Pulmonary nocardiosis. Therapy with minocycline and with erythromycin plus ampicillin.
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A patient with a yearlong fever of unknown origin responded to trimethoprim-sulfamethoxazole and was discovered to have culture-proved Nocardia asteroides sinusitis, with absence of detectable disease in other organs. An inhalational route is postulated as the mode of entry of the organism, with localization in the maxillary sinus.
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The first two Brazilian cases of human pulmonary nocardiosis are reported. Diagnosis was established on material obtained by direct lung puncture. A review of selected aspects on pulmonary nocardiosis in Latin American countries is presented.
The isolation of Nocardia pathogenic for man in soil of Tucumán revealed the convenience of undertaking a study of their virulence, to evaluate any potential danger it may imply. Thirty three strains were studied: 28 N. brasiliensis, 3 N. asteroides and 2 N. caviae by inoculating albino Swiss mice into the footpads and intraperitoneally. The results obtained revealed the existence of Nocardia of variable aggresiveness in the soil of Tucumán.
The tolerance of Nocardia brasiliensis, Nocardia asteroides and Nocardia caviae to different concentrations of acids and alkalis was studied in this work. The purpose was to determine their use: (a) in the differentiation of species; (b) for decontamination of clinical materials during the isolation of pathogenic Nocardia. The results showed (1) that both 2 M NH3 and 0.05 M H2SO4 solutions are useful for differentiating species. They can also be used as a complementary method for identification. (2) That both 1 M NH3 and 0.05 M H2SO4 solutions were useful for decontamination of clinical materials during the isolation of pathogenic Nocardia.
We report a case of localized cutaneous nocardiosis due to Nocardia asteroides, appearing on the anterior surface of the right forearm of a 29-year-old woman. Examination of the skin revealed a firm subcutaneous nodule measuring 32 x 20 mm and accompanied with a small ulcer. The histology of the lesion showed granulomatous changes interspersed with large numbers of polymorphonuclear leukocytes. On Gram staining, a few bacillary bodies were found scattered through the lesion, but no grains were detected. The classification of the clinical types of cutaneous nocardiosis is discussed, and the Japanese literature on localized cutaneous nocardiosis is examined.
A rare case of primary cerebral abscess due to Nocardia asteroides, and its surgical removal, are described. Postoperative meningitis caused by the same fungi was succesfully cured with sulphadiazine and cycloserine. The nocardial disease, its neurological complications, and therapy are reviewed.
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A case is reported of rapid onset concomitant pulmonary infection with Nocardia and Aspergillus fumigatus in a patient six weeks after the institution of immunosuppressive therapy for renal vasculitis. Pulmonary lesions completely resolved on treatment with a combination of imipenem, cotrimoxazole and a prolonged course of itraconazole.
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