Disseminated nocardiosis caused by Nocardia farcinica in a patient with colon cancer

Abstract Background and Aims Nocardiosis is a localized or disseminated bacterial infection caused by aerobic Actinomyces that commonly affects immunocompromised hosts. This study aimed to retrospectively review the clinical course and outcome of nocardiosis in renal transplant recipients at our center Method Data was obtained from hospital records retrospectively. Sixteen cases of nocardiosis were identified in a series of more than 1800 consecutive renal transplants performed at Sir Ganga Ram Hospital in the last decade from the year 2010 to 2019. Results Thirteen out of Sixteen patients(81.25%) had developed nocardiosis within a 1-year post-renal transplant. The diabetic population constituted 31.3%. CMV disease was present in 25% of patients six months prior to the diagnosis of Nocardiosis.56.3% of patients were on Trimethoprim-sulfamethoxazole prophylaxis while they were diagnosed with nocardiosis. Pleuropulmonary nocardiosis was the most common form of infection(68.75%). Primary cutaneous nocardiosis was identified in one patient(6.25%). cerebral nocardiosis and disseminated nocardiosis was diagnosed in two patients each(12.5%).In the last 3 years with the introduction of MALDI-TOF led to the identification of the subspecies of Nocardia which was not possible earlier. In the last 3 years, 6 patients were diagnosed with nocardiosis, in which 4 were infected with Nocardia farcinica, one patient with Nocardia Asiatica and one with Nocardia cyrigeorgica. Nocardia farcinica was resistant to cotrimoxazole, which used to be first-line therapy against Nocardiosis before subspecies identification and sensitivity testing. With the help of proper identification of subspecies by MALDI-TOF and antibiotic susceptibility by E-testing, 5 out of 6 patients could be treated while earlier 6 out of 10 patients could be treated. Conclusion Nocardiosis is a rare, difficult-to-diagnose-and-treat infection following kidney transplantation. Trimethoprim-sulfamethoxazole prophylaxis was not effective in the prevention of disease. The Subspecies identification and modification of the plan of management according to antibiotic sensitivity results in improved outcomes.

Download Full-text

Nocardia farcinica masquerading as intracerebral metastases in advanced metastatic prostatic cancer

BMJ Case Reports ◽

10.1136/bcr-2019-233678 ◽

2020 ◽

Vol 13 (9) ◽

pp. e233678 ◽

Cited By ~ 1

Author(s):

Claire Livings ◽

Mayu Uemura ◽

Reena Patel ◽

Mehran Afshar

Keyword(s):

Brain Imaging ◽

Best Supportive Care ◽

Antimicrobial Treatment ◽

Cutaneous Lesions ◽

Incision And Drainage ◽

Nocardia Farcinica ◽

Facial Numbness ◽

History Of ◽

Leg Weakness ◽

Disseminated Nocardiosis

A 67-year-old man with metastatic prostate cancer and underlying asymptomatic pancytopenia presented with a 1-week history of general malaise, left leg weakness and facial numbness. Initial brain imaging demonstrated two rim-enhancing lesions felt to represent intracerebral metastasis. Following neurosurgical referral, a multidisciplinary meeting decision was made for best supportive care and dexamethasone was given. He developed multiple cutaneous lesions, which on incision and drainage revealed Nocardia farcinica. Repeat brain imaging showed enlargement of the existing cavitating lesions and appearance of new lesions, now typical of cerebral abscesses. A diagnosis of disseminated nocardiosis with cutaneous and intracerebral infection was reached. He started taking empirical treatment with intravenous meropenem, co-trimoxazole and subsequent addition of amikacin, with little improvement. On further review of sensitivities, moxifloxacin was added. Following over 1 month of antimicrobial treatment, his neurological symptoms, cutaneous lesions and repeat MRI of the brain had improved.

Download Full-text

Disseminated nocardiosis due to Nocardia farcinica: diagnosis by thyroid abscess culture

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652005000600009 ◽

2005 ◽

Vol 47 (6) ◽

pp. 355-358 ◽

Cited By ~ 5

Author(s):

Cecília Bittencourt Severo ◽

Flávio de Mattos Oliveira ◽

Lenine Cunha ◽

Vlademir Cantarelli ◽

Luiz Carlos Severo

Keyword(s):

Low Back Pain ◽

Back Pain ◽

White Male ◽

Blood Cultures ◽

Low Back ◽

Nocardia Farcinica ◽

Thyroid Abscess ◽

Days Of Therapy ◽

History Of ◽

Disseminated Nocardiosis

A previously healthy 75-year-old white male dentist presented with a 6-month history of low-back pain treated with chronic steroid therapy had a Nocardia farcinica infection diagnosed by aspirate of thyroid abscess and six blood cultures. Despite the treatment with parenteral combination of trimethoprim/sulfamethoxazole, the patient failed to respond and died after two days of therapy. Autopsy revealed disseminated nocardiosis, involving lungs with pleural purulent exudate in both sides, heart, thyroid, kidneys, brain, bones, and lumbosacral soft tissue with destruction of L2-L4.

Download Full-text