destruction: unusual presentation form of pulmonary nocardiosis

Nocardia spp infection is associated with immunosuppresion states, neoplasms and immunosuppresors and glucocorticoids prolonged treatments. Pulmonary involvement is the most typic feature and the dissemination to chest wall and subcutaneous cellular tissue is uncommon. We report one case of pulmonary nocardiosis by Nocardia asteroides, in a diabetic patient without others risk factors, manifested as a chest wall abscess with fifth rib destruction. The treatment with cotrimoxazol after lesion drainage was successful. We review the literature and remain the different diagnostic and therapeutics attitudes.     

Trimethoprim/sulfamethoxazole-resistant Nocardia asteroides causing multiple hepatic abscesses. Successful treatment with ampicillin, amikacin, and limited computed tomography-guided needle aspiration

Hepatic abscesses are rarely encountered in disseminated Nocardia infections. Sulfonamides alone or trimethoprim/sulfamethoxazole is often efficacious in treating infections caused by Nocardia asteroides. In vitro resistance of N. asteroides to trimethoprim/sulfamethoxazole is occasionally present. The patient described in this report had disseminated nocardiosis initially manifesting as multiple subcapsular hepatic abscesses. In vitro susceptibility studies demonstrated resistance to trimethoprim/sulfamethoxazole. Subsequent treatment with ampicillin and amikacin in conjunction with computed tomography-guided needle aspiration of several of the hepatic abscesses, surgical drainage of a right pleural empyema, and eventual discontinuation of use of corticosteroids resulted in cure of the infection.     

Acute community acquired pneumopathy caused by Nocardia asteroides in a 93-year-old female patient

BACKGROUND: Lower respiratory tract infection (LRTI) by Nocardia species is most often considered as an opportunistic infection occurring mainly in middle-aged adults. CASE REPORT: A 93-year old woman without any significant comorbidity other than a mild asthma, presenting with a non-resolving pneumonia, was successfully treated for a community-acquired LRTI by Nocardia asteroides. DISCUSSION: LRTI by Nocardia asteroides is a rare occurrence. Although more frequent in immuno-compromised patients (50 to 85% of cases reported), Nocardia asteroides infection also occurs in immuno-competent individuals. Very few reports describe LRTI infection by Nocardia sp. in the very old, and almost exclusively in patients with major co-morbidities or variable degrees of immuno-suppression.     

Two cases of Nocardia asteroides sternotomy infection treated with ofloxacin and a review of other active antimicrobial agents.

Two patients who developed post-operative sternotomy infections due to Nocardia asteroides were treated successfully with ofloxacin, in vitro susceptibility of the organisms being used as a guide to dosage. The place of this drug in the treatment of infection due to Nocardia asteroides merits further investigation.     

Recurrent Nocardia pneumonia in an adult with chronic granulomatous disease

The diagnosis of chronic granulomatous disease was made for the first time in a young adult when he presented with Nocardia asteroides pneumonia. Treatment with trimethoprim/sulfamethoxazole for 10 wk brought about an apparent cure of the infection. Two and one half years later N. asteroides pneumonia recurred and resulted in death from respiratory failure. Antibiotic susceptibility studies suggested that both episodes were caused by the same organism. This suggestion was supported by endonuclease restriction analysis, which showed that the plasmids from both Nocardia isolates were identical. Late recurrence of pneumonia caused by N. asteroides occurs only rarely. In this patient, recurrent infection appeared to be related to persistence of colonizing organisms in the host.     

Bronchiolitis obliterans and Nocardia asteroides infection of the lung

This report describes a patient with right lower lung (RLL) pneumonia of a subacute nature. Sputum and bronchial washings both grew N asteroides. Open lung biopsy showed bronchiolitis obliterans. Both the clinical and radiologic picture dramatically improved during three weeks of treatment with trimethoprim and sulfamethoxazole (TMP - SMX), indicating the possibility that N asteroides infection contributed to bronchiolitis obliterans pneumonia in this patient.     

Treatment of experimental nocardiosis in mice: comparison of amikacin and sulfonamide.

Recent in vitro susceptibility studies have shown that amikacin inhibits more than 90% of isolates of Nocardia. This study was designed to evaluate the effect of treatment with amikacin or sulfonamides on infection caused by Nocardia asteroides with the use of murine models. In an acute lethality model in which infection was induced by intraperitoneal injection, 13 (45%) of 29 mice that had been treated with amikacin survived, in comparison to zero of 39 untreated animals in the control group and one of 39 mice that had been treated with sulfadiazine (P less than 0.001 for amikacin). When infected with a strain of N. asteroides that was resistant to amikacin, all mice that were treated with amikacin and all untreated mice died. Drug therapy was also evaluated in a chronic infection model, in which abscesses were produced by an intraperitoneal injection of N. asteroides in saline. Treatment with either amikacin (P less than 0.001) or sulfonamide (P less than 0.02) for two to three weeks significantly increased the rate of resolution of these abscesses. These murine models demonstrate that amikacin has in vivo activity against Nocardia and may be potentially useful in the treatment of human disease.     

Molecular diagnosis of fatal Nocardia farcinica pneumonia in an HIV-negative patient

Nocardiosis is a rare and potentially life-threatening infection caused by several species of the Nocardia genus. Most cases occur in immunocompromised patients, and a delay in establishing the diagnosis is common due to the non-specific clinical presentations and the difficulty in cultivating Nocardia. Although the majority of pulmonary nocardiosis cases are caused by Nocardia asteroides, cases of human infection due to N. farcinica are increasingly diagnosed due to recent developments in taxonomy and diagnostic methods. N. farcinica is a separate species from N. asteroides and appears to be more virulent and resistant to antibiotics. Herein, we describe the case of a 65-year-old HIV-negative immunocompromised patient with a fulminant bilateral pulmonary nocardiosis while on empirical treatment with trimethoprim/sulfamethoxazole and imipenem. Post-mortem diagnosis of N. farcinica infection was performed by means of DNA amplification and sequencing of the 65-kDa bacterial heat shock protein.     

Disseminated nocardiosis with psoas abscess in a patient with AIDS: first reported case

Psoas muscle abscess is an uncommon infection that have been diagnosed increasingly in the last years. We present a case of a patient with advanced human immunodeficiency virus infection who developed a disseminated infection due to Nocardia asteroides sensu stricto type VI with psoas abscess. To our knowledge no other cases of Nocardia psoas abscess in the setting of HIV infection have been reported in the literature.     

Disseminated Nocardia asteroides and coinfection with Trichophyton rubrum in a renal transplant recipient

Abstract: Disseminated Nocardia infection has a high mortality and morbidity rate in solid organ transplant recipients, even when appropriate antibiotics are given. In this report a renal transplant recipient is described, who developed disseminated Nocardia asteroides infection with lung, eye, and brain involvement, in addition to coinfection with Trichophyton rubrum .     

ICD nocardiosis

We present an initial report of Nocardia asteroides implantable cardioverter defibrillator infection. Systemic infection persisted despite pulse generator explant and several years of appropriate antibiotic therapy. Without epicardial lead system removal, chronic pleuropericardial disease developed.     

Disseminated nocardiosis after pulmonary collapse: a case report

A 24-year-old Thai woman receiving corticosteroid treatment for systemic lupus erythematosus, developed pulmonary nocardiosis after pulmonary collapse. The correct diagnosis was reached when dissemination had occurred which was characterized by two subcutaneous abscesses and acute uveitis of the right eye. Gram stain of sputum and pus revealed delicate, branching, Gram-positive filamentous mycelia which were identified as Nocardia asteroides on culture. Subcutaneous abscesses and exophthalmos disappeared after one week of therapy and she made an uneventful recovery.     

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.     

Lung infection caused by Nocardia asteroides in a renal-transplant patient

A 65-yr-old man developed an acute lung infection while being treated for a rejection episode 2 months after renal transplantation. A chest X-ray revealed a pulmonary infiltrate. Nocardia asteroides was cultured from a percutaneous lung aspirate. The patient was successfully treated with trimethoprim/sulfamethoxazole.     

An unexpected pulmonary infection in a patient with gastric tube interposition, reconstruction of the hypopharynx and gastric-hypopharyngeal anastomosis

Pulmonary infection by Nocardia spp. has been recognized the last decades. Nocardia is an opportunistic pathogen in immunocompromised individuals; nevertheless, it has been recognized as an uncommon pathogen in immunocompetent patients. We report a case of pulmonary infection by Nocardia asteroides in an immunocompetent host who had a history of sulfate acid aspiration, followed by gastric tube interposition, reconstruction of the hypopharynx and gastric-hypopharyngial anastomosis.     

Resistance of Nocardia asteroides to oxygen-dependent killing by neutrophils

Nocardia asteroides resists killing by neutrophils despite the occurrence of the oxidative metabolic burst when the organism is phagocytosed. In a study of the apparent resistance of N asteroides to oxygen-dependent killing by neutrophils, this organism and (for comparison) Staphylococcus aureus were exposed to metabolites of the oxidative metabolic burst. N asteroides was more resistant than S aureus to H2O2, hydroxyl radical, and singlet oxygen and to the combination of H2O2, lactoperoxidase, and iodide. The rate of iodination of N asteroides by neutrophils or by the combination of lactoperoxidase and H2O2 was significantly lower than that of S aureus. Lysates of N asteroides had 2.8 times more catalase than lysates of S aureus, but levels of superoxide dismutase were similar in the two lysates. A reduction in the level of catalase activity of N asteroides with aminotriazole or azide resulted in a modest decrease in resistance to oxidative metabolites. Thus, the relative resistance of N asteroides to killing appeared to be due partially but not completely to its relatively high level of catalase activity.     

Contribution of neutrophils and cell-mediated immunity to control of Nocardia asteroides in murine lungs

To distinguish between the contributions of neutrophils and cell-mediated immunity to defense against Nocardia asteroides in the lung, we induced pneumonia in BALB/c mice by intranasal inoculation. We studied the course of pneumonia by histology, bronchoalveolar lavage, and quantification of colony-forming units in lungs. Mice with intact host defenses had an initial inflammatory response, consisting mostly of neutrophils, followed by a mononuclear cell infiltrate. Nocardiae were eradicated during the seven days after inoculation. Mice in which the early, predominantly neutrophil inflammatory response was prevented with mechlorethamine or antiserum to neutrophils had little inflammation, and nocardiae grew extensively. Mice in which cell-mediated immunity was impaired with cyclosporin A or cortisone acetate developed abscesses; neutrophils were abundant, but nocardiae proliferated. The occurrence of these three separate and distinct patterns suggested that both neutrophils and cell-mediated immunity are necessary for optimal control of N. asteroides infection.     

Superior vena cava syndrome caused by Nocardia asteroides

A patient developed the superior vena cava syndrome from Nocardia asteroides pneumonia with mediastinitis. Specific treatment was dangerously delayed because malignancy was primarily suspected, and nocardial infection was not initially considered. The correct diagnosis was eventually made by appropriate stains and culture of a lung aspirate. Specific therapy with sulfonamide resulted in a cure of the infection, disappearance of facial swelling, and a long-term state of clinical well-being. Active nocardial pneumonia with mediastinitis is a treatable cause of the superior vena cava syndrome and should be considered in the differential diagnosis.     

First report of submandibular and parotid abscess due to Nocardia asteroides

Herein, we are presenting a first case report where multiple salivary glands abscesses were diagnosed to be due to N.asteroides. Minor trauma of buccal mucosa, due to cleansing of teeth unhygienically, was most probable mode of infection. It was managed successfully by surgical drainage and post surgical co-trimoxazole therapy.