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Pulmonary nocardiosis

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Abstract

Pulmonary nocardiosis is an uncommon but serious infection that is increasingly found in immunosuppressed persons, especially transplant recipients and persons with AIDS. The Nocardia species are denizens of soil and decaying plants that gain entry to humans through inhalation or inoculation. Pulmonary nocardiosis typically presents as an acute to subacute necrotizing pneumonia, with a variable clinical picture. Metastatic infections of the brain and subcutaneous tissues are common complications. Most clinical laboratories can isolate these microorganisms, but final speciation may be a challenge and antimicrobial susceptibility testing is especially difficult because of the slow rate of growth of Nocardia species. Full identification of species and susceptibility testing is important because of the epidemiologic implications and the difficulties of successfully treating these infections in immunosuppressed patients. Sulfonamides, including trimethoprim-sulfamethoxazole, remain the most reliable antimicrobials. Many alternative agents are active against Nocardia in vitro, but clinical data are limited.

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References and Recommended Reading

  1. Haas L: Edmond Isidore Etienne Nocard (1850-1903). J Neurol Neurosurg Psychiatry 2000, 69:130.

    Article  Google Scholar 

  2. Sorrell TC, Iredell JR, Mitchell DH: Nocardia species. In Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases, edn 5. Edited by Mandell GL, Bennett JE, Dolin R. Philadelphia: Churchill Livingstone; 2000:2637–2645.

    Google Scholar 

  3. Land G, McGinnis MR, Staneck J, et al.: Aerobic pathogenic Actinomycetales. In Manual of Clinical Microbiology, edn 5.Edited by Balows A. Washington, DC: American Society for Microbiology; 1991:340–359.

    Google Scholar 

  4. Laurent FJ, Provost F, Boiron P: Rapid identification of clinically relevant Nocardia species to genus level by 16S rRNA gene PCR. J Clin Microbiol 1999, 37:99–102.An excellent description of the utility of polymerase chain reaction for rapidly distinguishing members of the genus Nocardia from non-Nocardia species in culture.

    PubMed  CAS  Google Scholar 

  5. Conville PS, Fischer SH, Cartwright CP, et al.: Identification of Nocardia species by restriction endonuclease analysis of an amplified portion of the 16S rRNA gene. J Clin Microbiol 2000, 38:158–164.A good description of the methods and application of restriction endonuclease analysis for identification of Nocardia species.

    Google Scholar 

  6. Blümel J, Blümel E, Yassin AF, et al.: Typing of Nocardia farcinica by pulsed-field gel electrophoresis reveals an endemic strain as source of hospital infections. J Clin Microbiol 1998, 36:118–122.

    PubMed  Google Scholar 

  7. Louie L, Louie M, Simor AE: Investigation of a pseudooutbreak of Nocardia asteroides infection by pulsed-field gel electrophoresis and randomly amplified polymorphic DNA PCR. J Clin Microbiol 1997, 35:1582–1584.

    PubMed  CAS  Google Scholar 

  8. Curry WA: Human nocardiosis. A clinical review with selected case reports. Arch Intern Med 1980, 140:818–826.

    Article  PubMed  CAS  Google Scholar 

  9. Dominguez DC, Antony SJ: Actinomyces and Nocardia infections in immunocompromised and nonimmunocompromised patients. J Natl Med Assoc 1999, 91:35–39.

    PubMed  CAS  Google Scholar 

  10. Menendez R, Cordero PJ, Santos M, et al.: Pulmonary infection with Nocardia species: a report of 10 cases and review. Eur Respir J 1997, 10:1542–1546.

    Article  PubMed  CAS  Google Scholar 

  11. Uttamchandani RB, Daikos GL, Reyes RR, et al.: Nocardiosis in 30 patients with advanced human immunodeficiency virus infection: clinical features and outcome. Clin Infect Dis 1994, 18:348–353.

    PubMed  CAS  Google Scholar 

  12. Machado CM, Macedo MC, Castelli JB, et al.: Clinical features and successful recovery from disseminated nocardiosis after BMT. Bone Marrow Transplant 1997, 19:81–82.

    Article  PubMed  CAS  Google Scholar 

  13. Bhave AA, Thirunavukkarasu K, Gottlieb DJ, et al.: Disseminated nocardiosis in a bone marrow transplant recipient with chronic GVHD. Bone Marrow Transplant 1999, 23:519–521.

    Article  PubMed  CAS  Google Scholar 

  14. Palmer SM, Kanj SS, Davis RD, et al.: A case of disseminated infection with Nocardia brasiliensis in a lung transplant recipient. Transplantation 1997, 63:1189–1190.

    Article  PubMed  Google Scholar 

  15. Muñoz P, Palomo J, Guembe P, et al.: Lung nodular lesions in heart transplant recipients. J Heart Lung Transplant 2000, 19:660–667.

    Article  Google Scholar 

  16. Magee CC, Halligan RD, Milford EL, et al.: Nocardial infection in a renal transplant recipient on tacrolimus and mycophenolate mofetil. Clin Nephrol 1999, 52:44–46.

    PubMed  CAS  Google Scholar 

  17. Reddy SS, Holley JL: Nocardiosis in a recently transplanted renal patient. Clin Nephrol 1998, 50:123–127.

    PubMed  CAS  Google Scholar 

  18. Rinaldi S, D’Argenio P, Fiscarelli E, et al.: Fatal disseminated Nocardia farcinica infection in a renal transplant recipient. Pediatr Nephrol 2000, 14:111–113.

    Article  Google Scholar 

  19. Maccario M, Tortorano AM, Ponticelli C: Subcutaneous nodules and pneumonia in a kidney transplant recipient. Nephrol Dialysis Transplant 1998, 13:796–798.

    Article  CAS  Google Scholar 

  20. Lerner PI: Nocardiosis. Clin Infect Dis 1996, 22:891–905.

    PubMed  CAS  Google Scholar 

  21. Fijen CAP, Schrama J, Kuijper EJ, et al.: Infection due to Nocardia farcinica in a woman with chronic granulomatous disease. Clin Infect Dis 1998, 26:222–224.

    Article  PubMed  CAS  Google Scholar 

  22. Shetty AK, Arvin AM, Gutierrez KM: Nocardia farcinica pneumonia in chronic granulomatous disease. Pediatrics 1999, 104:961–964.

    Article  PubMed  CAS  Google Scholar 

  23. Mok CC, Yuen KY, Lau CS: Nocardiosis in systemic lupus erythematosus. Semin Arthritis Rheum 1997, 26:675–683.

    Article  PubMed  CAS  Google Scholar 

  24. Leong KP, Tee NWS, Yap WM, et al.: Nocardiosis in patients with systemic lupus erythematosus. J Rheumatol 2000, 27:1306–1312.

    Google Scholar 

  25. Vohra P, Burroughs MH, Hodes DS, et al.: Disseminated nocardiosis complicating medical therapy in Crohn’s disease. J Pediatr Gastroenterol Nutr 1997, 25:233–235.

    Article  PubMed  CAS  Google Scholar 

  26. Shimizu T, Furumoto H, Asagami C, et al.: Disseminated subcutaneous Nocardia farcinica abscesses in a nephrotic syndrome patient. J Am Acad Dermatol 1998, 38:874–876.

    Article  PubMed  CAS  Google Scholar 

  27. Cremades MJ, Menendez R, Santos M, et al.: Repeated pulmonary infection by Nocardia asteroides complex in a patient with bronchiectasis. Respiration 1998, 65:211–213.

    Article  PubMed  CAS  Google Scholar 

  28. Kroe DM, Shulman N, Kirsch CM, et al.: An anterior mediastinal mass with draining sternal sinus tracts due to Nocardia brasiliensis. West J Med 1997, 167:47–49.

    PubMed  CAS  Google Scholar 

  29. Jose MD, Bannister KM, Clarkson AR, et al.: Mesangiocapillary glomerulonephritis in a patient with Nocardia pneumonia. Nephrol Dialysis Transplant 1998, 13:2628–2629.

    Article  CAS  Google Scholar 

  30. Dockrell DH, Poland GA: Hypercalcemia in a patient with hypoparathyroidism and Nocardia asteroides infection: a novel observation. Mayo Clin Proc 1997, 72:757–760.

    PubMed  CAS  Google Scholar 

  31. Osoagbaka OU, Reiss E, Kaufman L: Immunodominant Nocardia asteroides antigens: isolation and characterization by enzyme-linked immunoelectrotransfer blotting, and the value of immunoblot strips. Br J Biomed Sci 1998, 55:258–263.

    Article  PubMed  CAS  Google Scholar 

  32. National Committee for Clinical Laboratory Standards: Susceptibility Testing of Mycobacteria, Nocardia, and Other Aerobic Actinomycetes, edn 2. Tentative standard M24-T2. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000. The NCCLS is establishing standards for susceptibility testing of Nocardia species. These standards may be revised as experience and comments are received over the next 2 years, but this is a useful document nonetheless.

    Google Scholar 

  33. Ambaye A, Kohner PC, Wollan PC, et al.: Comparison of agar dilution, broth microdilution, disk diffusion, E-test, and BACTEC radiometric methods for antimicrobial susceptibility testing of clinical isolates of the Nocardia asteroides complex. J Clin Microbiol 1997, 35:847–852.

    PubMed  CAS  Google Scholar 

  34. Leitersdorf I, Silver J, Naparstek E, et al.: Tetracycline derivatives, alternative treatment for nocardiosis in transplanted patients. Clin Nephrol 1997, 48:48–51.

    PubMed  CAS  Google Scholar 

  35. Brown BA, Ward SC, Mann L, et al.: In vitro activity of linezolid against multiple species of Nocardia: a new drug of choice for a difficult disease [abstract P00-0184]. Paper presented at Proceedings of the 100th General Meeting of the American Society for Microbiology. May 21–25, 2000. Los Angeles, CA.

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Baracco, G.J., Dickinson, G.M. Pulmonary nocardiosis. Curr Infect Dis Rep 3, 286–292 (2001). https://doi.org/10.1007/s11908-001-0032-5

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  • DOI: https://doi.org/10.1007/s11908-001-0032-5

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