Nocardiosis pulmonar y del sistema nervioso central: el alcoholismo como factor de inmunocompromiso / Pulmonary and central nervous system nocardiosis: Alcoholism as an immunocompromising factor

La nocardiosis es una enfermedad de distribución mundial; de forma habitual se encuentra en zonas tropicales y afecta principalmente a pacientes inmunocomprometidos, sin embargo, también existen casos reportados de infección en personas inmunocompetentes. Esta infección es causada por actinomicetos del género Nocardia spp. que son bacterias Gram positivas, saprófitos ambientales. Aunque la exposición a Nocardia spp. es casi universal, solo una pequeña fracción de las personas expuestas desarrollan la enfermedad. Se presenta el caso de un hombre de 47 años, sin dato de inmunosupresión, procedente de un área rural de Boyacá, que consultó por un cuadro clínico de cefalea intensa e intermitente, con parestesias y, finalmente, alteración del estado de conciencia. Se practicó una resonancia magnética cerebral, en la que se evidenció una lesión que ocupaba espacio de localización córtico-subcortical en la región fronto-témporo-parietal izquierda, con efecto compresivo y desplazamiento de las cavidades del sistema ventricular. Se sospechó, inicialmente, una lesión neoplásica o un absceso cerebral. El paciente fue sometido a una resección quirúrgica, y el cultivo de la lesión documentó Nocardia africana/nova; en estudios posteriores, se evidenció un posible foco pulmonar primario. Como único factor de riesgo en el paciente, se documentó alcoholismo. Completó seis semanas de tratamiento antibiótico intrahospitalario con evolución clínica y radiológica, y egresó con plan de un año de terapia antibiótica ambulatoria. Aunque la enfermedad por Nocardia spp. afecta principalmente a pacientes inmunocomprometidos, la "evidencia" clínica demuestra que este microorganismo también puede ser una amenaza para individuos sin los factores de riesgo tradicionales para inmunosupresión.

Nocardiosis is a disease with worldwide distribution. It is usually found in tropical areas and mainly affects immunocompromised patients, however, there are also cases where its infection has been reported in immunocompetent patients. This pathology is caused by bacteria known as Nocardia spp., which are gram-positive microorganisms and environmental saprophytes, and although exposure to Nocardia spp. is almost universal, only a small fraction of exposed people develops the disease. We present the case of a 47-year-old man, with no evidence of immunosuppression, from a rural area of Boyacá, who was admitted due to intense and intermittent headache accompanied by paresthesia and, finally, a decrease in consciousness. A brain magnetic resonance was performed and evidenced a fronto-temporo- occipital space-occupying lesion in the cortico-subcortical region with a compressive effect and displacement of the ventricular system cavities. It was suspected at first a neoplastic lesion or a brain abscess. The lesion was surgically resected, and its culture showed Nocardia africana/nova. In later studies a possible primary pulmonary focus was evidenced. Alcoholism was the only risk factor documented. The patient completed 6 weeks of hospital antibiotic treatment with favorable clinical and radiological evolution and was discharged with a 1-year plan of outpatient antibiotic therapy. Although Nocardia spp. mainly affects immunocompromised patients, evidence shows that this microorganism can also be a threat to individuals without traditional immunosuppression risk factors.

Clinical pharmaceutical practice of constructing mind map by clinical pharmacists for the consultation of pulmonary nocardiosis / 中国药房

OBJECTIVE To explore the construction of mind map by clinical pharmacists for the consultation of pulmonary nocardiosis and its application in clinical practice， and to provide reference for promoting the correct selection of nocardiosis treatment drugs in clinical practice and ensuring drug safety and efficacy. METHODS A total of 7 patients with Nocardia pulmonary infection from January 2017 to April 2022 in our hospital were collected. Based on evidence-based medicine， a consultation mind map （mainly including understanding the medical history， identifying infectious bacteria， identifying risk factors， developing treatment plans， and conducting evaluations） was constructed to address the difficulties of large differences in drug sensitivity among different strains of Nocardia and numerous adverse reactions of Compound sulfamethoxazole as a first-line drug. The treatment plan was developed for 7 patients with pulmonary nocardiosis， and whole-process pharmaceutical care was provided. RESULTS Combined with the mind map， different antibiotic combination regimens were given according to the drug sensitivity results of Nocardia， the different species of Nocardia， and the patient’s allergy history. Among them， 4 cases were treated with imipenem cilastatin， the patients receiving Compound sulfamethoxazole and linezolid for a long time were given full pharmaceutical care， and the adverse drug reactions were timely treated.CONCLUSIONS Clinical pharmacists apply the consultation mind map of pulmonary nocardiosis to the treatment of inpatients， take advantage of pharmacy， participate in clinical drug therapy， and really play a role in the clinical treatment team so as to promote rational drug use.

Pulmonary infection caused by Nocardia otitidiscaviarum a case report and literature review / 中国热带医学

@#Abstract: Objective　To investigate the clinical and laboratory characteristics of pulmonary infection caused by Nocardia otitidiscaviarum. Methods　The clinical data of a patient with pulmonary infection caused by Nocardia otitidiscaviarum were reported, and the clinical characteristics, laboratory characteristics and drug sensitivity of pulmonary infection caused by Nocardia otitidiscaviarum were summarized in combination with the relevant literature at home and abroad from January 2010 to December 2022. Results　A 67-year-old female patient was admitted to the hospital on June 30, 2020 because of "repeated chest tightness and shortness of breath for 3 years, aggravated cough, expectoration and fever". The sputum, alveolar lavage fluid and blood of the patient were collected for culture, and the detected pathogenic bacteria were identified. There are pathogenic bacteria growing in sputum and alveolar lavage fluid, which are identified as Nocardia otitidiscaviarum by Autof ms mass spectrometer. According to the results of pathogenic bacteria and the patient's condition, meropenem combined with compound sulfamethoxazole tablets were given anti-infection treatment, and the patient's condition improved and discharged. Conclusion　The clinical manifestations and imaging features of nocardiosis are lack of specificity, and are prone to misdiagnosis and missed diagnosis. Etiology is the key to disease diagnosis, and clinical examination and culture should be conducted in time.

Nocardiosis: a single-center experience and literature review

ABSTRACT Introduction: Nocardiosis is a rare bacterial infection caused by Nocardia spp. However, an increasing incidence has been described whereby data about epidemiology and prognosis are essential. Methods: A retrospective descriptive study was conducted among patients with positive Nocardia spp. culture, from January 2019 to January 2023, at a Terciary Hospital in Portugal. Results: Nocardiosis was considered in 18 cases with a median age of 63.8-years-old. At least one immunosuppressive cause was identified in 70% of patients. Five patients had Disseminated Nocardiosis (DN). The lung was the most common site of clinical disease (77.8%) and Nocardia was most commonly identified in respiratory tract samples. The most frequently isolated species were Nocardia nova/africana (n = 7) followed by Nocardia cyriacigeorgica (n = 3) and Nocardia pseudobrasiliensis (n = 3). The majority of the patients (94.4%) received antibiotic therapy, of whom as many as 55.6% were treated with monotherapy. The most frequently prescribed antibiotic was trimethoprim-sulfamethoxazole. Selected antimicrobial agents were generally effective, with linezolid and cotrimoxazole (100% Susceptibility [S]) and amikacin (94% S) having the most activity against Nocardia species. The median (IQR) duration of treatment was 24.2 (1-51.4) weeks for DN; The overall one-year case fatality was 33.3% (n = 6) and was higher in the DN (66.7%). No recurrence was observed. Conclusion: Nocardiosis is an emerging infectious disease with a poor prognosis, particularly in DN. This review offers essential epidemiological insights and underscores the importance of gaining a better understanding of the microbiology of nocardiosis. Such knowledge can lead to the optimization of antimicrobial therapy and, when necessary, guide appropriate surgical interventions to prevent unfavorable outcomes.

The Rare Imitator : Pulmonary Nocardiosis Mimics Tuberculosis Reactivation

Pulmonary Nocardiosis is a rare bacterial infection of lungs, caused by a filamentous bacterium. Immunocompromised people are known to be at danger, but there are other new emerging risk factors to consider. The presentation and clinical course in such patients differ from the previous. Here the present case is aimed to underline the presentation and diagnosis in non-risk individual.

Pleural fluid cytology in prompt diagnosis of pleuro-pulmonary nocardiosis masquerading as COVID-19

Introduction: There are few reports of nocardial infections among the Indian population. We report this case because of its rarity and unique presentation and to highlight the role of cytology in diagnosis. Case Details: A 74-year-old woman presented with fever and chest pain of a duration of 15 days. In view of the coronavirus disease (COVID) pandemic, she was given steroids. She developed breathlessness and was referred to a tertiary care hospital. Her pleural fluid cytology showed filamentous bacteria. A diagnosis of nocardia was confirmed by culture. Discussion: Nocardiosis refers to the localized or disseminated infection caused by filamentous aerobic bacteria of the genus Nocardia. The clinical presentation of nocardiosis is highly variable. In our case, clinical misdiagnosis as COVID-19 and steroid treatment would have caused deterioration of nocardiosis. Conclusion: All patients with pulmonary symptoms should be thoroughly evaluated before considering a diagnosis of COVID-19. Pleural fluid cytology can be of help in the diagnosis of nocardiosis.

Nocardia otitidiscaviarum as Possible Etiologic Agent of Non-resolving Pneumonia

Nocardia otitidiscaviarum is an infrequent cause of nocardial pneumonia and rarely affects non-immunocompromised individuals. Pneumonia may not resolve if the causative organism is not susceptible to the empirically given antimicrobial drug. Amoxicillin朿lavulanic acid is a commonly used initial empiric antibiotic for suspected community-acquired bacterial pneumonia on outpatient basis. We report an unusual case of N. otitidiscaviarum as a possible etiologic agent of non-resolving pneumonia due to amoxicillin-clavulanic acid resistance in a previously healthy adult male.

Absceso cerebral por Nocardia sp. En un paciente inmunocompetente en el Perú: reporte de caso / Brain abscess due to Nocardia sp. In an immunocompetent patient in Peru: a case report

RESUMEN La nocardiosis cerebral es una entidad rara que ha sido reportada principalmente en inmunosuprimidos, y en la actualidad no se dispone de guías clínicas que recomienden un tratamiento de primera línea. Presentamos el caso de un adulto mayor, inmunocompetente, con cuadro de encefalopatía y hemiparesia izquierda, asociado a lesiones compatibles con absceso cerebral múltiple y sugerente de etiología infecciosa. Recibió, inicialmente, tratamiento para la tuberculosis, absceso bacteriano y toxoplasmosis, sin respuesta clínica favorable. Se inició un tratamiento empírico para la nocardiosis con meropenem y trimetoprim/sulfametoxazol, y se logró mejoría clínica e imagenológica. La ocurrencia de eventos adversos obliga el uso temporal de medicamentos alternativos. Se resaltan algunos criterios a considerar para incluir la nocardiosis en el diagnóstico diferencial en los casos de absceso cerebral múltiple y se mencionan los métodos diagnósticos de laboratorio y los fármacos para iniciar un tratamiento empírico.

ABSTRACT Cerebral nocardia infections is a rare entity, which has been mainly reported in immunosuppressed patients. Currently, there are no clinical guidelines for first-line treatment. Our case refers to an older immunocompetent adult, with encephalopathy and left hemiparesis, associated with lesions compatible with multiple brain abscess and suggestive of infectious etiology. He initially received treatment for tuberculosis, bacterial abscess, and toxoplasmosis, without a favorable clinical response. An empirical treatment for nocardiosis started, by using meropenem and trimethoprim / sulfamethoxazole, and clinical and imaging improvement was achieved. The occurrence of adverse events forces the temporary use of alternative medications. We highlight some criteria for including nocardiosis in the differential diagnosis in cases of multiple brain abscess and mention laboratory diagnostic methods and drugs to initiate empirical treatment.

Clinical features of 24 cases of nocardiosis / 中华传染病杂志

Objective:To analyze the clinical characteristics of patients with nocardiosis, so as to improve the diagnosis and treatment of nocardia infection in the future.Methods:From May 2016 to October 2020, 24 patients with nocardiosis in Xiangya Hospital, Central South University were enrolled, and their clinical data including clinical features, laboratory examinations, imaging findings, diagnosis and treatment process, and outcome were retrospectively analyzed.Results:Among the 24 patients with nocardiosis, 18 cases (75.0%) were males, and the median age was 54.5 years.Twenty-three patients had underlying diseases, of which the most common disease was antineutrophil cytoplasmic antibody-related vasculitis (16.7%(4/24)). Of nine species of Nocardia identified from the 24 patients, Nocardia farcinica was the most common species (seven cases). The lesion sites were mainly lungs (70.8%(17/24)), skin and soft tissues (42.0%(10/24)), brain (25.0%(6/24)) and blood system (17.0%(4/24)). There were 12 cases (50.0%) of patients with more than two lesion sites. The clinical manifestations, imaging examinations and laboratory tests of the 24 patients were not specific. The diagnosis depended on the etiology. Nineteen patients received trimethoprim-sulfamethoxazole-based combination therapy, and two were discontinued due to adverse reactions of sulfa drugs. After treatment, 19 cases (79.2%) were improved and five cases (20.8%) died. Conclusions:Patients with nocardiosis often have atypical clinical manifestations, and multiple organs are easily affected.Early and accurate identification and rapid and effective anti-biotic therapy are the keys to improve the overall prognosis of these patients.

Micosis y nocardiosis de implantación: esporotricosis, cromoblastomicosis, micetomas y nocardiosis. Casuística del Laboratorio Central de Salud Pública, Paraguay, período 1997-2019 / Mycosis and nocardiosis implantation: Sporotrichosis, Chromoblastomycosis, Mycetomas and Nocardiosis. Casuistics in the Central Laboratory of Public Health, Paraguay, period 1997-2019

RESUMEN Introducción: la esporotricosis, cromoblastomicosis y micetomas (micosis de implantación) y las nocardiosis cutáneas son causados principalmente por inoculación traumática de hongos y bacterias del ambiente. Son de difícil manejo por las complicaciones y la poca efectividad en el tratamiento debido a la consulta tardía de los pacientes. Objetivos: determinar las características demográficas, presentación clínica de los casos e identificación de los agentes causales de las micosis de implantación y nocardiosis cutánea a partir de los registros de la sección de Micología del Laboratorio Central en el período 1997 - 2019. Metodología: estudio observacional descriptivo retrospectivo de fichas de las muestras de pacientes que acudieron al Laboratorio Central de Salud Pública en el período de estudio. Resultados: encontramos 11 pacientes con esporotricosis (complejo Sporothrix schenkii), 21 con cromoblastomicosis (Fonsecae pedrosoi complex) 47,6 %, Phialophora verrucosa 4,7 %), 4 micetomas (Scedosporium apiospermum, Acremonium kiliensi, Fusarium solani y Nocardia brasiliensis), y 7 nocardiosis cutánea (3 Nocardia brasiliensis, 2 Nocardia farcinica, 1 Nocardia transvalensis y 1 Nocardia sp.). Se mencionan presentación clínica y los departamentos de origen de los pacientes. Conclusiones: estas micosis son de impacto en salud pública y el enfoque para las acciones del gobierno y de las fundaciones no gubernamentales debe apuntar a la capacitación, pruebas diagnósticas, disponibilidad de antifúngicos e información a la población.

ABSTRACT Introduction: sporotrichosis, chromoblastomycosis and mousetomas (implantation mycosis) and cutaneous nocardiosis are mainly caused by traumatic inoculation of fungi and bacteria from the environment. They are difficult to manage due to complications and little difficulty in treatment due to the late consultation of the patients. Objectives: to determine the demographic characteristics, clinical presentation of cases and identification of the causative agents of implantation mycosis and cutaneous nocardiosis from the records of the Mycology section of the Central Laboratory in the period 1997-2019. Methodology: retrospective descriptive observational study of files of the samples of patients who attended the Central Laboratory of Public Health during the study period. Results: 11 patients were found with sporotrichosis (Sporothrix schenkii complex), 21 with chromoblastomycosis (Fonsecae pedrosoi complex 47.6%, Phialophora verrucosa 4.7%), 4 mice (Scedosporium apiospermum, Acremonium kiliensi, Fusarium solani and Nocardia brasiliens) and 7 cutaneous nocardiosis (3 Nocardia brasiliensis, 2 Nocardia farcinica, 1 Nocardia transvalensis and 1 Nocardia sp.). A clinical presentation and the departments of origin of the patients are mentioned. Conclusions: these mycoses have an impact on public health and the focus for the actions of the government and non-governmental foundations should be aimed at training, diagnostic tests, availability of antifungals and information to the population.

Abscesos cerebrales por Nocardia spp. en una paciente inmunocompetente / Multiple brain abscesses due to Nocardia spp. in an immunocompetent patient

La infección por Nocardia spp. no es común en pacientes inmunocompetentes. El tratamiento antimicrobiano empírico dirigido según las regiones anatómicas, no contempla las particularidades del germen y el análisis microbiológico se hace necesario para el tratamiento específico. A continuación, se presenta el caso de una paciente previamente sana, inmunocompetente y sin factores de riesgo conocidos para la infección por Nocardia spp., con evidencia de compromiso en el parénquima pulmonar y la piel, que posteriormente desarrolló varios abscesos cerebrales.

The infection by Nocardia spp is not common in immunocompetent patients. The empirical antimicrobial treatment directed by anatomical regions does not contemplate the particularities of the germ and the microbiological analysis is necessary for the specific treatment. We present the case of a previously healthy and immunocompetent patient, without known risk factors for Nocardia spp. infection, with evidence of involvement of the pulmonary parenchyma and the skin and subsequent development of multiple brain abscesses.

Nocardiosis linfocutánea en paciente inmunocomprometido

RESUMEN Se presenta el caso de un paciente, agricultor, adulto mayor, portador de hipertensión arterial, cardiopatía isquémica y cáncer de próstata con metástasis en hueso en tratamiento conservador. Acude por cuadro de 15 días de evolución con flictenas en miembro superior y fiebre. Durante su internación se aísla en la secreción de piel Nocardia brasiliensis y es tratado con trimetoprin - sulfametoxazol. En el 15° de internación se agrega una neumonía asociada a los cuidados de la salud. Posteriormente se detecta una lesión ósea destructiva en columna a nivel de L3. Sale de alta con el diagnóstico de nocardiosis linfocutánea en paciente inmunocomprometido a los 31 días de internación con buena respuesta clínica y con planes de continuar antibióticoterapia.

ABSTRACT The case of a patient, an elderly farmer who has hypertension, ischemic heart disease and prostate cancer with bone metastases in conservative treatment, is presented. He consults for a 15-day evolution case with flictenas in the upper limb and fever. During hospitalization, Nocardia basiliensis is isolated in the secretion of skin and is treated with trimethoprine - sulfamethoxazole. In the 15th day of hospitalization, health care-associated pneumonia is added. Subsequently, a destructive bone lesion in the spine is detected at the L3 level. He is discharged with the diagnosis of lymphocutaneous nocardiosis in an immunocompromised patient after 31 days of hospitalization with a good clinical response and with plans to continue antibiotic therapy.

Post Surgical Cutaneous Nocardiosis Mimicking Hypertrophic Scar: A Case Report

@#Nocardia species are gram-positive, aerobic, acid-fast bacteria which exist as saprophytes in nature. Invasive disseminated infections are particularly common in immunocompromised or debilitated hosts. Superficial infections with Nocardia species occur as a result of local trauma and contamination of the wound. Clinically, it may manifest as an acute infection (abscesses or cellulitis), mycetoma, or sporotrichoid infection. Herein we report a rare case of cutaneous nocardiosis following surgery mimicking a hypertrophic scar.

A case report of Nocardia cyriacigeorgica presenting as cellulitis with multiple discharging sinuses

Nocardia spp. are filamentous Gram positive bacteria that are ubiquitous soil saprophytes. The majority of nocardial infections occur in severely immunocompromised patients who are particularly susceptible to pulmonary disease and dissemination. Extrapulmonary nocardiosis is relatively common and can occur through hematogenous dissemination or a contiguous spread of necrotizing pneumonitis. Primary cutaneous and soft tissue nocardiosis can result from traumatic injury to the skin that involves contamination with soil. After skin inoculation, a superficial abscess or localized cellulitis can develop. Co-trimoxazole is the drug of choice for all types of nocardiosis. We are reporting a case of Nocardia cyriacigeorgica presenting as cellulitis followed tooth extraction.

Peritonite piogranulomatosa por Nocardia concava em cão - relato de caso / Piogranulomatous peritonitis by Nocardia concava in dog - Case Report

Nocardiose é causada por bactérias do gênero Nocardia do subgrupo Actinomycetos, que são Gram-positivas aeróbicas, filamentosas e podem apresentar ramificações. O diagnóstico baseia-se na presença de lesão inflamatória, com o microrganismo morfologicamente compatível, associada ao isolamento e à identificação microbiológica e molecular. Este trabalho tem por objetivo relatar um caso de nocardiose em canino, que desenvolveu inflamação piogranulomatosa peritoneal seis meses após ovariossalpingo-histerectomia. O animal apresentava hipertermia, distensão abdominal, taquipneia, polidipsia, hiporexia, mucosas hipocoradas e fezes pastosas. Os achados laboratoriais evidenciaram anemia leve e leucocitose por neutrofilia com desvio à esquerda e hipoalbuminemia. Uma massa na região mesogástrica e efusão peritoneal foram evidenciadas por meio da ultrassonografia abdominal. O líquido foi classificado como exsudato piogranulomatoso, e o animal submetido à laparotomia exploratória para lavagem abdominal e remoção da massa. Após procedimentos terapêuticos, ocorreu piora clínica e óbito. Peritonite piogranulomatosa foi a principal alteração anatomopatológica a qual foi associada à Nocardia spp. Molecularmente, a espécie isolada se aproxima da N. concava, por meio da análise filogenética. Essa espécie já foi descrita como causa de infecção em humanos na Ásia, no entanto não há registros na literatura na espécie canina, sendo este o primeiro relato.(AU)

Nocardiosis is caused by an aerobic, gram-positive, ramificated and filamentous bacteria of the Nocardia genus, subgroup Actinomycetos. The diagnosis is based on the presence of the inflammatory lesions with the morphologically compatible microorganism associated with microbiological and molecular isolation and identification. The objective of this work is to report a case of nocardiosis in a canine that developed peritoneal pyogranulomatous inflammation six months after ovariosalpingohisterectomy. The animal had hyperthermia, abdominal distention, tachypnea, polydipsia, hyporexia, hypocorous mucosae and pasty feces. The laboratory findings revealed mild anemia and leukocytosis due to neutrophilia with left deviation and hypoalbuminemia. A mass in the mesogastric region and peritoneal effusion were evidenced by abdominal ultrasonography. The fluid was classified as pyogranulomatous exudate and the animal underwent exploratory laparotomy for abdominal lavage and mass removal. Despite the therapeutic procedures and clinical alterations the dog died. Piogranulomatous peritonitis was the main anatomopathological alteration which was associated with Nocardia spp. Molecularly, the isolated species approaches the N. concava species through phylogenetic analysis. This specie was described as a cause of infection in humans in Asia; however, there are no records in literature on the canine species, being this the first report.(AU)

Disseminated Nocardia farcinica infection presenting as a paravertebral abscess in a patient with systemic lupus erythematosus

Disseminated Nocardia infections occur particularly in immunosuppressed hosts and are most often due to Nocardia farcinica, Nocardia nova, and Nocardia cyriacigeorgica. Here, we report an unusual case of disseminated N. farcinica infection presenting as a paravertebral abscess in a patient with systemic lupus erythematosus.

Nocardiosis linfocutánea en una niña sana, a propósito de un caso clínico / A clinical case of lymphocutaneous nocardiosis in a healthy infant / Um caso clínico de neocardiose linfocutânea numa menina saudável

Resumen: Las nocardiosis son infecciones poco frecuentes producidas por distintas especies del género Nocardia. Las dos especies más prevalentes son N. asteroides y N. brasiliensis. Presentan un amplio espectro de enfermedad, con formas locales o diseminadas, de evolución aguda, subaguda y/o crónica. Pueden causar enfermedad severa sobre todo en pacientes inmunodeprimidos. La infección de piel y partes blandas puede presentarse en personas inmunocompetentes y ocasionalmente en niños sanos. Se presenta el caso de una preescolar de 18 meses que presentó absceso de pie con adenoflemón inguinal derecho. El estudio microbiológico del material obtenido del drenaje de la lesión observó bacterias grampositivas de aspecto filamentoso, por lo que se planteó el diagnóstico preliminar de nocardiosis. Dicho diagnóstico se confirmó posteriormente con el cultivo bacteriológico. Recibió tratamiento con clotrimoxazol durante seis semanas por vía oral, con buena evolución, sin otras complicaciones. La valoración inmunológica inicial no mostró alteraciones. El seguimiento evolutivo de la paciente no evidencia alteraciones sugestivas de trastornos específicos de la inmunidad.

Summary: Nocardiosis is a rare infection. The two most prevalent species, N. asteroides and N. brasiliensis, can cause a broad spectrum of clinical diseases, which could be local or disseminated infections with an acute, subacute or chronic evolution. It can cause severe infections to immunocompromised patients, or even to healthy children, who can experience skin and soft tissue infections. This is the clinical case of a healthy 18-month-old girl with a foot abscess with right inguinal adenophlegmon. The microbiological study of the lesion drainage confirmed a diagnosis of Nocardia sp. She was treated with clotrimazole for 6 weeks and had no further complications. The initial immunoassay showed no abnormalities. The patient's evolutionary follow-up does not show alterations resulting from specific immunological disorders.

Resumo: A nocardiose é uma infeção pouco frequente produzida por diferentes espécies do gênero da Nocardia. As duas espécies mais prevalentes são N. asteroides e N. brasiliensis. Geram um amplo espectro de doenças, com formas locais ou disseminadas, de evolução aguda, subaguda e / ou crônica. Podem causar doença grave, especialmente a pacientes imunodeprimidos. A infecção da pele e dos tecidos moles pode acometer a pacientes imunocompetentes ou ocasionalmente a crianças saudáveis. Apresentamos o caso de uma paciente de 18 meses de idade que apresentou abscesso permanente com adenofleimão inguinal direito. O estudo microbiológico, obtido a partir da drenagem da lesão, mostrou bactérias gram-positivas de aspecto filamentoso compatível com o diagnóstico preliminar de nocardiose. Este diagnóstico foi posteriormente confirmado através duma cultura bacteriológica. Ela recebeu tratamento com Clotrimazol por 6 semanas por via oral, teve boa evolução, sem outras complicações. A avaliação imunológica inicial não mostrou alterações. O acompanhamento evolutivo da paciente não apresenta alterações que indiquem distúrbios específicos da imunidade.

Multiple nodules accompanied by pulmonary nocardiosis in a patient with systemic lupus erythematosus

Background:A retrospective case series study was done onforearm diaphyseal fracture in adolescents treated with TENS (titanium elastic nailing system).Purpose of the study was analysis of functional outcome of TENS in forearm diaphyseal fractures in children between 12-18 year age group. Methods:We retrospectively evaluated 30 patients operated by same senior surgeon during the period from March 2014 to February 2015 with closed diaphyseal forearm fractures in age group 12–18 years treated with TENS in whom closed reduction could not be achieved. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensifier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and finger movements and suture removal done after 2 weeks. Patients were followed up for minimum period of one year.Results:In terms of union and range of motion using Anderson et al criteria 24 patients had excellent results, 4 patients had satisfactory results and one patienthad poor result having non-union of ulna. Two patients had superficial infection at the nail entry site which eventually resolved. One patient lost for follow up.Conclusions:We conclude that TENS in both bone forearm fractures in adolescent age group interms of union and range of motion is a minimally invasive and effective method of fixation.

Pulmonary nocardiosis: Report of two cases from a tertiary care hospital

Pulmonary nocardiosis is an uncommon bacterial infection that may lead to severe disease in immunocompromised patients. The disease is rare in immunocompetent patients. Reported cases are few, and the literature is limited because disease recognition is difficult. We present a case report of two patients of pulmonary nocardiosis, who had different clinicoradiological presentations and also responded differently to treatment. Given the rising incidence of cancer, organ transplantation, and use of parenteral steroids, Nocardia is likely to attain a higher place among the causes of pulmonary infections.