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PubMed1996

Western blot monitoring of disseminated Nocardia nova infection treated with clarithromycin, imipenem, and surgical drainage.

A case of disseminated infection due to Nocardia nova with subcutaneous popliteal and retrosternal abscesses and lung involvement in an immunocompromised patient is reported. The patient did not respond to sulfonamide therapy. Clinical recovery was obtained upon treatment with imipenem then clarithromycin. Western blot studies revealed an antibody response to a known Nocardia-specific 55-kDa antigen in four successive sera samples collected in the period from the time of admission to seven months later. The resolution of the disseminated nocardiosis and efficacy of the clarithromycin treatment were assessed on the basis of disappearance of the antibodies to the 55-kDa antigen, without invasive sampling.

Anti-Bacterial Agents↗
PubMed1978

Treatment of Nocardia asteroides infection with trimethoprim-sulfamethoxazole.

Although sulfonamide therapy has reduced the case fatality rate in infection due to Nocardia asteroides from nearly 100% to 25% to 45% there remains a need for a still more effective chemotherapeutic regimen. We describe three cases of serious infection due to N asteroides treated successfully with trimethoprim-sulfamethoxazole (TMP-SMX) and review an additional 15 cases from the world literature. Trimethoprim and sulfamethoxazole exhibit a synergistic interaction in vitro against N asteroides, and the agent reaches antibacterial concentrations in blood, lung, and the central nervous system. Clinical results have been satisfactory in the limited number of patients treated to date.

Aged↗
PubMed1978

Relationship of macrophages to cell-mediated immunity in experimental Nocardia asteroides infection.

Marked in vivo intracellular killing of Nocardia asteroides occurred in the peritoneal macrophages obtained 72 h after an intraperitoneal challenge with N. asteroides, in guinea pigs either actively immunized with ribonucleic acid protein or passively immunized by immune spleen cell transfer from actively immunized donor guinea pigs. This specific killing of N. asteroides in immune macrophages persisted for at least up to 60 days. Administration of antimacrophage sera before intravenous challenge with N. asteroides in the immune guinea pigs produced an early death of the animals, and the total tissue counts of N. asteroides in the liver, spleen, lungs, and heart remained the same in them as in unimmunized controls.

Animals↗
PubMed2001

Nocardia brasiliensis infection seen on grafted skin of the dorsum of a foot.

For the past 4 years a 23 y-old female has noticed erythema on the dorsum of the right foot, where skin was grafted due to a traffic accident 20 years ago. She visited the Department of Dermatology of Gifu Prefectural Hospital on Oct. 19, 1998; her general health was good. Physical examination disclosed a swelling with erythema, papules and pustules on the dorsum of the right foot. The results of routine laboratory investigations were within normal limits except for the white blood cell count (11,300/mm(3)), blood sediment rate (25 mm/hrs), C reactive protein (1.21) and rheumatoid factor (x 16.6). Several yellowish and verrucous or wrinkled colonies were grown on Sabourauds agar culture from the biopsied specimen of the foot. Histopathological features showed epidermal hyperplasia with elongation of rete ridges and granulomatous changes in the dermis; many mononuclear and giant cells were present, and several positive fine filamentous and irregularly branching structures with PAS and Grocott stains were seen in the granulomatous nests. Both clinical and histopathological features led to speculation of Nocardia infection, and Nocardia brasiliensis was determined. The patient was treated by surgical total resection including the grafted skin. Although a soybean-sized nodule was seen on the border of the skin-graft of the foot three months later, there was no recurrence after the local resection.

Adult↗
PubMed2003

Nocardia veterana isolated from ascitic fluid of a patient with human immunodeficiency virus infection.

Nocardia veterana is a recently characterized species within the genus Nocardia, and only three human clinical isolates have been reported for this species. We describe a case of ascitic fluid infection in an immunocompromised patient due to N. veterana. To our knowledge, this is the first report of a Nocardia sp. strain from ascitic fluid and the fourth report of N. veterana isolated from human samples. Chemotaxonomic methods showed the strain to belong to the genus Nocardia, and identification to the species level was done by 16S ribosomal DNA gene sequencing. The antibiotic susceptibility profile of N. veterana is reported here for the second time. The strain was deposited in the Collection of the Pasteur Institute and in the Culture Collection of the University of Göteborg (CIP 107497 and CCUG 46576). The corresponding 16S ribosomal DNA gene sequence is available from the GenBank database under accession number AY149599. A phylogenetic analysis was conducted and showed that N. veterana was most closely related to the recently characterized species Nocardia africana rather than to Nocardia vaccinii, as previously reported.

AIDS-Related Opportunistic Infections↗
PubMed1976

Nocardia asteroides and Nocardia brasiliensis infections in mice.

A model for Nocardia asteroides and Nocardia brasiliensis infections in Swiss white mice has been established without the addition to the inocula of any form of adjuvant. Serial histopathological studies revealed that these two actinomycetes cause lesions that are quite different in their features. An acute suppurative abscess characterizes the lesions of N. asteroides. In the case of N. brasiliensis infections a granuloma is produced in which a striking feature is the presence of large numbers of foam-laden macrophages, although occasional exceptions to this pattern were noted. Electron microscopic studies demonstrated that these macrophages contain within their cytoplasm organisms in varying stages of degeneration. Repeated mortality studies in mice failed to demonstrate differences in mortality rates produced by N. asteroides and N. brasiliensis. Thus, despite relatively trivial biochemical and antigenic differences between these two species of Nocardia, the local pathogenic response is quite different. The presence in the "brasiliensis lesion" of foamy macrophages with intracellular organisms is reminiscent of the histopathological features of lepromatous leprosy and of disseminated Myocobacterium bovis infection when this occurs in the immune suppressed situation. It is possible that N. brasiliensis infection produces a depression of cellular immunity that modifies the local host response to the organism.

Animals↗
PubMed2004

Humoral immunity through immunoglobulin M protects mice from an experimental actinomycetoma infection by Nocardia brasiliensis.

An experimental model of infection with Nocardia brasiliensis, used as an example of a facultative intracellular pathogen, was tested. N. brasiliensis was injected into the rear foot pads of BALB/c mice to establish an infection. Within 30 days, infected animals developed a chronic actinomycetoma infection. Batch cultures of N. brasiliensis were used to purify P61, P38, and P24 antigens; P61 is a catalase, and P38 is a protease with strong caseinolytic activity. Active and passive immunizations of BALB/c mice with these three purified soluble antigens were studied. Protection was demonstrated for actively immunized mice. However, immunity lasted only 30 days. Other groups of immunized mice were bled at different times, and their sera were passively transferred to naive recipients that were then infected with N. brasiliensis. Sera collected 5, 6, and 7 days after donor immunization conferred complete, long-lasting protection. The protective effect of passive immunity decreased when sera were collected 2 weeks after donor immunization. However, neither the early sera (1-, 2-, and 3-day sera) nor the later sera (30- or 45-day sera) prevented the infection. Hyperimmune sera with the highest levels of immunoglobulin G (IgG) to N. brasiliensis antigens did not protect at all. The antigens tested induced two IgM peaks. The first peak was present 3 days after immunization but was not antigen specific and did not transfer protection. The second peak was evident 7 days after immunization, was an IgM response, was antigen specific, and conferred protection. This results clearly demonstrate that IgM antibodies protect the host against a facultative intracellular bacterium.

Adoptive Transfer↗
PubMed1998

Nocardiasis in patients with HIV infection.

The frequency of Nocardia infection in HIV-infected patients has increased during the past few years from 0.3% in 1985 to 1.8% in 1989. Although it is not of great concern as an AIDS-associated infection, the nonspecific clinical presentation in these patients might be confused with other lung infections such as tuberculosis (TB). The mortality rate can be as high as 60%. The authors diagnosed three homosexual men with nocardiasis among 1060 HIV-infected patients (0.2%) in a tertiary care center in Mexico City from 1981 to 1997. The mean age was 32 years. The CD4 count was less than 260 cells/mm3 in all these individuals. The clinical presentations were subacute sinusitis, chronic localized abdominal abscess, and acute disseminated nocardiasis. The respective associated infections were none; TB and cytomegalovirus (CMV); and candidiasis, TB, CMV, Isospora belli, and disseminated Mycobacterium avium complex (MAC). Trimethoprim/sulfamethoxazole (TMP/SMX) was the treatment in all the cases; at the time of this writing, two patients were living and one had died during the acute episode. A literature search uncovered 130 cases of Nocardia infection in HIV patients since 1982. According to the published data and our results, nocardiasis should be suspected in those HIV-infected patients who (1) do not respond to appropriate antituberculous treatment; (2) are intravenous drug users; and (3) develop a characteristic pericardial infection. Finally, adequate surgical or percutaneous drainage of abscesses are extremely valuable for diagnosis and therapy.

AIDS-Related Opportunistic Infections↗
PubMed1982

Enhanced resistance to Nocardia brasiliensis infection in mice depleted of antigen-specific B cells.

This study deals with the roles of T and B cells in Nocardia brasiliensis infection in mice. Nocardia injected into the animals' footpads caused inflammatory responses and mycetomas in situ, resulting in granulomatous lesions of subcutaneous tissues and eventual bone destruction. These clinical features resemble those of humans infected with Nocardia. The effect, if any, of antibody was studied by passively transferring anti-Nocardia serum into either immunologically normal or T-deficient infected mice. Such transfers had no protective function in either group. To the contrary, the antibody seemed to favor infection and worsen bone disease compared to that in mice not given antibody. Furthermore, passive transfer of the antibody along with injection of Nocardia coated with the antibody magnified the severity of subsequent symptoms. Although these experiments ruled out any role for antibody in protection from Nocardia, they did not directly prove T cell participation in such resistance. Therefore, the role of T cells during Nocardia infection was examined further by transferring spleen cells depleted of B lymphocytes bearing receptors for a Nocardia extract (NE). Lethally irradiated mice reconstituted with a population depleted of NE-specific B cells totally lacked the ability to form antibodies to NE; however, they mounted effective delayed-type hypersensitivity reactions and completely controlled their Nocardia infection, establishing the importance of cell-mediated immunity in halting this disease process.

Animals↗
PubMedDate not supplied

Acute primary cutaneous Nocardia asteroides infection in a patient with systemic lupus erythematosus. Case report.

We report a case of acute primary cutaneous infection of traumatic origin caused by Nocardia asteroides, appeared as cellulitis in a patient with systemic lupus erythematosus. Diagnosis was established by direct examination and cultures from aspirate specimens. The clinical forms of Nocardia infections that affect the skin, reported in Rio Grande do Sul and Uruguay, are discussed.

Acute Disease↗
PubMed2000

[Nocardia asteroides infection in a patient with systemic lupus erythematosus].

Nocardia asteroides infection are unusually observed in systemic Lupus erithematous (SLE) patients. They are generally associated to steroidal and immunosuppressive therapy. We report a 24 years old female with SLE diagnosed in 1994 who developed a severe preeclampsia in her first pregnancy requiring emergency caesarean section. Post partum acute renal failure and type IV lupus nephropathy were treated with hemodialysis, methylprednisolone, cyclophosphamide and prednisone. Three months later, while she was receiving the fourth cyclophosphamide dose, she presented with a pleuro pneumonia and occipital abscess, both caused by Nocardia asteroides. She was treated with cotrimoxazole + cefixime and pleural decortication was required. Five months later, she developed Meningitis caused by Nocardia asteroides and hydrocephalus. She was treated with ceftriaxone, vancomycin, cotrimoxazole and ventricular shunting procedure. Two months later, a retroperitoneal abscess was diagnosed and surgically drained but the patient died, due to a methicillin-resistant Staphylococcus aureus septicemia.

Adult↗
PubMed1998

Primary cutaneous Nocardia asteroides infection after heart transplantation.

Skin diseases due to Nocardia are rare in Europe and usually occur as the secondary localization of a pulmonary lesion in immunocompromised patients. We describe a cutaneous pyoderma and cold abscess due to Nocardia asteroides infection in a cardiac transplant recipient. An insect bite represents the wound of this soil saprophyte belonging to the actinomycetes. Treatment by sulfone and ampicillin-clavulanic acid allowed the regression of lesions without extracutaneous dissemination.

Heart Transplantation↗
PubMed1981

An outbreak of Nocardia asteroides infection in a renal transplant unit.

An outbreak of Nocardia asteroides infection occurred in the nephro-urological intensive care unit, St. Peter's Group of Hospitals, London in 1979. In is suggested that the outbreak has been due to patient-to-patient transmission. Five months before the outbreak. N. asteroides was first isolated from nephrostomy urine from an asymptomatic patient who had undergone several urological operations. Subsequently six of the seven patients admitted for renal transplant over a three month period developed proven infections. The first transplant patient had an abdominal abscess and the other five had only pulmonary disease with obvious radiological lesions. Bacteriological diagnosis was made in three patients by examination of sputum and in the other three from bronchoscopic specimen, pleural fluid and pus from an abscess respectively. Five of the six renal transplant patients were treated with amoxycillin and erythromycin. Clinical and radiological improvement was observed and no patient died as a result of the infection. In the intensive care unit air and dust samplings were positive for N. Asteroides. The unit was closed and fumigated with formaldehyde and when the air sampling continued to be negative the unit was then re-opened.

Adult↗
PubMed1985

Nocardia asteroides infection in horses: a review.

From 1965 to 1983, Nocardia asteroides infection was diagnosed in 16 horses at the Veterinary Medical Teaching Hospital, University of California, Davis. In 2 of the cases, the infection was traumatic in origin and local in extent; the horses recovered without relevant antimicrobial therapy. Fourteen horses had pulmonary or disseminated infections that ended fatally. All 14 had various degrees of immunosuppression. Of these, 8 were Arabian foals with combined immunodeficiency disease and 3 were aged horses with hyperadrenocorticism secondary to ACTH-secreting pituitary tumors. Of the other 3, one had lymphosarcoma, another, hepatic disease presumed to be of toxic origin, and the third, a mixed disseminated bacterial infection.

Animals↗
PubMed1994

Disseminated Nocardia farcinica infection in an AIDS patient.

This report describes an AIDS patient presenting with disseminated Nocardia farcinica infection diagnosed by percutaneous kidney biopsy. The isolate was initially identified as Nocardia asteroides. Though Nocardia asteroides remains sensitive to most antimicrobial agents, Nocardia farcinica is resistant to gentamicin, tobramycin and cephalosporins and is indistinguishable from Nocardia asteroides by regular laboratory methods. In view of the rising incidence of infections with Nocardia farcinica, third-generation cephalosporins should not be used in the initial management of Nocardia infections, and all isolates should be submitted for antibiotic susceptibility testing.

AIDS-Related Opportunistic Infections↗