ABSTRACT
We report the case of a primary lymphocutaneous nocardiosis occurring on the right calf of a healthy 56-year-old man after an insect bite. Analysis of the purulent exudate obtained from the nodule revealed Nocardia brasiliensis. The initial therapy with trimethoprim-sulfamethoxazole had to be stopped due to a drug eruption. However, with minocycline treatment the patient recovered within 5 weeks. Superficial (sporotrichoid) infections and a history of outdoor injury should be considered suspicious for cutaneous nocardiosis.
Subject(s)
Insect Bites and Stings/complications , Nocardia Infections/transmission , Skin Diseases, Bacterial/transmission , Humans , Male , Middle Aged , Nocardia Infections/diagnosis , Nocardia Infections/drug therapy , Skin Diseases, Bacterial/diagnosis , Skin Diseases, Bacterial/drug therapyABSTRACT
Nocardia brasiliensis is a bacterium that is most commonly found in the soil. Traumatic inoculation of N. brasiliensis into the skin is the most typical mode of acquisition of infection due to this organism. To the best of my knowledge, I report the first case of lymphocutaneous N. brasiliensis disease from a penetrating cat scratch of the skin, thereby establishing cats as vehicles for the transmission of this infection. Treatment with penicillin produced a rapid resolution of all signs and symptoms of infection. The efficacy of penicillin against the N. brasiliensis isolate recovered from this patient was highly unusual. In general, penicillin has limited therapeutic value since these organisms elaborate beta-lactamase. Sulfonamides remain the drugs of choice for the treatment of these infections. These soil-borne organisms are most likely carried on the claws of cats and may establish infection after percutaneous inoculation. A high index of suspicion for N. brasiliensis soft-tissue infection is required since a delayed or missed diagnosis may be associated with progressive local disease and/or widespread disseminated infection.
Subject(s)
Cats/microbiology , Lymphadenitis/microbiology , Nocardia Infections/transmission , Nocardia/isolation & purification , Skin Diseases, Bacterial/transmission , Wound Infection/microbiology , Adult , Animals , Disease Vectors , Female , Humans , Lymphadenitis/drug therapy , Microbial Sensitivity Tests , Nocardia/drug effects , Nocardia Infections/drug therapy , Penicillins/therapeutic use , Skin Diseases, Bacterial/drug therapy , Wound Infection/drug therapyABSTRACT
On the basis of correlative data on the global distribution of leprosy, its bacteria metabolizing fossil fuels (FF), and the FF themselves, the origin of leprosy in the world as a whole, and in the leprosy-free countries, in particular, as indigenous cases, appeared to be primarily due to a soil-to-man, and secondarily due to a man-to-man infection. These findings helped to elucidate similar problems of animal leprosies and nocardial diseases.