Critically Ill Patients with Visceral Nocardia Infection, France and Belgium, 2004-2023.

We studied 50 patients with invasive nocardiosis treated during 2004-2023 in intensive care centers in France and Belgium. Most (65%) died in the intensive care unit or in the year after admission. Nocardia infections should be included in the differential diagnoses for patients in the intensive care setting.

Risk factors for Nocardia infection among allogeneic hematopoietic cell transplant recipients: A case-control study of the Infectious Diseases Working Party of the European Society for Blood and Marrow Transplantation.

OBJECTIVES: Nocardiosis is a rare but life-threatening infection after hematopoietic cell transplantation (HCT). We aimed at identifying risk factors for nocardiosis after allogeneic HCT and clarifying the effect of trimethoprim-sulfamethoxazole prophylaxis on its occurrence. METHODS: We performed a retrospective multicenter case-control study of patients diagnosed with nocardiosis after allogeneic HCT between January 2000 and December 2018. For each case, two controls were matched by center, transplant date, and age group. Multivariable analysis was conducted using conditional logistic regression to identify potential risk factors for nocardiosis. Kaplan-Meier survival curves of cases and controls were compared using log-rank tests. RESULTS: Sixty-four cases and 128 controls were included. Nocardiosis occurred at a median of 9 months after allogeneic HCT (interquartile range: 5-18). After adjustment for potential confounders in a multivariable model, Nocardia infection was associated with tacrolimus use (adjusted odds ratio [aOR] 9.9, 95 % confidence interval [95 % CI]: 1.6-62.7), lymphocyte count < 500/µL (aOR 8.9, 95 % CI: 2.3-34.7), male sex (aOR 8.1, 95 % CI: 2.1-31.5), recent use of systemic corticosteroids (aOR 7.9, 95 % CI: 2.2-28.2), and recent CMV infection (aOR 4.3, 95 % CI: 1.2-15.9). Conversely, use of trimethoprim-sulfamethoxazole prophylaxis was associated with a significantly decreased risk of nocardiosis (aOR 0.2, 95 % CI: 0.1-0.8). HCT recipients who developed nocardiosis had a significantly decreased survival, as compared with controls (12-month survival: 58 % and 90 %, respectively; p < 0.0001). CONCLUSIONS: We identified six factors independently associated with the occurrence of nocardiosis among allogeneic HCT recipients. In particular, trimethoprim-sulfamethoxazole prophylaxis was found to protect against nocardiosis.

Nocardiosis in kidney transplant recipients: A tertiary care center experience.

INTRODUCTION: Kidney transplant recipients are at increased risk of opportunistic infections, including Nocardia. The incidence of nocardiosis in kidney transplant recipients is 0.4-1.3%. The data regarding its epidemiology and outcomes is limited. METHODS: This was a 10-year retrospective observational study from January 2012 to December 2021 at a tertiary care center in northern India, in which all kidney transplant recipients with Nocardia infection were included and followed. RESULTS: 12 (1.1%) patients had a Nocardia infection among the 1108 kidney transplant recipients. All were living donor kidney transplant recipients, and the mean age at diagnosis was 48.67 ± 12.60 years. Nocardia infection occurred at a median of 26 months (range 4-235) post-transplantation, with 4 (33.1%) of the cases occurring within a year of transplant. Breakthrough infection occurred in 7 (58.3%) patients on cotrimoxazole prophylaxis. 41.7% (n = 5) cases had an episode of rejection in the preceding year of Nocardia diagnosis. Concurrent cytomegalovirus (CMV) infection was present in one (8.3%) case. The lung was the most frequently involved organ. Microscopy was positive in all the cases; while culture was positive in 10 cases, and antimicrobial susceptibility testing (AST) were performed for these isolates. The majority (60%) of isolates were resistant to cotrimoxazole. All tested isolates remained susceptible to Amikacin, Imipenem, and Linezolid. No patients experienced Nocardia recurrence after completion of antibiotic therapy. The mortality at 12 months was 66.7% (n = 4), and only one death was Nocardia-related. CONCLUSION: Nocardia may cause a late-manifesting infection beyond the traditional window. The cotrimoxazole prophylaxis may not be sufficient for Nocardia prevention.

Características epidemiológicas, clínico-patológicas e morfotintoriais de quatorze casos de nocardiose em cães / Epidemiological, clinical, pathological and morphotinctorial features of fourteen cases of nocardiosis in dogs

Este artigo descreve os aspectos epidemiológicos, clínicos, patológicos e características morfotintoriais em quatorze casos de nocardiose em cães. Para isso foi realizado um estudo retrospectivo durante o período de janeiro de 2005 a dezembro de 2015 e selecionados os casos sugestivos de nocardiose. A identificação e caracterização do agente foi realizada através de técnicas histoquímicas especiais de Metenamina nitrato de prata de Grocott (GMS), Ziehl-Neelsen modificado, coloração de Gram do tipo Brown-Brenn modificado e Giemsa. Foram afetados predominantemente filhotes e em doze casos havia associação com o vírus da cinomose canina (VCC). Os sinais clínicos variaram de alterações respiratórias, neurológicas e cutâneas, relacionadas principalmente à infecção concomitante pelo VCC. Macroscopicamente haviam áreas multifocais a coalescentes, branco-amareladas, firmes, elevadas na superfície e que se aprofundavam ao corte, por vezes com material purulento, entremeadas por áreas avermelhadas irregulares afetando principalmente pulmões, linfonodos, fígado, rins e encéfalo. As lesões cutâneas foram observadas predominantemente nas regiões cervical e inguinal e variaram de supurativas a piogranulomatosas. No exame histopatológico a lesão era caracterizada principalmente por inflamação piogranulomatosa, porém em algumas áreas havia predomínio de inflamação necrossupurativa, e frequentemente eram observados macrófagos epitelioides, formando aglomerados de forma radiada, muitas vezes lembrando pseudorosetas. Nas técnicas histoquímicas foram observadas estruturas filamentosas, ramificadas, não septadas, medindo aproximadamente 1µm de espessura, impregnadas na coloração de prata, coradas em vermelho no Ziehl-Neelsen modificado, em azul na coloração de Gram do tipo Brown-Brenn modificado e fracamente rósea pálido no Giemsa. A nocardiose deve ser considerada em animais jovens que apresentam sinais respiratórios e neurológicos progressivos, bem como em lesões cutâneas com envolvimento do subcutâneo e linfonodos regionais. Deve ser investigado ainda um provável fator predisponente, como a infecção pelo vírus da cinomose canina e hemoparasitoses. O diagnóstico foi estabelecido através do exame histopatológico baseando-se na morfologia da bactéria e suas características histoquímicas, distinguindo principalmente de outros agentes bacterianos e fúngicos, constituindo uma importante ferramenta para o diagnóstico, quando não é possível a coleta do material para cultivo e isolamento do agente.(AU)

This paper describes the epidemiological, clinical, pathological and morphotinctorial characteristics in fourteen cases of nocardiosis in dogs. A retrospective study for the period of January 2005 to December 2015 was made and selected suggestive cases of nocardiosis. The identification and characterization of the agent was performed by special histochemical techniques Methenamine silver nitrate Grocott (GMS), modified Ziehl-Neelsen, Gram stain type modified Brown-Brenn and Giemsa. Were affected predominantly young and in twelve cases were associated with canine distemper virus (CDV). Clinical signs vary from respiratory, neurological and skin changes, mainly related to concomitant infection by CDV. Macroscopically had multifocal areas coalescing, yellowish-white, firm, elevated in surface and deepened the court, sometimes with purulent material, intermixed by irregular reddened areas affecting mainly lungs, lymph nodes, liver, kidneys, and brain. The cutaneous lesions were predominantly observed in cervical and inguinal and ranged from suppurative well as pyogranulomatous. In the histopathologic examination the injury was mainly characterized by inflammation pyogranulomatous, but in some areas there was a predominance of necrossupurativa inflammation, epithelioid macrophages and were frequently observed, forming clusters radiated form, often reminding rosettes. In the histochemical techniques were observed filamentous structures, branched, non-septate, measuring approximately 1µm thick, impregnated on silver staining, stained in red on the modified Ziehl-Neelsen, in blue on Gram stain type modified Brown-Brenn and weakly pale pink in Giemsa. The nocardiosis should be considered in young animals with progressive respiratory and neurological signs, as well as skin lesions involving the subcutaneous tissue and regional lymph nodes. It should be further investigated a possible predisposing factor, such as infection by canine distemper virus and hemoparasites. The diagnosis was established by histopathological examination based on the morphology of the bacteria and their histochemical characteristics, distinguishing mainly from other bacterial and fungal agents and is an important tool for the diagnosis, when the collection of material for cultivation and isolation of the agent is not possible.(AU)

Estudio clínico y microbiológico de los micetomas observados en el Hospital de Infecciosas Francisco J. Muñiz en el período 1989-2004 / Clinical and microbiological study of mycetomas at the Muñiz Hospital of Buenos Aires between 1989 and 2004

Se presentan las características clínicas, microbiológicas y los resultados del tratamiento de 76 casos de micetomas observados en el período 1989-2004 en el Hospital Muñiz. Cuarenta y nueve fueron varones y 27 mujeres, con una edad promedio de 43,4 años. La mayor parte de los pacientes adquirió la infección en nuestro país, las provincias más afectadas fueron Santiago del Estero con 31 casos y el Chaco con 11; 8 enfermos procedían del exterior, 6 de Bolivia y 2 de Paraguay. El promedio de evolución de la enfermedad fue de 9,2 años. Las localizaciones más comunes fueron las de los miembros inferiores: pies 63, tobillos 3 y rodillas 2. Se comprobó compromiso óseo en 48 casos y adenomegalias en 5. Fueron identificados los siguientes agentes causales: Madurella grisea 29 casos, Actinomadura madurae 26, Scedosporium apiospermum 5, Nocardia brasiliensis 5, Acremoniun spp. 4 (Acremonium falciforme 2, Acremonium kiliense 1 y Acremonium recifei 1), Madurella mycetomatis 3, Fusarium solani 2, Nocardia asteroides y Streptomyces somaliensis 1 caso cada uno. Los tratamientos más frecuentemente utilizados fueron ketoconazol o itraconazol en los micetomas maduromicósicos y la asociación de cotrimoxazol con ciprofloxacina o amicacina en los micetomas actinomicéticos. La amputación del miembro afectado se realizó en 6 casos, 25 pacientes alcanzaron la remisión clínica completa y 34 presentaron mejorías importantes.

This work presents clinical, microbiological and outcome data collected from 76 patients with mycetomas at the Muñiz Hospital from 1989 to 2004. Forty-nine patients were male and 27 female; the mean age was 43.4 years. The majority of the patients acquired the infection in Argentina: the most affected provinces were Santiago del Estero with 31 cases, and Chaco with 11; 8 cases came from other countries (Bolivia 6 and Paraguay 2). The mean evolution of the disease was 9.2 years. The most frequently observed sites were: feet 63 cases, ankles 3, and knees 2. Forty-eight patients had bone lesions and 5, adenomegalies. The following etiological agents were identified: Madurella grisea 29 cases, Actinomadura madurae 26, Scedosporium apiospermum 5, Nocardia brasiliensis 5, Acremonium spp. 4 (Acremonium falciforme 2, Acremonium kiliense 1, Acremonium recifei 1), Madurella mycetomatis 3, Fusarium solani 2, Nocardia asteroides 1 and Streptomyces somaliensis 1. The main drugs used in the treatments were ketoconazole and itraconazole for maduromycotic mycetomas, and cotrimoxazole associated with ciprofloxacin or amikacin for actinomycetic mycetoma. Six patients had to undergo amputation, 25 cases achieved complete clinical remission and 34 showed remarkable improvement.

Respuesta de los autores: Nocardiosis cutánea primaria por Nocardia brasiliensis en España / Author’s reply: Primary nocardiosis by Nocardia brasiliensis in Spain

No disponible

No disponible

Epidemiología y manifestaciones clínicas de la infección por especies de Nocardia en Tarragona, 1997 a 2008: Nocardia cyriacigeorgica es un patógeno emergente / Epidemiology and clinical manifestations of infection due to Nocardia species in Tarragona, 1997–2008: Nocardia cyriacigeorgica is an emerging pathogen

Introducción Las infecciones por Nocardia son infrecuentes y la experiencia clínica es limitada. Métodos Se describen las características clínicas de 22 pacientes (17 varones) con infección por Nocardia atendidos entre 1997 y 2008.ResultadosLa edad media fue de 63,2 ± 19,2 años. Las formas clínicas más frecuentes fueron infecciones respiratorias (15 de 22: 8 bronquitis y 7 neumonías, el 68%) en pacientes con enfermedad pulmonar obstructiva crónica (EPOC) (10 de 22, el 45%) y cutáneas (4 de 22, el 19%). Las infecciones fueron causadas por 7 especies de Nocardia distintas y las predominantes fueron N. asteroides (n=6), N. abscessus (n=4) y N. cyriacigeorgica (n=4). Se obtuvo informe de sensibilidad en 16 de 22 aislamientos y en todos ellos la especie de Nocardia era sensible a cotrimoxazol. N. cyriacigeorgica causó infecciones respiratorias, 2 bronquitis y 2 neumonías con una tasa de mortalidad del 50%.ConclusiónLa forma clínica más común de infección por Nocardia es la infección del tracto respiratorio inferior en pacientes con EPOC. Se observa un incremento de la identificación de infecciones por N. cyriacigeorgic a(AU)

Introduction Nocardia infections are uncommon, and the clinical experience with this pathogen is limited. Methods We describe the clinical characteristics of a series of 22 patients (17 men) with Nocardia infection seen between 1997 and 2008.ResultsMean age was 63.2±19.2 years. The most common clinical forms observed were lower respiratory tract infection (15/22, 68%, 8 bronchitis and 7 pneumonia) mainly in patients with chronic obstructive pulmonary disease (10/22, 45%), and skin involvement (4/22, 19%). Seven different Nocardia species were recovered, the most common being N. asteroides (n=6), N. abscessus (n=4), and N. cyriacigeorgica (n=4). Sensitivity studies, available in 16/22 patients, showed that all Nocardia were sensitive to cotrimoxazole. N. cyriacigeorgica caused respiratory infections (2 bronchitis and 2 pneumonia) with a mortality rate of 50%.ConclusionThe most common clinical form of Nocardia infection is a lower respiratory tract infection in patients with chronic obstructive pulmonary disease. Infections by N. cyriacigeorgica are increasing (AU)

Nocardiosis y bronquiectasias. ¿Una asociación infrecuente? / Nocardiosis and bronchiectasis. An uncommon association?

OBJETIVO. La nocardiosis es una enfermedad de difícil diagnóstico que, en contadas ocasiones, se ha asociado a bronquiectasias y/o fibrosis quística. Se analizan las características clínico-microbiológicas de 40 pacientes en los que se aislaron microorganismos pertenecientes al complejo Nocardia asteroides. MÉTODOS. Se estudiaron 27 varones y 13 mujeres, con una media de edad de 45 años (8-82). Se aisló Nocardia spp. en 129 muestras. El cultivo se realizó por métodos convencionales, utilizándose además BCYE-alfa modificado(m) al visualizarse bacilos grampositivos ramificados en el examen microscópico. RESULTADOS. En el 77,5% de los casos la investigación de Nocardia spp. estuvo motivada por el examen microscópico, en 6 pacientes fue un hallazgo fortuito en medio BCYE-alfa (m) y sólo en 3 pacientes existía la sospecha clínica de nocardiosis. Tenían nocardiosis 25 pacientes (5 infecciones diseminadas y 20 pulmonares)y los 15 restantes estaban colonizados. El factor de riesgo más frecuente en las infecciones, diseminadas o no, fue la utilización de glucocorticoides por vía sistémica(p = 0,001), la enfermedad de base que más se asoció a todos los cuadros clínicos fueron las bronquiectasias (80%), asociadas o no a fibrosis quística (FQ). Se produjeron 7 muertes y 2 pacientes presentaron secuelas neurológicas. CONCLUSIONES. Las bronquiectasias suponen un factor importante de riesgo para la colonización (p = 0,01)en todos los pacientes y para la infección (p = 0,05)por Nocardia spp. en los pacientes sin fibrosis quística. La utilización del medio de BCYE-alfa (m) en el procesamiento de las secreciones respiratorias facilitó extraordinariamente el aislamiento de Nocardia spp (AU)

OBJECTIVE. Nocardiosis is difficult to diagnose and infrequently associated with bronchiectasis or cysticfibrosis. This study analyzes the clinical and microbiological characteristics of 40 patients in whom microorganisms belonging to the Nocardia asteroides complex were isolated. METHODS. We studied 27 males and 13 females, with a mean age of 45 years (8-82). Nocardia spp. were isolated in129 samples. Cultures were performed with conventional methods; additionally, when branching Gram-positive bacilli were visualized on microscopic examination, modified BCYE-alpha (m) medium was used. RESULTS. In 77.5% of the cases, investigation for Nocardiaspp. was based on microscopy findings, in six patients it was a fortuitous finding in BCYE-alpha (m) medium, and in only three patients nocardiosis was clinically suspected. Twenty-five patients had nocardiosis (5 disseminated infection and 20 lung infection) and the remaining 15 were colonized. The most frequent risk factor in the infections, whether disseminated or not, was systemic glucocorticoiduse (P = .001). The most frequent underlying pathology was bronchiectasis (80%), associated or not with cysticfibrosis. There were seven deaths and two patients had neurological sequelae. CONCLUSIONS. Bronchiectas is was an important risk factor for colonization by Nocardia spp. (P = 0.01) in all the patients studied, and for infection (P = 0.05) in patients without cystic fibrosis. The use of BCYE-alpha (m) medium in processing respiratory secretions highly facilitated the isolation of Nocardia spp (AU)

Nocardiosis en pacientes infectados por el VIH / Nocardiosis in patients with human immunodeficiency virus infection

Antecedentes. La nocardiosis es una enfermedad bacteriana asociada con estados de inmunodeficiencia, incluyendo la infección por el virus de la inmunodeficiencia humana (VIH). Métodos. Se analizaron en forma retrospectiva las historias clínicas de 27 pacientes con nocardiosis e infección por VIH asistidos entre los años 1993 y 2004. Se evaluaron las características epidemiológicas, clínicas, inmunológicas, microbiológicas y terapéuticas. Resultados. Eran hombres el 81% con una mediana de edad de 30 años. Un elevado porcentaje de pacientes (89%) tenían antecedentes de enolismo, tabaquismo (80%) y uso de drogas intravenosas (82%). El 85% tenía diagnóstico previo de infección por el VIH. La mediana de linfocitos T CD4+ (n = 17) al momento del diagnóstico de nocardiosis fue de 15 cél./μl. Predominaron las formas clínicas pulmonar (70%), cutánea (11%) y diseminada (11%). Los materiales más frecuentes para el diagnóstico incluyeron muestras de esputo (52%), punción-aspiración de piel y partes blandas (22%) y lavado broncoalveolar (19%). El patrón radiológico pulmonar predominante fue alveolar: 74%, seguido de cavidades pulmonares en el 32%. La especie se pudo identificar en 13 pacientes (48%); la más frecuente fue el complejo Nocardia asteroides en el 84% (n = 11). Los antimicrobianos más utilizados fueron cotrimoxazol (78%), amikacina (59%) y ciprofloxacino (33%). En el 78% de los casos el tratamiento fue combinado y la asociación más frecuente fue cotrimoxazol-amikacina. La mortalidad global fue del 37%. Conclusiones. La nocardiosis es una enfermedad poco frecuente en pacientes infectados por el VIH. Su diagnóstico debería considerarse en sujetos con inmunodepresión grave (linfocitos T CD4+ < 50 cél./μl) y compromiso pulmonar o pericárdico (AU)

Background. Nocardiosis is a bacterial disease that occurs in immunocompromised patients, including those infected by the human immunodeficiency virus (HIV). Methods. We retrospectively analyzed the clinical records of 27 HIV-positive patients with nocardiosis seen during the period of 1993 to 2004. Clinical presentations, diagnostic methods, predominant species, antimicrobial therapy and outcome were analyzed. Results. Among the total, 81% were males and the median age was 30 years. There was an elevated percentage of alcoholism (89%), smoking (80%) and intravenous drug use (82%). A previous positive serology for HIV infection was present in 85% of the patients. Plasma CD4+ T cell count at the time of diagnosis in 15 of 17 patients (88%) was below 50 cells/ml (median 15 cells/μl). The most frequent clinical onset was pulmonary in 70%, followed by cutaneous in 11% and disseminated in 11%. The main specimens for diagnostic bacterial isolation were sputum (54%), skin and soft tissues (22%) and bronchoalveolar lavage (19%). The predominant pulmonary radiological pattern was alveolar infiltration (74%), followed by cavitations (32%). The species was identified in 13 patients (48%); Nocardia asteroides was isolated in 84% (n = 11). The main antimicrobial drugs prescribed were cotrimoxazole (78%), amikacin (59%) and ciprofloxacin (33%). Dual therapy was used in 78% of the cases, with cotrimoxazole-amikacin being the most frequent. Overall mortality was 37%. Conclusions. Nocardiosis is an unusual infection among HIV-infected patients. The diagnosis should be considered in patients with CD4+ T cell counts below 50/μL and lung or pericardial involvement (AU)

Nocardiosis / Nocardiosis

No disponible

Nocardiosis en pediatría: caso clínico y revisión de la literatura / Nocardiosis in pediatrics: case report and brief review

Nocardiosis es una infección poco frecuente en pediatría, que se presenta habitual, pero no exclusivamente, en pacientes inmunocomprometidos, pudiendo producir cuadros localizados o diseminados. El diagnóstico se hace muchas veces mediante estudio histológico por visualización del microorganismo en los tejidos, dada la dificultad de confirmación bacteriológica, estudio que debe ser orientado por la sospecha clinica. Se presenta el caso de una preescolar inmunocompetente que cursó con un síndrome febril prolongado en que se descartaron múltiples causas infecciosas, tumores y mesenquimopatías; la histología de las lesiones nodulares hepato-esplénicas, aparecidas durante su estudio, confirmada con tomografía. Es importante considerar Nocardia sp entre las etiologías a estudiar en un cuadro febril de origen obscuro, ya que es posible su demostración mediante un estudio de laboratorio bien orientado frente a la sospecha clínica

Nocardiosis pulmonar en un paciente con síndrome de inmunodeficiencia adquirida / Pulmonary nocardiosis in a male patient with AIDS

Se presenta un paciente de sexo masculino portador de una nocardiosis pulmonar asociada a SIDA. La radiografía de tórax mostró un infiltrado heterogéneo hilioapical izquierdo y se observaron signos de cavitación en la tomografía lineal. El recuento de linfocitos CD4 fue de 70/mm3. El diagnóstico se realizó por el hallazgo del agente etiológico en el esputo. Con el tratamiento con trimetropina-sulfametoxazol se logró la mejoría clínica y la negativización de los cultivos de esputo. En forma asociada presentó: sarcoma de Kaposi, candidiasis cutánea y esofagogástrica y bacteriemia por Salmonella O.S.A.

Nocardiosis pulmonar primaria: presentación de un caso

Informamos el caso de una mujer de 46 años con tos no productiva, disnea CF II, hipoxemia y pérdida de peso. Los Rx de tórax mostraban opacidades de tipo insterticial bilaterales. Se le diagnostica nocardiosis pulmonar primaria mediante cultivo del lavado broncoalveolar y de la biopsia pulmonar a cielo abierto. Presentamos los principales hallazgos clínicos, radiológicos, bacteriológicos y de patología.