Nocardia infections among immunomodulated inflammatory bowel disease patients:A review

Human nocardiosis,caused by Nocardia spp.,an ubiquitous soil-borne bacteria,is a rare granulomatous disease close related to immune dysfunctions.Clinically can occur as an acute life-threatening disease,with lung,brain and skin being commonly affected.The infection was classically diagnosed in HIV infected persons,organ transplanted recipients and long term corticosteroid treated patients.Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario.Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings.We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals.Eleven cases of nocardiosis associated with anti-tumor necrosis factor(TNF) prescription(9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease(IBD),4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients,lung disease in 4 patients,hepatic in one and disseminated disease in 3 patients.From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine.In conclusion,nocardiosis requires high levels of clinical suspicion and experience of laboratory staff,in order to establish a timely diagnosis and by doing so avoid worst outcomes.Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential.The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated.

Chronic Meningococcemia

Neisseria meningitidis is a gram-negative diplococcus which causes invasive disease. The most frequent clinical manifestations caused by infection with this pathogen, are meningitis and fulminant septic shock. More benign forms with a subacute or chronic pattern are rare but still can evolve to meningitis and have a fatal outcome. This entity is difficult to recognize, as febrile erythema with otherwise good general condition may simulate other diseases, namely viral infections. The authors reported the cases of two healthy young adults who were misdiagnosed with a viral infection. What they really had was a meningococcemia without meningitis presenting with mild and unspecific symptoms, such as, intermittent fever and a discrete macular rash. We pretend to highlight this rare, unspecific and heterogeneous symptoms which can provoke negligence of a potentially life threatening condition.

BCG Infection after Bladder Cancer Treatment—3 Clinical Case Reports

Immunotherapy with Bacillus Calmette-Guérin (BCG) to treat non-muscle invasive bladder cancer has become an effective and superior alternative to chemotherapy. Intravesical treatment with BCG appears to be relatively safe;however, occasionally BCG infection complicates such treatment. In the present work we describe three patients in whom BCG infection occurred after intravesical BCG therapy. All patients had positive urine culture forMycobacterium tuberculosis complex, using AccuProbe culture identification and then Genotype Mycobacterium MTBC test identified Mycobacterium bovis BCG. The diagnosis is difficult and microbiologic study is usually negative, so high index of suspicion is essential.

Spondylodiscitis Caused by Streptococcus dysgalactiae Subspecies Equisimilis:A Case Report of an Increasingly Recognized Pathogenic Organism

Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a β-hemolytic Streptococcus that possesses genetic and clinical similarities to Streptococcus pyogenes. It is increasingly recognized as the etiological microorganism of invasive diseases. We report a case of a 74-year-old male who was admitted to this hospital with lower back and neck pain and infected with leg ulcer. The diagnosis of spondylodiscitis C2-C3 and L1-L3 caused by Streptococcus dysgalactiae subsp. equisimilis was made. The present case demonstrates the risk of older patients of developing invasive disease upon skin infection with Streptococcus dysgalactiae subsp. equisimilis, even when risk factors are absent or well controlled (as was diabetes mellitus in this case), suggesting that the pathogenic potential of SDSE should not be underestimated.