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1.
Int J Dermatol ; 49(12): 1380-5, 2010 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21155087

RESUMO

BACKGROUND: Cutaneous nocardiosis is an uncommon infectious disease that presents as a primary cutaneous infection or as a disseminated disease. It is often misdiagnosed because of its rarity and nonspecific clinical picture. METHODS: We report a case of each type. The first case is an immunocompetent patient who was infected by Nocardia while gardening and developed a superficial skin infection--one of the three clinical manifestations of primary cutaneous nocardiosis. The second case is an immunocompromised patient with pulmonary nocardiosis that extended to the skin as part of a disseminated disease. RESULTS: The immunocompetent patient with primary cutaneous nocardiosis had the classical features of a superficial skin infection. He had a nodular­pustular lesion on the right arm, which appeared 7 days after gardening with bare hands. Nocardia was identified in a skin culture taken from a pustule, unfortunately not to the species level. Treatment with minocycline for 3 months resulted in full remission of the lesion. The immunocompromised patient with disseminated nocardiosis had high fever, productive cough, hemoptysis, and erythematous nodules and pustules on the extremities. N. brasiliensis was isolated from bronchial samples and skin. Treatment with a high dose of trimethoprim and sulfamethoxazole for five months resulted in full recovery from cutaneous and pulmonary complaints. No relapse of the infection was found on follow-up in either patient. CONCLUSION: These cases demonstrate the need for a high degree of suspicion, focused clinical search, and appropriate laboratory procedures in the diagnosis and management of cutaneous nocardiosis.


Assuntos
Nocardia/isolamento & purificação , Pneumonia Bacteriana/microbiologia , Dermatopatias Bacterianas/microbiologia , Idoso , Anti-Infecciosos/uso terapêutico , Diagnóstico Diferencial , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Minociclina/uso terapêutico , Nocardia/efeitos dos fármacos , Nocardiose/diagnóstico , Nocardiose/tratamento farmacológico , Nocardiose/microbiologia , Pneumonia Bacteriana/diagnóstico , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/tratamento farmacológico , Sulfametoxazol/uso terapêutico , Trimetoprima/uso terapêutico
2.
J Am Acad Dermatol ; 57(3): 413-20, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-17368631

RESUMO

BACKGROUND: Absence of a pathognomonic clinical picture and variable histologic findings often delay diagnosis of nontuberculous mycobacteria (NTM)-induced cutaneous infections, and antimicrobial therapy varies. OBJECTIVE: We sought to investigate the clinical, microbiologic, and pathological findings of cutaneous NTM infections and response to different treatments. METHODS: Records of patients with NTM infections of the skin confirmed by positive cultures or histologic findings were reviewed. Clinical, microbiologic, and epidemiologic data were collected and skin biopsy specimens were reassessed. RESULTS: The series included 25 cases, one diagnosed by histology and 24 by positive culture: 16 cases with Mycobacterium marinum, 3 of atypical Mycobacterium without species identification, and one each with M chelonae, M xenopi, M abscessus, M gordonae, and M fortuitum. One of 16 patients with M marinum developed tenosynovitis. Mean interval between clinical presentation and diagnosis was 7.1 months (range: 1-27.3 months). All isolates analyzed for antimicrobial susceptibility pattern were sensitive to clarithromycin. LIMITATIONS: Limitations include methods of case collection, retrospective study, and relatively small number of patients. CONCLUSIONS: Diagnosis of NTM should be confirmed by histology and bacteriology studies of tissue cultures. Strong clinical suggestion of M marinum infection warrants initial empirical treatment to prevent progression to deep infection. The recommended treatment as indicated by the results of the in vitro susceptibility and clinical response is clarithromycin.


Assuntos
Infecções por Mycobacterium/diagnóstico , Infecções por Mycobacterium/tratamento farmacológico , Dermatopatias Bacterianas/diagnóstico , Dermatopatias Bacterianas/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Claritromicina/uso terapêutico , Erros de Diagnóstico , Resistência a Medicamentos , Quimioterapia Combinada , Feminino , Dedos , Humanos , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Mycobacterium/classificação , Mycobacterium/isolamento & purificação , Infecções por Mycobacterium/microbiologia , Infecções por Mycobacterium/patologia , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Micobactérias não Tuberculosas/isolamento & purificação , Estudos Retrospectivos , Dermatopatias Bacterianas/microbiologia , Dermatopatias Bacterianas/patologia , Fatores de Tempo , Resultado do Tratamento , Extremidade Superior
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