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Nocardiosis: Updated Clinical Review and Experience at a Tertiary Center

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Abstract

Nocardiosis is a rare opportunistic disease that affects mainly patients with deficient cell-mediated immunity, such as those with acquired immunodeficiency syndrome (AIDS) or transplant recipients. Pulmonary disease is the most common presentation in immunosuppressed patients and approximately one-third have a disseminated disease. Primary cutaneous nocardiosis is more frequently observed in immunocompetent patients with direct inoculation of the organism through professional exposure. The diagnosis can be challenging, as signs and symptoms are not specific and a high index of clinical of suspicion is necessary. Although gram stain, modified acid-fast stain, and cultures remain as the standard diagnostic tools, novel molecular techniques have changed the taxonomy of these organisms and, in some instances, have facilitated their identification. The disease has a marked tendency to recur and a high morbidity and mortality rate in immunosuppressed patients. Treatment is usually prolonged and an associated antibiotic treatment is preferred for severe disease. Although sulfonamides in combination with other antibiotics are still the treatment of choice, other associations such as imipenem plus amikacin are preferred in some centers. Linezolid is a useful alternative therapeutic agent due to its oral availability and activity against most of the isolates studied. Twenty-eight cases of nocardiosis were diagnosed at our center between January 1989 and April 2009. We report the epidemiologic characteristics of Nocardia spp. observed in our institution and discuss the risk factors, clinical features, diagnosis, and management of the disease.

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References

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

    CAS  PubMed  Google Scholar 

  2. Filice GA: Nocardiosis in persons with human immunodeficiency virus infection, transplant recipients, and large, geographically defined populations. J Lab Clin Med 2005; 145: 156–162.

    Article  PubMed  Google Scholar 

  3. Brown-Elliott BA, Brown JM, Conville PS, Wallace RJ Jr: Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev 2006; 19: 259–282.

    Article  CAS  PubMed  Google Scholar 

  4. Yildiz O, Doganay M: Actinomycoses and Nocardia pulmonary infections. Curr Opin Pulm Med 2006; 12: 228–234.

    Article  PubMed  Google Scholar 

  5. Matulionyte R, Rohner P, Uçkay I, Lew D, Garbino J: Secular trends of Nocardia infection over 15 years in a tertiary care hospital. J Clin Pathol 2004; 57: 807–812.

    Article  CAS  PubMed  Google Scholar 

  6. Beaman BL, Burnside J, Edwards B, Causey W: Nocardial infections in the United States, 1972–1974. J Infect Dis 1976; 134: 286–289.

    CAS  PubMed  Google Scholar 

  7. Yildiz O, Alp E, Tokgoz B, Tucer B, Aygen B, Sumerkan B, Couble A, Boiron P, Doganay M: Nocardiosis in a teaching hospital in the Central Anatolia region of Turkey: treatment and outcome. Clin Microbiol Infect 2005; 11: 495–499.

    Article  CAS  PubMed  Google Scholar 

  8. Hui CH, Au VW, Rowland K, Slavotinek JP, Gordon DL: Pulmonary nocardiosis re-visited: experience of 35 patients at diagnosis. Respir Med 2003; 97: 709–717.

    Article  CAS  PubMed  Google Scholar 

  9. Ferrer A, Llorenç V, Codina G, De Gracia-Roldán J: Nocardiosis and bronchiectasis. An uncommon association? Enferm Infecc Microbiol Clin 2005; 23: 62–66.

    Article  PubMed  Google Scholar 

  10. Satterwhite TK, Wallace RJ Jr: Primary cutaneous nocardiosis. JAMA 1979; 242: 333–336.

    Article  CAS  PubMed  Google Scholar 

  11. Inamadar AC, Palit A: Primary cutaneous nocardiosis: a case study and review. Indian J Dermatol Venereol Leprol 2003; 69: 386–391.

    CAS  PubMed  Google Scholar 

  12. Fukuda H, Saotome A, Usami N, Urushibata O, Mukai H: Lymphocutaneous type of nocardiosis caused by Nocardia brasiliensis: a case report and review of primary cutaneous nocardiosis caused by N. brasiliensis reported in Japan. J Dermatol 2008; 35: 346–353.

    Article  PubMed  Google Scholar 

  13. Martínez R, Reyes S, Menéndez R: Pulmonary nocardiosis: risk factors, clinical features, diagnosis and prognosis. Curr Opin Pulm Med 2008; 14: 219–227.

    Article  PubMed  Google Scholar 

  14. Khan BA, Duncan M, Reynolds J, Wilkes DS: Nocardia infection in lung transplant recipients. Clin Transplant 2008; 22: 562–566.

    Article  PubMed  Google Scholar 

  15. 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: 492–497.

    Article  PubMed  Google Scholar 

  16. Kakihana K, Ohashi K, Iguchi M, Negishi K, Suzuki T, Shitara M, Honma M, Akiyama H, Sakamaki H: Frequent exacerbation of pulmonary nocardiosis during maintenance antibiotic therapies in a hematopoietic stem cell transplant recipient. Int J Hematol 2007; 86: 455–458.

    Article  CAS  PubMed  Google Scholar 

  17. Hamadani M, Benson DM Jr, Blum W, Garzon R, Devine SM: Pulmonary Nocardia and Aspergillus co-infection in a patient with chronic graft-versus-host disease. Transpl Infect Dis 2008; 10: 24–26.

    Article  CAS  PubMed  Google Scholar 

  18. Husain S, McCurry K, Dauber J, Singh N, Kusne S: Nocardia infection in lung transplant recipients. J Heart Lung Transplant 2002; 21: 354–359.

    Article  PubMed  Google Scholar 

  19. Peleg AY, Husain S, Qureshi ZA, Silveira FP, Sarumi M, Shutt KA, Kwak EJ, Paterson DL: Risk factors, clinical characteristics, and outcome of Nocardia infection in organ transplant recipients: a matched case-control study. Clin Infect Dis 2007; 44: 1307–1314.

    Article  PubMed  Google Scholar 

  20. Biscione F, Cecchini D, Ambrosioni J, Bianchi M, Corti M, Benetucci J: Nocardiosis in patients with human immunodeficiency virus infection. Enferm Infecc Microbiol Clin 2005; 23: 419–423.

    Article  PubMed  Google Scholar 

  21. Rasheed MU, Belay G: Nocardiosis in HIV seropositive clinically suspected pulmonary tuberculosis patients. Trop Doct 2008; 38: 34–35.

    Article  CAS  PubMed  Google Scholar 

  22. Uttamchandani RB, Daikos GL, Reyes RR, Fischl MA, Dickinson GM, Yamaguchi E, Kramer MR: Nocardiosis in 30 patients with advanced human immunodeficiency virus infection: clinical features and outcome. Clin Infect Dis 1994; 18: 348–353.

    CAS  PubMed  Google Scholar 

  23. Corti ME, Villafañe-Fioti MF: Nocardiosis: a review. Int J Infect Dis 2003; 7: 243–250.

    Article  PubMed  Google Scholar 

  24. Pintado V, Gómez-Mampaso E, Cobo J, Quereda C, Meseguer MA, Fortún J, Navas E, Moreno S: Nocardial infection in patients infected with the human immunodeficiency virus. Clin Microbiol Infect 2003; 9: 716–720.

    Article  CAS  PubMed  Google Scholar 

  25. Chouciño C, Goodman SA, Greer JP, Stein RS, Wolff SN, Dummer JS: Nocardial infections in bone marrow transplant recipients. Clin Infec Dis 1996; 23: 1012–1019.

    Google Scholar 

  26. Arduino RC, Johnson PC, Miranda AG: Nocardiosis in renal transplant recipients undergoing immunosuppression with cyclosporine. Clin Infect Dis 1993; 16: 505–512.

    CAS  PubMed  Google Scholar 

  27. Elenkov IJ: Glucocorticoids and the Th1/Th2 balance. Ann N Y Acad Sci 2004; 1024: 138–146.

    Article  CAS  PubMed  Google Scholar 

  28. Ono M, Kobayashi Y, Shibata T, Maruyama D, Kim SW, Watanabe T, Mikami Y, Tobinai K: Nocardia exalbida brain abscess in a patient with follicular lymphoma. Int J Hematol 2008; 88: 95–100.

    Article  PubMed  Google Scholar 

  29. Kundranda MN, Spiro TP, Muslimani A, Gopalakrishna KV, Melaragno MJ, Daw HA: Cerebral nocardiosis in a patient with NHL treated with rituximab. Am J Hematol 2007; 82: 1033–1034.

    Article  PubMed  Google Scholar 

  30. Ansari SR, Safdar A, Han XY, O’Brien S: Nocardia veterana bloodstream infection in a patient with cancer and a summary of reported cases. Int J Infect Dis 2006; 10: 483–486.

    Article  PubMed  Google Scholar 

  31. Christidou A, Maraki S, Scoulica E, Mantadakis E, Agelaki S, Samonis G: Fatal Nocardia farcinica bacteremia in a patient with lung cancer. Diagn Microbiol Infect Dis 2004; 50: 135–139.

    Article  PubMed  Google Scholar 

  32. Pruitt AA: Nervous system infections in patients with cancer. Neurol Clin 2003; 21: 193–219.

    Article  PubMed  Google Scholar 

  33. Sharma NL, Mahajan VK, Agarwal S, Katoch VM, Das R, Kashyap M, Gupta P, Verma GK: Nocardial mycetoma: diverse clinical presentations. Indian J Dermatol Venereol Leprol 2008; 74: 635–640.

    Article  PubMed  Google Scholar 

  34. Yin X, Liang S, Sun X, Luo S, Wang Z, Li R: Ocular nocardiosis: HSP65 gene sequencing for species identification of Nocardia spp.. Am J Ophthalmol 2007; 144: 570–573.

    Article  CAS  PubMed  Google Scholar 

  35. Bharathi MJ, Ramakrishnan R, Vasu S, Meenakshi, Chirayath A, Palaniappan R: Nocardia asteroides keratitis in South India. Indian J Med Microbiol 2003; 21: 31–36.

    CAS  PubMed  Google Scholar 

  36. Javadi MA, Kanavi MR, Zarei S, Mirbabaei F, Jamali H, Shoja M, Mahdavi M, Haghshgar N, Yazdani S, Faramarzi A: Outbreak of Nocardia keratitis after photorefractive keratectomy: clinical, microbiological, histopathological, and confocal scan study. J Cataract Refract Surg 2009; 35: 393–398.

    Article  PubMed  Google Scholar 

  37. Gates JD, Warth JA, McGowan K: Nocardia asteroides-infected aneurysm of the aorta: case report and review of the literature. Vascular 2006; 14: 165–168.

    Article  PubMed  Google Scholar 

  38. Kontoyiannis DP, Ruoff K, Hooper DC: Nocardia bacteremia. Report of 4 cases and review of the literature. Medicine (Baltimore) 1998; 77: 255–267.

    Article  CAS  Google Scholar 

  39. Van Luin A, Manson WL, van der Molen L, van der Heide JJ, van Son WJ: An intrarenal abscess as presenting symptom of an infection with Nocardia farcinica in a patient after renal transplantation. Transpl Infect Dis 2008; 10: 214–217.

    Article  PubMed  Google Scholar 

  40. Baraboutis IG, Argyropoulou A, Papastamopoulos V, Psaroudaki Z, Paniara O, Skoutelis AT: Primary sternal osteomyelitis caused by Nocardia nova: case report and literature review. Braz J Infect Dis 2008; 12: 257–259.

    Article  PubMed  Google Scholar 

  41. Saubolle MA, Sussland D: Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol 2003; 41: 4497–4501.

    Article  PubMed  Google Scholar 

  42. Ashdown LR: An improved screening technique for isolation of Nocardia species from sputum specimens. Pathology 1990; 22: 157–161.

    Article  CAS  PubMed  Google Scholar 

  43. Roth A, Andrees S, Kroppenstedt RM, Harmsen D, Mauch H: Phylogeny of the genus Nocardia based on reassessed 16S rRNA gene sequences reveals underspeciation and division of strains classified as Nocardia asteroides into three established species and two unnamed taxons. J Clin Microbiol 2003; 41: 851–856.

    Article  CAS  PubMed  Google Scholar 

  44. Tatti KM, Shieh WJ, Phillips S, Augenbraun M, Rao C, Zaki SR: Molecular diagnosis of Nocardia farcinica from a cerebral abscess. Hum Pathol 2006; 37: 1117–1121.

    Article  CAS  PubMed  Google Scholar 

  45. Alfaresi M, Elkosh A: Rapid identification of clinically relevant Nocardia species using real-time PCR with SYBR Green and melting-curve analysis. J Med Microbiol 2006; 55: 1711–1715.

    Article  CAS  PubMed  Google Scholar 

  46. Cloud JL, Conville PS, Croft A, Harmsen D, Witebsky FG, Carroll KC: Evaluation of partial 16S ribosomal DNA sequencing for identification of Nocardia species by using the MicroSeq 500 system with an expanded database. J Clin Microbiol 2004; 42: 578–584.

    Article  CAS  PubMed  Google Scholar 

  47. Smilack JD: Images in clinical medicine. Pulmonary and disseminated nocardiosis. N Engl J Med 1999; 341: 885.

    Article  CAS  PubMed  Google Scholar 

  48. Gezici AR, Daglioglu E, Ergungor F, Okay O, Polat O: Cerebral abscess caused by Nocardia nova. Neurol Neurochir Pol 2008; 42: 153–156.

    PubMed  Google Scholar 

  49. Diego C, Ambrosioni JC, Abel G, Fernando B, Tomás O, Ricardo N, Jorge B: Disseminated nocardiosis caused by Nocardia abscessus in an HIV-infected patient: first reported case. AIDS 2005; 19: 1330–1331.

    Article  PubMed  Google Scholar 

  50. Kennedy KJ, Chung KH, Bowden FJ, Mews PJ, Pik JH, Fuller JW, Chandran KN: A cluster of nocardial brain abscesses. Surg Neurol 2007; 68: 43–49.

    Article  PubMed  Google Scholar 

  51. Chakrabarti P, Nandi SS, Todi SK: Nocardia brain abscess in a diabetic patient. Indian J Pathol Microbiol 2008; 51: 151–153.

    Article  PubMed  Google Scholar 

  52. Vialle R, Aghakhani N, Otayza F, Monteanu V, Safi H, Tadie M: Nocardia farcinica brain abscess: clinical and specific radiological findings and management. Report of two cases in immunononcompromised patients. Neurochirurgie 2002; 48: 516–521.

    CAS  PubMed  Google Scholar 

  53. Marnet D, Brasme L, Peruzzi P, Bazin A, Diallo R, Servettaz A, Bernard MH, Rousseaux P, De Champs C, Jaussaud R, Scherpereel B: Nocardia brain abscess: features, therapeutic strategies and outcome. Rev Neurol (Paris) 2009; 165: 52–62.

    CAS  Google Scholar 

  54. Wallace RJ Jr, Septimus EJ, Williams TW Jr, Conklin RH, Satterwhite TK, Bushby MB, Hollowell DC: Use of trimethoprim-sulfamethoxazole for treatment of infections due to Nocardia. Rev Infect Dis 1982; 4: 315–325.

    CAS  PubMed  Google Scholar 

  55. Hitti W, Wolff M: Two cases of multidrug-resistant Nocardia farcinica infection in immunosuppressed patients and implications for empiric therapy. Eur J Clin Microbiol Infect Dis 2005; 24: 142–144.

    Article  CAS  PubMed  Google Scholar 

  56. Lerner PI: Nocardiosis. Clin Infect Dis 1996; 22: 891–903.

    CAS  PubMed  Google Scholar 

  57. Maraki S, Scoulica E, Alpantaki K, Dialynas M, Tselentis Y: Lymphocutaneous nocardiosis due to Nocardia brasiliensis. Diagn Microbiol Infect Dis 2003; 47: 341–344.

    Article  PubMed  Google Scholar 

  58. Negroni R, López Daneri G, Arechavala A, Bianchi MH, Robles AM: Clinical and microbiological study of mycetomas at the Muñiz hospital of Buenos Aires between 1989 and 2004. Rev Argent Microbiol 2006; 38: 13–18.

    CAS  PubMed  Google Scholar 

  59. Brown-Elliott BA, Ward SC, Crist CJ, Mann LB, Wilson RW, Wallace RJ Jr: In vitro activities of linezolid against multiple Nocardia species. Antimicrob Agents Chemother 2001; 45: 1295–1297.

    Article  CAS  PubMed  Google Scholar 

  60. Moylett EH, Pacheco SE, Brown-Elliott BA, Perry TR, Buescher ES, Birmingham MC, Schentag JJ, Gimbel JF, Apodaca A, Schwartz MA, Rakita RM, Wallace RJ Jr: Clinical experience with linezolid for the treatment of Nocardia infection. Clin Infect Dis 2003; 36: 313–318.

    Article  CAS  PubMed  Google Scholar 

  61. Jodlowski TZ, Melnychuk I, Conry J: Linezolid for the treatment of Nocardia spp. infections. Ann Pharmacother 2007; 41: 1694–1699.

    Article  CAS  PubMed  Google Scholar 

  62. Ntziora F, Falagas ME: Linezolid for the treatment of patients with central nervous system infection. Ann Pharmacother 2007; 41: 296–308.

    Article  CAS  PubMed  Google Scholar 

  63. Valarezo J, Cohen JE, Valarezo L, Spektor S, Shoshan Y, Rosenthal G, Umansky F: Nocardial cerebral abscess: report of three cases and review of the current neurosurgical management. Neurol Res 2003; 25: 27–30.

    Article  PubMed  Google Scholar 

  64. Dahan K, El Kabbaj D, Venditto M, Pastural M, Delahousse M: Intracranial Nocardia recurrence during fluorinated quinolones therapy. Transpl Infect Dis 2006; 8: 161–165.

    Article  CAS  PubMed  Google Scholar 

  65. Devi KR, Singh LR, Devi NT, Singh NS: Subcutaneous nocardial abscess in a post-renal transplant patient. Indian J Med Microbiol 2007; 25: 279–281.

    Article  CAS  PubMed  Google Scholar 

  66. Lichon V, Khachemoune A: Mycetoma: a review. Am J Clin Dermatol 2006; 7: 315–321.

    Article  PubMed  Google Scholar 

  67. Clare G, Mitchell S: Iris root abscess and necrotizing sclerokeratitis caused by Mycobacterium abscessus and presenting as hemorrhagic anterior uveitis. Cornea 2008; 27: 255–257.

    Article  PubMed  Google Scholar 

  68. Gokhale NS, Garg P, Rodrigues C, Haldipurkar S: Nocardia infection following phacoemulsification. Indian J Ophthalmol 2007; 55: 59–61.

    Article  PubMed  Google Scholar 

  69. Shah HR, Zamboni WA, Khiabani KT: Nocardial septic arthritis of the wrist diagnosed and treated by arthroscopy. Scand J Plast Reconstr Surg Hand Surg 2005; 39: 252–254.

    Article  PubMed  Google Scholar 

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Ambrosioni, J., Lew, D. & Garbino, J. Nocardiosis: Updated Clinical Review and Experience at a Tertiary Center. Infection 38, 89–97 (2010). https://doi.org/10.1007/s15010-009-9193-9

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