Nocardiosis manifests as an opportunistic infection,primarily affecting individuals who are immunocompromised and susceptible to the infection.We present a case study of one patient with nephrotic syndrome and membran...Nocardiosis manifests as an opportunistic infection,primarily affecting individuals who are immunocompromised and susceptible to the infection.We present a case study of one patient with nephrotic syndrome and membranous nephropathy,who underwent treatment with prednisone and cyclosporine in 2016.In early 2017,the patient was diagnosed with a"fungal infection"and discontinued the use of cyclosporine.After one month of anti-infection therapy,a cranial magnetic resonance imaging scan showed multiple abscesses in the right temporal region.The diagnosis of nocardiosis was confirmed based on the presence of metastatic abscess masses,multiple lung and brain lesions,and a positive culture of Nocardia in the drainage.We changed the anti-infection therapy to a combination of trimethoprim-sulfamethoxazole(TMP-SMX),minocycline,and voriconazole.However,the patient experienced a sudden cardiac arrest and subsequently recovered after cardiopulmonary resuscitation.During the five-month follow-up period following the discharge,the patient displayed an enhanced nutritional status and stable renal function.The focal infection ultimately resolved during the subsequent three years.Neuro-infection caused by Nocardia should be considered in immunocompromised patients,and TMP-SMX is the preferred initial therapy;however,because of the high mortality rate,a long-term combination therapy with imipenem,cefotaxime,amikacin,and TMP-SMX is suggested.展开更多
BACKGROUND Infections by non-tuberculous mycobacteria(NTM)have become more common in recent years.Mycobacterium canariasense(M.canariasense)was first reported as an opportunistic pathogen in 2004,but there have been v...BACKGROUND Infections by non-tuberculous mycobacteria(NTM)have become more common in recent years.Mycobacterium canariasense(M.canariasense)was first reported as an opportunistic pathogen in 2004,but there have been very few case reports since then.Nocardia is a genus of aerobic and Gram-positive bacilli,and these species are also opportunistic pathogens and in the Mycobacteriales order.Conventional methods for diagnosis of NTM are inefficient.Metagenomic next-generation sequencing(mNGS)can rapidly detect many pathogenic microorganisms,even rare species.Most NTM and Nocardia infections occur in immunocompromised patients with atypical clinical symptoms.There are no previous reports of infection by M.canariasense and Nocardia farcinica(N.farcinica),especially in immunocompetent patients.This case report describes an immunocompetent 52-year-old woman who had overlapping infections of M.canariasense,N.farcinica,and Candida parapsilosis(C.parapsilosis)based on mNGS.CASE SUMMARY A 52-year-old woman presented with a productive cough and chest pain for 2 wk,and recurrent episodes of moderate-grade fever for 1 wk.She received antibiotics for 1 wk at a local hospital,and experienced defervescence,but the productive cough and chest pain persisted.We collected samples of a lung lesion and alveolar lavage fluid for mNGS.The lung tissue was positive for M.canariasense,N.farcinica,and C.parapsilosis,and the alveolar lavage fluid was positive for M.canariasense.The diagnosis was pneumonia,and application of appropriate antibiotic therapy cured the patient.CONCLUSION Etiological diagnosis is critical for patients with infectious diseases.mNGS can identify rare and novel pathogens,and does not require a priori knowledge.展开更多
BACKGROUND Nocardia pneumonia shares similar imaging and clinical features with pulmonary tuberculosis and lung neoplasms,but the treatment and anti-infective medication are completely different.Here,we report a case ...BACKGROUND Nocardia pneumonia shares similar imaging and clinical features with pulmonary tuberculosis and lung neoplasms,but the treatment and anti-infective medication are completely different.Here,we report a case of pulmonary nocardiosis caused by Nocardia cyriacigeorgica(N.cyriacigeorgica),which was misdiagnosed as community-acquired pneumonia(CAP)with repeated fever.CASE SUMMARY A 55-year-old female was diagnosed with community-acquired pneumonia in the local hospital because of repeated fever and chest pain for two months.After the anti-infection treatment failed in the local hospital,the patient came to our hospital for further treatment.Enhanced computed tomography showed multiple patchy,nodular and strip-shaped high-density shadows in both lungs.A routine haematological examination was performed and showed abnormalities in CD19+B cells and CD4+T cells.Positive acid-fast bifurcating filaments and branching gram-positive rods were observed in the bronchoalveolar lavage fluid of the patient under an oil microscope,which was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry as N.cyriacigeorgica.The patient’s condition quickly improved after taking 0.96 g compound sulfamethoxazole tablets three times a day.CONCLUSION The antibiotic treatment of Nocardia pneumonia is different from that of common CAP.Attention should be given to the pathogenic examination results of patients with recurrent fever.Nocardia pneumonia is an opportunistic infection.Patients with CD4+T-cell deficiency should be aware of Nocardia infection.展开更多
BACKGROUND Nocardia infection is a relatively uncommon disease,with no reports among patients with interstitial pneumonia.Due to its atypical clinical symptoms and chest computed tomography(CT)findings and the frequen...BACKGROUND Nocardia infection is a relatively uncommon disease,with no reports among patients with interstitial pneumonia.Due to its atypical clinical symptoms and chest computed tomography(CT)findings and the frequent yielding of negative results by conventional cultures,it poses challenges for timely diagnosis and treatment.CASE SUMMARY A 63-year-old female patient presented to our hospital in July 2022 with a 3-mo history of intermittent cough and poor appetite,accompanied by a 2-wk long duration of headaches.She had a previous medical history of interstitial pneumonia and was on oral prednisone and cyclosporine.Chest CT revealed the presence of newly developed round nodules.The diagnosis of Nocardia cyriacigeorgica infection was confirmed through metagenomic next-generation sequencing(mNGS)performed on bronchoalveolar lavage fluid.Targeted antiinfection therapy was initiated,resulting in symptom improvement and radiological resolution,further validating the mNGS results.CONCLUSION Nocardia cyriacigeorgica infection is a clinically rare condition that is primarily observed in immunocompromised patients.Its clinical and radiological manifestations lack specificity,but mNGS can aid in rapidly obtaining pathogenic information.Early initiation of targeted antimicrobial therapy based on mNGS results can improve patient prognosis.展开更多
BACKGROUND Nocardia cyriacigeorgica (N. cyriacigeorgica) infection is uncommon in clinicalpractice. Pulmonary sequestration complicated with N. cyriacigeorgica has notbeen reported in the literature. Here, we present ...BACKGROUND Nocardia cyriacigeorgica (N. cyriacigeorgica) infection is uncommon in clinicalpractice. Pulmonary sequestration complicated with N. cyriacigeorgica has notbeen reported in the literature. Here, we present a case of pulmonary sequestrationcomplicated with N. cyriacigeorgica infection in an immunocom-petentwoman.CASE SUMMARYA 37-year-old woman complaining of a recurrent cough was admitted to ourhospital. Pulmonary sequestration in the lower lobe of the left lung wasdiagnosed by enhanced computed tomography. Bronchoalveolar lavage fluid wasthen collected, which showed gram positive bacilli with weakly positive modifiedacid-fast staining. The pathogen was identified as N. cyriacigeorgica after bacterialculture and mass spectrometry analysis. The patient was diagnosed withpulmonary sequestration complicated with N. cyriacigeorgica infection, and hersymptoms quickly improved following anti-infective therapy.CONCLUSION Nocardiosis is considered to be an opportunistic infection. This is the first reportof pulmonary sequestration complicated with N. cyriacigeorgica infection in apatient with normal immunity.展开更多
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,brai...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.展开更多
Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients.We reported a case of 36 year o...Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients.We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever,cough with scanty sputum,hemoptysis,left sided chest pain and exertional dyspnea for two weeks.There was no past history of tuberculosis,diabetes mellitus or steroid therapy.Chest X-ray showed homogenous peripherally based opacity in the left upper zone.Bronchoscopy was done and brushing sent for culture,which showed colonies with features of Nocardia species after 48 hours.Further phenotypic characterization revealed it to be Nocardia otitidiscaviarum.Patient was treated with cotrimaxazole for six months after which complete recovery was evidenced symptomatically and radiologically.We report this case to emphasize the fact that among the Nocardia species,Nocardia otitidiscaviarum as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals.展开更多
BACKGROUND Streptococcus suis(S.suis)is an anthropozoonotic pathogen that shows clinical manifestations of meningitis,septicemia,and arthritis in infected humans.Nocardia is another type of anthropozoonotic bacteria,w...BACKGROUND Streptococcus suis(S.suis)is an anthropozoonotic pathogen that shows clinical manifestations of meningitis,septicemia,and arthritis in infected humans.Nocardia is another type of anthropozoonotic bacteria,with clinical manifestations of skin,lung,and brain abscesses in infected humans.Few intracranial infections caused by S.suis or Nocardia have been reported.To the best of our knowledge,no study has reported a patient with simultaneous intracranial infection by S.suis and Nocardia.CASE SUMMARY A 66-year-old male presented at Liaocheng People’s Hospital(Liaocheng,Shandong Province,China)reporting dizziness with nausea and vomiting.Metagenomic next-generation sequencing(m NGS)was performed on cerebrospinal fluid for examination,and the patient was diagnosed with suppurative meningitis caused by S.suis infection.He received anti-infection treatment with penicillin sodium and ceftriaxone.The patient’s condition initially improved but then deteriorated.Further m NGS of cerebrospinal fluid revealed both S.suis and Nocardia.Imaging examination revealed a brain abscess.Furthermore,a mixed infection of S.suis and Nocardia was detected in the patient’s central nervous system.The patient was treated with antibiotics and sulfamethoxazole.He was discharged after his condition improved.CONCLUSION This case shows that the disease can be recurrent in patients with intracranial infection of a rare pathogen.The possibility of mixed infection should also be considered,especially in patients treated with immunosuppressive agents.m NGS of cerebrospinal fluid is a supplement to conventional microbial pathogen identification methods.Patients with unknown pathogen diagnosis,early extensive use of antibiotics and infection with rare pathogens can be diagnosed by the combination of conventional methods and m NGS of cerebrospinal fluid.展开更多
Objective:To isolate and identify Nocardiaspp. from soil in different regions of Isfahan province in the center of Iran.Methods:This study was conducted in 32 districts(16 cities and 16 villages)in Isfahan province du...Objective:To isolate and identify Nocardiaspp. from soil in different regions of Isfahan province in the center of Iran.Methods:This study was conducted in 32 districts(16 cities and 16 villages)in Isfahan province during two years. A total of 800 soil samples from these regions were studied by using kanamycin. The isolated Nocardiaspecies were examined by gram and acid-fast staining and were identified biochemically and morphologically. The frequency and distribution of Nocardia spp. were determined in relation to different factors such as soil pH and temperate climate.Results:From 153(19.1%)Nocardiaisolates identified,Nocardia asteroids(N. asteroids)complex(45.5%) andNocardia brasiliensis(N. brasiliensis)(24.7%) were the most frequently isolated species, followed by Nocardia otitidiscaviarum (2.2%),Nocardiopsis dassonvillei,Actinom adura actinomadura(each 1.7%) and Nocardia transvalensis(1.1%) and also unknown spp.(23.0%). In this study, most species(54.4%) of Nocardia, especially N. asteroides complex were isolated fromsoils with pH: 7.01-8, whereas in pH: 8.01-9 more N. brasiliensis was isolated. The most Nocardia spp. was detected from regions with semi-nomadic and temperate climate(41.1%).Conclusions:N. asteroids complex is more prevalent in Isfahan province and soil can be a potential source of nocardiosis infections. It is to be considering that climate and soil pH are involved in the frequency and diversity of aerobic Actinomy cetes.展开更多
Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts.Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for t...Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts.Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for two days.Diagnosis: Disseminated nocardiosis due to Nocardia otitidiscaviarum. Interventions: Initial antimicrobial therapy with imipenem and trimethoprim/sulfamethoxazole was switched to 6 weeks of trimethoprim/sulfamethoxazole, linezolid and tigecycline after sensitivity test results were available. Thereafter, the patient was switched to maintenance trimethoprim/sulfamethoxazole and moxifloxacin. Prednisolone was gradually tapered.Outcomes: Soft tissue swelling and pain disappeared and the patient was discharged uneventfully.Lessons: Disseminated nocardiosis due to Nocardia otitidiscaviarum should be suspected in immunocompetent hosts with risk factors such as medication with prednisolone. Early identification of the causative species and susceptibility results is crucial given the diverse resistance patterns amongst various Nocardia species.展开更多
Objective:To observe and compare the curative effect between the intrapleural-chemotherapy combined Nocardia rubra cell wall skeleton-injection and the Nocardia rubra cell wall skeleton-injection after control of the ...Objective:To observe and compare the curative effect between the intrapleural-chemotherapy combined Nocardia rubra cell wall skeleton-injection and the Nocardia rubra cell wall skeleton-injection after control of the malignant pleural effusion by chemotherapy.Methods:Every time after elimination of pleural effusion,we injected DDP and Nocardia rubra cell wall skeleton at the same time into pleural cavity;or after we emplaced an improved central vena catheter into pleural cavity then took out closed-drainage or eliminated the pleural effusion every day,then injected 5-FU 0.5 qd intrapleural-space.After the malignant pleural effusion had being controlled,800μg Nocardia rubra cell wall skeleton was injected intrapleural-space. (We call it as"improved following-therapy").Results:Using the improved following-therapy,the control rate of malignant pleural effusion increased:CR+PR,79.07%>65.79%(P<0.05),and the incidence rate of the encapsulated pleural effusion that would impact on patient’s respiratory faction decreased.Conclusion:Giving chemotherapy after closed-drainage or immediately after taking out pleural effusion everyday,then giving biotherapy after pleural effusion had been controlled,the curative effect would be enhanced and the side-reaction would be reduced.展开更多
Nocardiosis diagnosis is a major challenge. The clinical features and radiological findings are nonspecific. Traditionally, Nocardia identification is based on colonial and microscopical morphology and biochemical tes...Nocardiosis diagnosis is a major challenge. The clinical features and radiological findings are nonspecific. Traditionally, Nocardia identification is based on colonial and microscopical morphology and biochemical tests. However, molecular biology techniques allow a better characterization of species and biotypes. PCR-RFLP of the 65-kDa heat shock protein (HSP) gene provides a rapid, sensitive, and time and labor-efficient method for this proposal. Using this technique, six of eight isolates tested were identified as Nocardia asteroides type VI. PCR-RFLP of the 65-kDa HSP gene could be very useful for determining the incidence of this pathogen in different population groups and its association with susceptibility/resistance profiles to the drugs of choice for treatment. This work is the first molecular detection of Nocardia species in Cuba.展开更多
基金funded by grants from the National Natural Science Foundation of China(Grant No.81570666)International Society of Nephrology Clinical Research Program(Grant No.18-01-0247)+3 种基金Program of Jiangsu Clinical Research Center(Grant No.BL2014084)Jiangsu Province Key Medical Personnel Project(Grant No.ZDRCA2016002)CKD Anemia Research Foundation from China International Medical Foundation(Grant No.Z-2017-24-2037)Outstanding Young and Middle-aged Talents Support Program of the First Affiliated Hospital of Nanjing Medical University(Jiangsu Province Hospital).
文摘Nocardiosis manifests as an opportunistic infection,primarily affecting individuals who are immunocompromised and susceptible to the infection.We present a case study of one patient with nephrotic syndrome and membranous nephropathy,who underwent treatment with prednisone and cyclosporine in 2016.In early 2017,the patient was diagnosed with a"fungal infection"and discontinued the use of cyclosporine.After one month of anti-infection therapy,a cranial magnetic resonance imaging scan showed multiple abscesses in the right temporal region.The diagnosis of nocardiosis was confirmed based on the presence of metastatic abscess masses,multiple lung and brain lesions,and a positive culture of Nocardia in the drainage.We changed the anti-infection therapy to a combination of trimethoprim-sulfamethoxazole(TMP-SMX),minocycline,and voriconazole.However,the patient experienced a sudden cardiac arrest and subsequently recovered after cardiopulmonary resuscitation.During the five-month follow-up period following the discharge,the patient displayed an enhanced nutritional status and stable renal function.The focal infection ultimately resolved during the subsequent three years.Neuro-infection caused by Nocardia should be considered in immunocompromised patients,and TMP-SMX is the preferred initial therapy;however,because of the high mortality rate,a long-term combination therapy with imipenem,cefotaxime,amikacin,and TMP-SMX is suggested.
基金Supported by The Guangxi TCM Suitable Technology Development and Promotion Project,No.GZSY20-20.
文摘BACKGROUND Infections by non-tuberculous mycobacteria(NTM)have become more common in recent years.Mycobacterium canariasense(M.canariasense)was first reported as an opportunistic pathogen in 2004,but there have been very few case reports since then.Nocardia is a genus of aerobic and Gram-positive bacilli,and these species are also opportunistic pathogens and in the Mycobacteriales order.Conventional methods for diagnosis of NTM are inefficient.Metagenomic next-generation sequencing(mNGS)can rapidly detect many pathogenic microorganisms,even rare species.Most NTM and Nocardia infections occur in immunocompromised patients with atypical clinical symptoms.There are no previous reports of infection by M.canariasense and Nocardia farcinica(N.farcinica),especially in immunocompetent patients.This case report describes an immunocompetent 52-year-old woman who had overlapping infections of M.canariasense,N.farcinica,and Candida parapsilosis(C.parapsilosis)based on mNGS.CASE SUMMARY A 52-year-old woman presented with a productive cough and chest pain for 2 wk,and recurrent episodes of moderate-grade fever for 1 wk.She received antibiotics for 1 wk at a local hospital,and experienced defervescence,but the productive cough and chest pain persisted.We collected samples of a lung lesion and alveolar lavage fluid for mNGS.The lung tissue was positive for M.canariasense,N.farcinica,and C.parapsilosis,and the alveolar lavage fluid was positive for M.canariasense.The diagnosis was pneumonia,and application of appropriate antibiotic therapy cured the patient.CONCLUSION Etiological diagnosis is critical for patients with infectious diseases.mNGS can identify rare and novel pathogens,and does not require a priori knowledge.
文摘BACKGROUND Nocardia pneumonia shares similar imaging and clinical features with pulmonary tuberculosis and lung neoplasms,but the treatment and anti-infective medication are completely different.Here,we report a case of pulmonary nocardiosis caused by Nocardia cyriacigeorgica(N.cyriacigeorgica),which was misdiagnosed as community-acquired pneumonia(CAP)with repeated fever.CASE SUMMARY A 55-year-old female was diagnosed with community-acquired pneumonia in the local hospital because of repeated fever and chest pain for two months.After the anti-infection treatment failed in the local hospital,the patient came to our hospital for further treatment.Enhanced computed tomography showed multiple patchy,nodular and strip-shaped high-density shadows in both lungs.A routine haematological examination was performed and showed abnormalities in CD19+B cells and CD4+T cells.Positive acid-fast bifurcating filaments and branching gram-positive rods were observed in the bronchoalveolar lavage fluid of the patient under an oil microscope,which was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry as N.cyriacigeorgica.The patient’s condition quickly improved after taking 0.96 g compound sulfamethoxazole tablets three times a day.CONCLUSION The antibiotic treatment of Nocardia pneumonia is different from that of common CAP.Attention should be given to the pathogenic examination results of patients with recurrent fever.Nocardia pneumonia is an opportunistic infection.Patients with CD4+T-cell deficiency should be aware of Nocardia infection.
基金Medical Science and Technology Development Foundation,Nanjing Department of Health,No.YKK20067.
文摘BACKGROUND Nocardia infection is a relatively uncommon disease,with no reports among patients with interstitial pneumonia.Due to its atypical clinical symptoms and chest computed tomography(CT)findings and the frequent yielding of negative results by conventional cultures,it poses challenges for timely diagnosis and treatment.CASE SUMMARY A 63-year-old female patient presented to our hospital in July 2022 with a 3-mo history of intermittent cough and poor appetite,accompanied by a 2-wk long duration of headaches.She had a previous medical history of interstitial pneumonia and was on oral prednisone and cyclosporine.Chest CT revealed the presence of newly developed round nodules.The diagnosis of Nocardia cyriacigeorgica infection was confirmed through metagenomic next-generation sequencing(mNGS)performed on bronchoalveolar lavage fluid.Targeted antiinfection therapy was initiated,resulting in symptom improvement and radiological resolution,further validating the mNGS results.CONCLUSION Nocardia cyriacigeorgica infection is a clinically rare condition that is primarily observed in immunocompromised patients.Its clinical and radiological manifestations lack specificity,but mNGS can aid in rapidly obtaining pathogenic information.Early initiation of targeted antimicrobial therapy based on mNGS results can improve patient prognosis.
文摘BACKGROUND Nocardia cyriacigeorgica (N. cyriacigeorgica) infection is uncommon in clinicalpractice. Pulmonary sequestration complicated with N. cyriacigeorgica has notbeen reported in the literature. Here, we present a case of pulmonary sequestrationcomplicated with N. cyriacigeorgica infection in an immunocom-petentwoman.CASE SUMMARYA 37-year-old woman complaining of a recurrent cough was admitted to ourhospital. Pulmonary sequestration in the lower lobe of the left lung wasdiagnosed by enhanced computed tomography. Bronchoalveolar lavage fluid wasthen collected, which showed gram positive bacilli with weakly positive modifiedacid-fast staining. The pathogen was identified as N. cyriacigeorgica after bacterialculture and mass spectrometry analysis. The patient was diagnosed withpulmonary sequestration complicated with N. cyriacigeorgica infection, and hersymptoms quickly improved following anti-infective therapy.CONCLUSION Nocardiosis is considered to be an opportunistic infection. This is the first reportof pulmonary sequestration complicated with N. cyriacigeorgica infection in apatient with normal immunity.
文摘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.
文摘Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients.We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever,cough with scanty sputum,hemoptysis,left sided chest pain and exertional dyspnea for two weeks.There was no past history of tuberculosis,diabetes mellitus or steroid therapy.Chest X-ray showed homogenous peripherally based opacity in the left upper zone.Bronchoscopy was done and brushing sent for culture,which showed colonies with features of Nocardia species after 48 hours.Further phenotypic characterization revealed it to be Nocardia otitidiscaviarum.Patient was treated with cotrimaxazole for six months after which complete recovery was evidenced symptomatically and radiologically.We report this case to emphasize the fact that among the Nocardia species,Nocardia otitidiscaviarum as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals.
文摘BACKGROUND Streptococcus suis(S.suis)is an anthropozoonotic pathogen that shows clinical manifestations of meningitis,septicemia,and arthritis in infected humans.Nocardia is another type of anthropozoonotic bacteria,with clinical manifestations of skin,lung,and brain abscesses in infected humans.Few intracranial infections caused by S.suis or Nocardia have been reported.To the best of our knowledge,no study has reported a patient with simultaneous intracranial infection by S.suis and Nocardia.CASE SUMMARY A 66-year-old male presented at Liaocheng People’s Hospital(Liaocheng,Shandong Province,China)reporting dizziness with nausea and vomiting.Metagenomic next-generation sequencing(m NGS)was performed on cerebrospinal fluid for examination,and the patient was diagnosed with suppurative meningitis caused by S.suis infection.He received anti-infection treatment with penicillin sodium and ceftriaxone.The patient’s condition initially improved but then deteriorated.Further m NGS of cerebrospinal fluid revealed both S.suis and Nocardia.Imaging examination revealed a brain abscess.Furthermore,a mixed infection of S.suis and Nocardia was detected in the patient’s central nervous system.The patient was treated with antibiotics and sulfamethoxazole.He was discharged after his condition improved.CONCLUSION This case shows that the disease can be recurrent in patients with intracranial infection of a rare pathogen.The possibility of mixed infection should also be considered,especially in patients treated with immunosuppressive agents.m NGS of cerebrospinal fluid is a supplement to conventional microbial pathogen identification methods.Patients with unknown pathogen diagnosis,early extensive use of antibiotics and infection with rare pathogens can be diagnosed by the combination of conventional methods and m NGS of cerebrospinal fluid.
基金financially supported by Teheran University of Medical Sciences(grant No.TUMS/HF-2446)
文摘Objective:To isolate and identify Nocardiaspp. from soil in different regions of Isfahan province in the center of Iran.Methods:This study was conducted in 32 districts(16 cities and 16 villages)in Isfahan province during two years. A total of 800 soil samples from these regions were studied by using kanamycin. The isolated Nocardiaspecies were examined by gram and acid-fast staining and were identified biochemically and morphologically. The frequency and distribution of Nocardia spp. were determined in relation to different factors such as soil pH and temperate climate.Results:From 153(19.1%)Nocardiaisolates identified,Nocardia asteroids(N. asteroids)complex(45.5%) andNocardia brasiliensis(N. brasiliensis)(24.7%) were the most frequently isolated species, followed by Nocardia otitidiscaviarum (2.2%),Nocardiopsis dassonvillei,Actinom adura actinomadura(each 1.7%) and Nocardia transvalensis(1.1%) and also unknown spp.(23.0%). In this study, most species(54.4%) of Nocardia, especially N. asteroides complex were isolated fromsoils with pH: 7.01-8, whereas in pH: 8.01-9 more N. brasiliensis was isolated. The most Nocardia spp. was detected from regions with semi-nomadic and temperate climate(41.1%).Conclusions:N. asteroids complex is more prevalent in Isfahan province and soil can be a potential source of nocardiosis infections. It is to be considering that climate and soil pH are involved in the frequency and diversity of aerobic Actinomy cetes.
文摘Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts.Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for two days.Diagnosis: Disseminated nocardiosis due to Nocardia otitidiscaviarum. Interventions: Initial antimicrobial therapy with imipenem and trimethoprim/sulfamethoxazole was switched to 6 weeks of trimethoprim/sulfamethoxazole, linezolid and tigecycline after sensitivity test results were available. Thereafter, the patient was switched to maintenance trimethoprim/sulfamethoxazole and moxifloxacin. Prednisolone was gradually tapered.Outcomes: Soft tissue swelling and pain disappeared and the patient was discharged uneventfully.Lessons: Disseminated nocardiosis due to Nocardia otitidiscaviarum should be suspected in immunocompetent hosts with risk factors such as medication with prednisolone. Early identification of the causative species and susceptibility results is crucial given the diverse resistance patterns amongst various Nocardia species.
文摘Objective:To observe and compare the curative effect between the intrapleural-chemotherapy combined Nocardia rubra cell wall skeleton-injection and the Nocardia rubra cell wall skeleton-injection after control of the malignant pleural effusion by chemotherapy.Methods:Every time after elimination of pleural effusion,we injected DDP and Nocardia rubra cell wall skeleton at the same time into pleural cavity;or after we emplaced an improved central vena catheter into pleural cavity then took out closed-drainage or eliminated the pleural effusion every day,then injected 5-FU 0.5 qd intrapleural-space.After the malignant pleural effusion had being controlled,800μg Nocardia rubra cell wall skeleton was injected intrapleural-space. (We call it as"improved following-therapy").Results:Using the improved following-therapy,the control rate of malignant pleural effusion increased:CR+PR,79.07%>65.79%(P<0.05),and the incidence rate of the encapsulated pleural effusion that would impact on patient’s respiratory faction decreased.Conclusion:Giving chemotherapy after closed-drainage or immediately after taking out pleural effusion everyday,then giving biotherapy after pleural effusion had been controlled,the curative effect would be enhanced and the side-reaction would be reduced.
文摘Nocardiosis diagnosis is a major challenge. The clinical features and radiological findings are nonspecific. Traditionally, Nocardia identification is based on colonial and microscopical morphology and biochemical tests. However, molecular biology techniques allow a better characterization of species and biotypes. PCR-RFLP of the 65-kDa heat shock protein (HSP) gene provides a rapid, sensitive, and time and labor-efficient method for this proposal. Using this technique, six of eight isolates tested were identified as Nocardia asteroides type VI. PCR-RFLP of the 65-kDa HSP gene could be very useful for determining the incidence of this pathogen in different population groups and its association with susceptibility/resistance profiles to the drugs of choice for treatment. This work is the first molecular detection of Nocardia species in Cuba.
