Disseminated nocardiosis masking an atypical zygomycosis presentation in a kidney transplant recipient

E. Colón‐Santos, M. González‐Ramos, J. Bertrán‐Pasarell, G. Rodríguez‐Vega, M. Almira‐Suarez, R. Vélez‐Rosario. Disseminated nocardiosis masking an atypical zygomycosis presentation in a kidney transplant recipient.
Transpl Infect Dis 2011: 13: 380–384. All rights reserved Abstract: Immunosuppressive agents increase the vulnerability of solid organ transplant patients to opportunistic infections. An atypical clinical presentation of a bacterial and fungal co‐infection makes diagnosis and treatment even more challenging in this population. A 54‐year‐old hypertensive woman underwent a cadaveric kidney transplant after years on hemodialysis. Her treatment included mycophenolate, tacrolimus, and prednisone. By post‐transplant week 8, she had pneumonia followed by progressive visual changes and seizures. Diagnostic work‐up, consisting of magnetic resonance imaging of the brain and chest x‐ray, showed several cerebral ring‐enhancing lesions, and a pulmonary cavitary lesion. Disseminated nocardiosis was suspected and therapy was started. Skin biopsy was taken from a nodular lesion and culture confirmed Nocardia species infection. During hospitalization, neurological deficit persisted with worsening of brain lesions. She underwent excision of a brain abscess and the final pathologic report showed mucormycosis, revealing the patient's co‐infection by 2 different pathogens. After therapy with liposomal amphotericin B and posaconazole, she has remained stable for more than 1 year. Disseminated nocardiosis masked and delayed the diagnosis and treatment of a more aggressive and worrisome organism. Mucormycosis, as a non‐fatal isolated brain abscess without rhinal involvement, is an atypical presentation, and only a few cases have been reported.     

Unusual infections: Femoral abscess due to Nocardia abscessus in a patient suffering from metastatic peripheral bronchial carcinoma and hygienic consequences

During the course of a peripheral bronchial carcinoma with pulmonary and cerebral metastases a femoral abscess developed in a 49 year-old patient after radio- and chemotherapy. A bacterial strain, which was isolated four times from a deep wound of the left thigh was tentatively identified as a member of the genus Nocardia on the basis of selected phenotypic and chemotaxonomic characteristics. The isolate was confirmed to belong to Nocardia abscessus by 16S rRNA gene sequencing. This species had previously been described as the causative agent of soft tissue infections. Although rare, nocardia soft tissue infections as complication of systemic nocardiosis are typical air born infections of immuncompromised patients and need specific attention. Infection prevention can be realized by restriction of soil and aerosol (builder's dust) together with antibiotic intervention (oral administration of trimethoprim/sulfamethoxazole).     

Ocular Nocardiosis: A Case Report

Purpose: To describe the challenging diagnosis of ocular nocardiosis in a patient with anaplastic astrocytoma

Methods: A 56-year-old patient with recurrent cerebral anaplastic astrocytoma and a history of surgical resection, who underwent radiotherapy and chemotherapy, presented with a unilateral white subretinal mass at the posterior pole of his left eye. Vitrectomy and fine-needle biopsy of the vitreous as well as the subretinal mass were performed.

Results: Magnetic resonance imaging verified progression of the lesion’s size at follow-up. Histopathological workup of the material revealed gram-positive filamentous bacteria consistent with Nocardia cyriacigeorgica.

Conclusion: Endogenous Nocardia should be suspected in case of choroidal abscess in immunocompromised patients. Clinical diagnosis is challenging; therefore, early subretinal biopsy should be considered to facilitate treatment decision.     

Concurrent Nocardia Related Brain Abscess and Semi-Invasive Pulmonary Aspergillosis in an Immunocompetent Patient

We describe here the first case of a concurrent brain abscess caused by Norcardia spp. and semi-invasive pulmonary aspergillosis in an immunocompetent patient. After one year of appropriate antimicrobial therapy and surgical drainage of the brain abscess, the nocardia brain abscess and pulmonary aspergillosis have resolved.     

Disseminated nocardiosis diagnosed by fine needle aspiration biopsy: quick and accurate diagnostic approach

Nocardia is an uncommon pathogen in immunocompetent patients; however, it has been increasingly recognized as a significant opportunistic pathogen in organ transplant patients. Diagnosis of Nocardiosis is usually made by microbiologic culture or cytologic examination of pulmonary specimens including, sputum, and brushing/washings or by histologic evaluation of tissue biopsy material. We report a case of subcutaneous Nocardiosis diagnosed by Fine-needle aspiration biopsy (FNA). The patient is a 66-year-old man with a history of lung transplantation and posttransplant lymphoproliferative disorder who presented with subcutaneous masses in the right upper arm and the left shoulder. FNA was performed in an outpatient clinic setting, with immediate morphologic assessment revealing filamentous branching organisms suspicious for Nocardiosis. Subsequent examination with special stains and microbiologic culture confirmed the diagnosis. The quick and accurate diagnosis by FNA led to emergent and appropriate treatment.     

原发性皮肤奴卡菌病一例

患者,男,72岁。右侧手背、前臂结节伴肿痛3天。组织病理学:(右侧前臂)表皮缺失,真皮可见大片坏死组织,大量中性粒细胞、淋巴细胞及少许多核巨细胞浸润。右侧前臂分泌物细菌培养示:星形奴卡菌生长。诊断为原发性(淋巴型)皮肤奴卡菌病。给予哌拉西林钠舒巴坦钠,夫西地酸乳膏,红光照射治疗后逐渐好转。     

甘肃省10例诺卡菌病患者的临床特征

目的 分析诺卡菌病患者的临床特征,为诺卡菌病的诊疗提供经验。方法 回顾性分析2017年1月—2021年11月兰州大学第一医院诊断为诺卡菌病住院患者的临床资料。结果 共收治10例诺卡菌病患者,男性8例,女性2例,平均年龄(59.1±15.4)岁,≥60岁3例,职业类型以农民为主(5例,50.0%)。肺诺卡菌病5例,皮肤诺卡菌病4例,播散性诺卡菌病1例。菌株分型主要为星形诺卡菌(5株)。80.0%患者有基础疾病,主要为支气管扩张症(3例)、长期服用糖皮质激素(3例)。肺诺卡菌病患者均有咳嗽、咳痰,查体均可闻及啰音;皮肤诺卡菌病主要为病灶处红肿、流脓;1例脑诺卡菌病系播散性感染,有意识丧失中枢神经系统受累表现。患者C反应蛋白为72.75(39.25～96.74)mg/L,均有所升高。肺部CT检查主要为大小不等的小结节影和斑片影(6例)、双肺多发索条影(4例)、大片磨玻璃阴影(3例)、胸腔积液(3例)。所有患者经积极抗感染治疗,9例好转出院,1例病情加重放弃治疗。结论 对有肺部基础疾病及抵抗力差的中老年人,常规抗感染治疗效果不佳时,需考虑诺卡菌感染,积极送病原学检查是关键。     

肺诺卡菌病误诊肺结核1例并文献复习

[摘要]?诺卡菌属于较为罕见的人类病原体，主要通过创伤侵入或吸入方式感染。其感染多见于免疫缺陷，特别是细胞免疫缺陷人群，以肺诺卡菌病最为常见。诺卡菌侵袭性及播散性强，易通过血行播散至其他部位，影像学上可符合血型散播疾病特点，且染色及形态特征与分枝杆菌类似，常误诊为结核分枝杆菌感染。本文对1例以咳嗽、咳痰为主要表现，经抗痨治疗效果欠佳，后明确为北京诺卡菌感染并经治好转的病例进行报道，旨在提高临床医生对本病的认识，减少误诊和漏诊。