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PubMed1983

Nocardial infection of the skin.

This paper describes the relationship between different forms of nocardia infection involving the skin. The best recognized of these conditions are systemic nocardiosis and actinomycetoma due to Nocardia spp. in which the organisms are present in either filamentous or grain form respectively. Attention is drawn to evidence for the existence of a primary cutaneous form of nocardiosis which follows inoculation and in which the organisms grow in filamentous phase. It is not clear whether such cases can progress to mycetoma formation if left untreated, or whether other factors are involved. The clinical and laboratory features of these different clinical varieties of nocardia infection are discussed.

Animals↗
PubMed2000

[Pulmonary Nocardia otitidiscaviarum infection in an immunocompetent host].

A rare case of pulmonary Nocardia otitidiscaviarum (N. otitidiscaviarum) was encountered in an immunocompetent host. A 74-year-old man was admitted to our hospital with a high fever and a productive cough. His chest radiograph and CT scan revealed infiltrative shadows in the right middle and lower lung fields. Although several antibiotics (third-generation cephalosporin, minocycline, imipenem) were administered, the fever and cough persisted, and C-reactive protein remained elevated. Repeated sputum cultures showed normal flora, so a transbronchial lung biopsy and bronchoalveolar lavage (BAL) were performed bronchoscopically at the right S5. The BAL fluid contained acid-fast, branching filamentous structures. The microorganism was identified as N. otitidiscaviarum by the Research Center for Pathogenic Fungi and Microbial Toxicoses (Chiba University). Trimethoprim-sulfamethoxazole was therefore administered, but the fever continued to rise daily, and C-reactive protein remained elevated. This isolated N. otitidiscaviarum showed resistance to multiple antimicrobial agents in vitro when examined by the disk diffusion method, and so, on the basis of the antibiogram, the patient was treated with clarithromycin (oral, 600 mg/day) plus amikacin (400 mg/day), which proved successful. Testing for pulmonary nocardiosis should be added to the differential diagnosis procedures for refractory pneumonia as an opportunistic infection and for community-acquired pneumonia.

Aged↗
PubMed2005

[Bacteremic infection due to Nocardia otitidiscaviarum: case report and review].

We present a case of bacteremic pneumonia caused by Nocardia otitidiscaviarum in a corticodependent COPD. Blood and sputum cultures on Mycobacterial media were positives and identification was done using 16S rDNA sequencing. In this article we review the most relevant communications about Nocardia spp infection and study the strain susceptibility using E-test.

Aged↗
PubMed2000

[A case of pulmonary Nocardia farcinica infection in a patient with non-tuberculous mycobacteriosis].

A 64 years old woman without systemic immunological disorders was admitted to our hospital because of a productive cough, low grade fever and bloody sputum. Chest X-ray revealed multiple nodules with calcification, infiltrates and bronchiectasis. Laboratory findings showed mild hypoproteinemia and elevated sedimentation rate. Both Nocardia farcinica and Mycobacterium intracellulare were isolated from the bronchial lavage fluid. Administration of sulfamethoxazole-trimethoprim improved her symptoms. In a recurrent study of bronchial lavage N. farcinica was not isolated, but M. intracellurale was still isolated. We believe that N. farcinica may cause infectious exacerbation of chronic lung disease: non-tuberculous mycobacteriosis and bronchiectasis.

Female↗
PubMed2001

Increase of gammadelta T lymphocytes in murine lungs occurs during recovery from pulmonary infection by Nocardia asteroides.

Previous studies have demonstrated that gammadelta T lymphocytes are important for host resistance to pulmonary infection of the murine lung by log-phase cells of Nocardia asteroides. To study the role of gammadelta T cells in nocardial interactions in the murine lung, C57BL/6J wild type and C57BL/6J-Tcrd (gammadelta T-cell knockout mice) were infected intranasally with log-phase cells of N. asteroides GUH-2. At 3, 5, and 7 days after infection, the gammadelta T cells were quantified by multiparameter flow cytometry. At the same time, Gram and hematoxylin-eosin stains of paraffin sections were performed to monitor the host responses. The data showed that gammadelta T lymphocytes increased significantly within the lungs after intranasal infection, and the peak of this cellular increase occurred at 5 days. Furthermore, at this time, greater than 50% of the CD3 T-cell receptor (TCR)-positive (CD3+) cells were gammadelta TCR positive. Histological examination clearly showed divergent inflammatory responses in the lungs of wild-type mice compared to gammadelta T-cell knockout mice. The C57BL/6J-Tcrd mice were less capable of clearing the organism, and the polymorphonuclear leukocyte response lasted longer than in wild-type C57BL/6J mice. These results showed that gammadelta T cells were actively involved in modulating the innate host responses to murine pulmonary infection by N. asteroides.

Animals↗
PubMed1984

Trimethoprim/sulfamethoxazole-resistant Nocardia asteroides causing multiple hepatic abscesses. Successful treatment with ampicillin, amikacin, and limited computed tomography-guided needle aspiration.

Hepatic abscesses are rarely encountered in disseminated Nocardia infections. Sulfonamides alone or trimethoprim/sulfamethoxazole is often efficacious in treating infections caused by Nocardia asteroides. In vitro resistance of N. asteroides to trimethoprim/sulfamethoxazole is occasionally present. The patient described in this report had disseminated nocardiosis initially manifesting as multiple subcapsular hepatic abscesses. In vitro susceptibility studies demonstrated resistance to trimethoprim/sulfamethoxazole. Subsequent treatment with ampicillin and amikacin in conjunction with computed tomography-guided needle aspiration of several of the hepatic abscesses, surgical drainage of a right pleural empyema, and eventual discontinuation of use of corticosteroids resulted in cure of the infection.

Amikacin↗
PubMed2000

Monoamine changes in the brain of BALB/c mice following sub-lethal infection with Nocardia asteroides (GUH-2).

BALB/c mice injected intravenously with a single, sub-lethal dose of Nocardia asteroides GUH-2 develop several levodopa responsive movement disorders. These included headshake, stooped posture, bradykinesia, and hesitation to forward movement. The changes in monoamine levels in the brain of these mice were determined. There was a significant loss of dopamine with greatly increased dopamine turnover in the neostriatum 7 to 29 days after infection. These effects were specific for dopaminergic neurons since minimal changes were found in neostriatal norepinephrine and serotonin even though serotonin turnover was increased. Changes in monoamine metabolism were not limited to the neostriatum. There were reduced levels of serotonin and norepinephrine with increased serotonin turnover in the cerebellum. One year after infection, dopamine metabolism had returned to near normal levels, but many of the movement disorders persisted. Specific changes in neurochemistry did not always appear to correspond with these impairments. Nevertheless, these data are similar to those reported in MPTP treated BALB/c mice.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1985

Nocardia asteroides infection with dissemination to skin and joints.

A 56-year-old diabetic woman developed multiple cutaneous lesions and septic arthritis secondary to disseminated Nocardia asteroides pulmonary infection. The diagnosis was made rapidly by Gram's and acid-fast stains of pus, sputum, and synovial fluid and later confirmed by cultures. Sulfonamides are the drugs of choice for nocardiosis, and this patient had a complete response to two weeks of intravenous trimethoprim and sulfamethoxasole followed by three months of oral therapy.

Arthritis, Infectious↗
PubMed2002

Murine polymorphonuclear neutrophils produce interferon-gamma in response to pulmonary infection with Nocardia asteroides.

Nocardia asteroides causes an acute, necrotizing pneumonia characterized by extensive infiltration of polymorphonuclear neutrophils (PMNs) into the lungs. Although PMNs have historically been classified as end-point cells, recent investigations have indicated that PMNs have the ability to secrete cytokines such as interleukin (IL)-4 and IL-12. This study investigated the ability of PMNs to produce cytokines in a murine model of N. asteroides pulmonary infection. Flow cytometric analysis demonstrated the production of interferon-gamma (IFN-gamma), but not IL-4, by PMNs in response to this infection. IFN-gamma production correlated with peak infiltration of PMNs into the lungs. Cell sorting and enzyme-linked immunosorbent assay were used to confirm cytokine production by cells with nuclear morphology characteristic of PMNs. This is the first report of IFN-gamma production by neutrophils in response to an infection in vivo. These results suggest that PMNs play an important role in directing the host toward a T helper cell type 1 phenotypic response in the lungs.

Animals↗
PubMed2006

Actinomycoses and Nocardia pulmonary infections.

PURPOSE OF REVIEW: Actinomycosis and nocardiosis are uncommon pulmonary infections with distinct morphologic features. Both infections most commonly present as chronic, debilitating illnesses with radiographic manifestations simulating lung cancer or tuberculosis. Immunocompromised hosts, however, may develop fulminant disease resembling acute bacterial pneumonia. The purpose of this review is primarily to review the clinical features, diagnosis, and management of actinomycosis and nocardiosis. RECENT FINDINGS: Treatment of actinomycosis is usually simple, requiring long-term, high-dose intravenous penicillin. Short-course chemotherapy, however, has recently been reported to be successful. Pulmonary nocardiosis is an important cause of opportunistic infection in immunosuppressed patients, and the incidence of this infection is increasing. The sulfonamides are still first-line agents in the management of nocardiosis, but resistance is most common among N. farcinica and N. otitidiscaviarum isolates. Carbapenems should be used as an alternative treatment for severely ill patients. Broth microdilution, E-test (AB Biodisk, Solna, Sweden) and BACTEC (Becton Dickinson, Sparks, Maryland, USA) radiometric method may be more useful in the routine clinical laboratory for antimicrobial testing of aerobic actinomycetes. SUMMARY: The practical distinction between the two diseases is in the matter of therapy. Diagnosis depends on a high degree of suspicion so as to alert the microbiology and pathology laboratories to employ special methods to identify the organisms. Early recognition and prompt treatment usually results in complete cure.

Actinomyces↗
PubMed2006

[Clinical, microbiological, and therapeutic aspects of Nocardia sp. infections in the Bordeaux hospital from 1993 to 2003].

OBJECTIVE: Our goal was to describe the epidemiological, clinical, and microbiological characteristics of nocardiosis in the Bordeaux teaching hospital, between January 1, 1993 and December 31, 2003. DESIGNS: The retrospective study included patients examined between January 1, 1993 and December 31, 2003 in whom a Nocardia bacterium had been identified from a biological sample. RESULTS: Twenty-four out of 30 Nocardia sp. strains identified during the study period were classified as colonizing strains. 19 patients presented with risk factors for nocardiosis. Nocardia asteroïdes were found in 22 samples, mainly from pulmonary samples. 11 cases of infection due to Nocardia sp. were reported during the study period. Immunosuppression was reported in 7 cases. The clinical forms were not specific. The species incriminated belonged to the N. asteroïdes complex in 8 cases. Treatment consisted in a combination of 2 or 3 molecules including cotrimoxazole for an average duration of 9 months. 9 patients recovered. CONCLUSIONS: The variability of clinical presentation and the lack of standard identification methods delayed the diagnostic. The treatment is not well defined. Clinical strains should be reported to the reference laboratory and prospective studies are necessary.

Anti-Bacterial Agents↗
PubMed1992

Infection with Nocardia species in Queensland. A review of 102 clinical isolates.

OBJECTIVE: To review the species distribution, pathologic significance and disease associations of clinical isolates of Nocardia and related bacteria in Queensland, and to examine the characteristics, treatment and outcome of patients infected with these organisms. DESIGN AND SETTING: A retrospective review of Queensland State Health Laboratory records provided microbiological data for Nocardia isolates referred from other laboratories during the period January 1983 to December 1988. Clinical information was extracted from hospital case notes, or obtained from detailed questionnaires completed by attending physicians. Nocardia isolates were classified as "significant" if specific treatment for nocardiosis was given, or on the basis of autopsy findings. PATIENTS: One hundred and two patients had a Nocardia species or a related organism isolated from clinical specimens during the study period. RESULTS: The 102 isolates included Nocardia asteroides (45), N, brasiliensis (35), N. caviae (5) and N. transvalensis (5). Clinical results were available for 93 patients, of whom 74 (80%) had a significant isolate recovered. Primary pulmonary or disseminated disease occurred in 35 patients, and was caused mainly by N. asteroides. Significant infections of skin and soft tissues, primarily due to N. brasiliensis, were found in 39 patients. Preexisting lung disease and treatment with steroids and immunosuppression were risk factors for pulmonary and disseminated nocardiosis. A history of inoculation in an outdoor setting was frequent in patients with cutaneous disease. Antibiotic regimens that included trimethoprim-sulfamethoxazole or another sulfonamide agent were used to treat the majority of patients with significant infection. Deaths were confined to those with pulmonary and disseminated disease, with a case fatality rate of 40% in that group. CONCLUSION: Infection with Nocardia species appears to be more common than is generally appreciated. The local species distribution and disease spectrum are similar to those described elsewhere. A high index of suspicion for nocardiosis should be maintained in susceptible hosts with pulmonary infiltrates, particularly when there is evidence for metastatic infection, and in patients with superficial infections and a history of outdoor injury.

Adolescent↗
PubMed2005

Disseminated Nocardia farcinica infection in a uraemia patient with idiopathic thrombocytopenia purpura receiving steroid therapy.

Nocardia farcinica has been reported as an increasingly frequent cause of localized and disseminated infections in immunocompromised patients in recent years, but N. farcinica bacteraemia remains a rare finding. Here, the case is described of a 68-year-old man with end-stage renal disease and idiopathic thrombocytopenia purpura treated with steroid therapy who developed disseminated infection (bacteraemia, multilobar pneumonia and brain abscesses) due to N. farcinica. The isolate was confirmed by partial sequencing analysis of the 16S rRNA gene. The patient recovered after prolonged trimethoprim-sulfamethoxazole therapy with no recurrence in over 1 year.

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