Intracranial Nocardia recurrence during fluorinated quinolones therapy.

Nocardia infection is a well-recognized complication in renal transplant recipients and other immunocompromised hosts. It is mostly a primary pulmonary infection, which can disseminate to other organs in half of the cases. Nocardiosis is a life-threatening infection. Therefore, an efficient long-lasting treatment must be rapidly administered. We report 1 case of disseminated nocardiosis with pulmonary involvement, brain lesions, and bone lesions in a renal transplant patient, who was treated with stereotactic aspiration in association with high dose of trimethoprim/sulfamethoxazole (TMP/SMX) and imipenem, changed, after 3 weeks to moxifloxacin. First, clinical manifestations decreased after surgical drainage and combination therapy with the 2 antimicrobial agents, but later the patient developed a recurrence of brain lesions during treatment with quinolones. Consequently, the patient was again treated with TMP/SMX and imipenem, after which the patient recovered. It is surprising that moxifloxacin was efficient in vitro and the antimicrobial concentration in the central nervous system was high, yet the nocardial abscess recurred under this therapy.

Therapeutic considerations: lower respiratory tract infections in smokers.

Tobacco smoke can alter both the structural and the immunologic defenses of the lungs against infection. The gases from smoke can also inhibit repair of the damages they create. Smokers have been found to have increased bacterial adherence to the respiratory tract, decreased IgA and IgG, and a decrease in vital capacity two to three times greater than that of nonsmokers. These and other respiratory tract alterations put smokers at an added disadvantage when acute lower respiratory tract infections strike. A history of smoking influences the diagnosis of respiratory tract infections because smokers are more prone than nonsmokers to infection by certain organisms. The major causes and characteristics of lower respiratory tract infections, methods of outpatient diagnosis, and the pros and cons of various modes of therapy are discussed.