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Nocardia beijingensis pulmonary infection successfully treated with intravenous beta-lactam antibiotics and oral minocycline

Abstract

We report a case of pulmonary infection caused by a rare Nocardia species, Nocardia beijingensis, in a 48-year-old man who received multiple immunosuppressive therapy after renal transplantation. This pathogen was isolated from a bronchoscopic protected specimen brush and was identified as N. beijingensis by 16S rRNA gene sequence analysis. The patient was initially treated with imipenem/cilastatin followed by ceftriaxone and oral minocycline. Traditionally, trimethoprim-sulfamethoxazole (SXT) has been one of the first-line antibiotics chosen as an initial therapy for pulmonary nocardiosis, but this case was successfully treated without SXT. Considering recent reports about failures of both prophylaxis and treatment for nocardial infections with SXT and its various side effects, treatment with beta-lactam antibiotics and minocycline for pulmonary nocardiosis can be chosen in mild to moderate cases with confirmed susceptibility to these antibiotics in vitro.

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References

  1. Muller MP, Richardson DC, Walmsley SL. Trimethoprim-sulfamethoxazole induced aseptic meningitis in a renal transplant patient. Clin Nephrol. 2001;55(1):80–4.

    PubMed  CAS  Google Scholar 

  2. Slatore CG, Tilles SA. Sulfonamide hypersensitivity. Immunol Allergy Clin North Am 2004;24(3):477–90, vii

  3. Garvey JP, Brown CM, Chotirmall SH, Dorman AM, Conlon PJ, Walshe JJ. Trimethoprim-sulfamethoxazole induced acute interstitial nephritis in renal allografts: clinical course and outcome. Clin Nephrol. 2009;72(5):331–6.

    PubMed  CAS  Google Scholar 

  4. Tuo MH, Tsai YH, Tseng HK, Wang WS, Liu CP, Lee CM. Clinical experiences of pulmonary and bloodstream nocardiosis in two tertiary care hospitals in northern Taiwan, 2000–2004. J Microbiol Immunol Infect. 2008;41(2):130–6.

    PubMed  Google Scholar 

  5. Ameen M, Arenas R, Vasquez del Mercado E, Fernandez R, Torres E, Zacarias R. Efficacy of imipenem therapy for Nocardia actinomycetomas refractory to sulfonamides. J Am Acad Dermatol. 2010;62(2):239–46.

    PubMed  Article  CAS  Google Scholar 

  6. Wang L, Zhang Y, Lu Z, et al. Nocardia beijingensis sp. nov., a novel isolate from soil. Int J Syst Evol Microbiol. 2001;51(pt 5):1783–8.

    PubMed  Article  CAS  Google Scholar 

  7. Kageyama A, Poonwan N, Yazawa K, Mikami Y, Nishimura K. Nocardia beijingensis is a pathogenic bacterium to humans: the first infectious cases in Thailand and Japan. Mycopathologia. 2004;157(2):155–61.

    PubMed  Article  Google Scholar 

  8. Takayanagi K, Kimura Y, Kawakami K, Koyama K, Harada Y, Yamaryo T. A case of pulmonary nocardiosis with Nocardia beijingensis. Kansenshogaku Zasshi. 2008;82(1):43–6.

    PubMed  Google Scholar 

  9. Beaman BL, Burnside J, Edwards B, Causey W. Nocardial infections in the United States, 1972–1974. J Infect Dis. 1976;134(3):286–9.

    PubMed  Article  CAS  Google Scholar 

  10. Queipo-Zaragoza JA, Broseta-Rico E, Alapont-Alacreu JM, Santos-Durantez M, Sanchez-Plumed J, Jimenez-Cruz JF. Nocardial infection in immunosuppressed kidney transplant recipients. Scand J Urol Nephrol. 2004;38(2):168–73.

    PubMed  Article  CAS  Google Scholar 

  11. Peleg AY, Husain S, Qureshi ZA, et al. Risk factors, clinical characteristics, and outcome of Nocardia infection in organ transplant recipients: a matched case–control study. Clin Infect Dis. 2007;44(10):1307–14.

    PubMed  Article  Google Scholar 

  12. McNeil MM, Brown JM. The medically important aerobic actinomycetes: epidemiology and microbiology. Clin Microbiol Rev. 1994;7(3):357–417.

    PubMed  CAS  Google Scholar 

  13. Cercenado E, Marin M, Sanchez-Martinez M, Cuevas O, Martinez-Alarcon J, Bouza E. In vitro activities of tigecycline and eight other antimicrobials against different Nocardia species identified by molecular methods. Antimicrob Agents Chemother. 2007;51(3):1102–4.

    PubMed  Article  CAS  Google Scholar 

  14. Chu RW, Lung D, Wong SN. Pulmonary abscess caused by Nocardia beijingensis: the second report of human infection. Pediatr Infect Dis J. 2008;27(6):572–3.

    PubMed  Google Scholar 

  15. Lai CC, Tan CK, Lin SH, et al. Comparative in vitro activities of nemonoxacin, doripenem, tigecycline and 16 other antimicrobials against Nocardia brasiliensis, Nocardia asteroides and unusual Nocardia species. J Antimicrob Chemother. 2009;64(1):73–8.

    PubMed  Article  CAS  Google Scholar 

  16. Reddy AK, Garg P, Kaur I. Speciation and susceptibility of Nocardia isolated from ocular infections. Clin Microbiol Infect 2010;16(8):1168–71.

    Google Scholar 

  17. Tan CK, Lai CC, Lin SH, et al. Clinical and microbiological characteristics of nocardiosis including those caused by emerging Nocardia species in Taiwan, 1998–2008. Clin Microbiol Infect 2010;16(7):966–72.

    Google Scholar 

  18. Lerner PI. Nocardiosis. Clin Infect Dis. 1996;22(6):891–903. (quiz 904–905).

    PubMed  Article  CAS  Google Scholar 

  19. van Burik JA, Hackman RC, Nadeem SQ, et al. Nocardiosis after bone marrow transplantation: a retrospective study. Clin Infect Dis. 1997;24(6):1154–60.

    PubMed  Article  Google Scholar 

  20. Husain S, McCurry K, Dauber J, Singh N, Kusne S. Nocardia infection in lung transplant recipients. J Heart Lung Transplant. 2002;21(3):354–9.

    PubMed  Article  Google Scholar 

  21. Lopez FA, Johnson F, Novosad DM, Beaman BL, Holodniy M. Successful management of disseminated Nocardia transvalensis infection in a heart transplant recipient after development of sulfonamide resistance: case report and review. J Heart Lung Transplant. 2003;22(4):492–7.

    PubMed  Article  Google Scholar 

  22. Gowrinath K, Baig WW, Prabhu AR, Chawla K, Bairy I. Pulmonary nocardiosis due to Nocardia farcinica in a renal transplant recipient. Indian J Chest Dis Allied Sci. 2009;51(4):237–9.

    PubMed  CAS  Google Scholar 

  23. Steingrube VA, Wallace RJ Jr, Brown BA, et al. Acquired resistance of Nocardia brasiliensis to clavulanic acid related to a change in beta-lactamase following therapy with amoxicillin–clavulanic acid. Antimicrob Agents Chemother. 1991;35(3):524–8.

    PubMed  CAS  Google Scholar 

  24. Sorrell TC, Mitchell DH, Iredell JR, Chen S. Nocardia species. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases, vol 2. 7th edn ed. Philadelphia: Churchill Livingstone/Elsevier; 2009. p. 3205–6.

    Google Scholar 

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Correspondence to Kei Kasahara.

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Ogawa, T., Kasahara, K., Yonekawa, S. et al. Nocardia beijingensis pulmonary infection successfully treated with intravenous beta-lactam antibiotics and oral minocycline. J Infect Chemother 17, 706–709 (2011). https://doi.org/10.1007/s10156-011-0233-2

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  • DOI: https://doi.org/10.1007/s10156-011-0233-2

Keywords

  • Nocardia beijingensis
  • Beta-lactam antibiotics
  • Pulmonary nocardiosis
  • Trimethoprim-sulfamethoxazole
  • Minocycline