Weathering the storm: diagnosis and treatment of a life-threatening disseminated Nocardia otitidiscaviarum infection.

Nocardiosis demonstrates a temporal categorization that includes acute, subacute, and chronic stages alongside distinct typical localizations such as pulmonary, cutaneous, and disseminated forms. Disseminated nocardiosis, commonly caused by Nocardia asteroides, N. brasiliensis, and N. farcinica, continues to result in substantial morbidity and mortality. Herein, we report a life-threatening disseminated nocardiosis caused by Nocardia otitidiscaviarum in a patient with minimal change disease. This study emphasizes the difficulty in the diagnosis and treatment of unknown infections in clinical settings and highlights the important role played by laboratories in solving infectious diseases caused by rare pathogens.

Nocardia otitidiscaviarum causing pulmonary nocardiosis: a case report and its review of the literature.

Background: Infections caused by Nocardia spp. can occur in immunocompromised as well as immunocompetent individuals. Although nocardiosis is rare, it is being increasingly recognized owing to the rise in occurrence rate over the years. The documentation of pleural involvement in nocardiosis is rare in India. Case: We report a case of pulmonary nocardiosis in an immunocompromised individual caused by Nocardia otitidiscaviarum. Discussion: Pulmonary nocardiosis caused by Nocardia otitidiscaviarum may go unnoticed without clinical suspicion. Correct and timely identification is the key to proper patient management. Conclusion: Coordination between clinicians and microbiologists is necessary for early diagnosis and appropriate management of nocardiosis.

A Fatal Case of Multidrug-Resistant Pleural Nocardiosis by Nocardia otitidiscaviarum in an Immunosuppressed Patient: A Case Report and Literature Review.

Nocardiosis is known as an opportunistic infection in immunocompromised hosts. We present to you a case of pleural nocardiosis in a 38-year-old male patient who was a chronic smoker and presented with a left-sided pleural effusion. He was a known case of thrombocytopenia due to immune thrombocytopenia (ITP) and was on steroid therapy. On admission, he was found to be positive for HIV. Pleural fluid was sent to microbiology, where acid-fast staining with 1% sulfuric acid (H2SO4)showed acid-fast branching filamentous rods and cultures grew Nocardia, which was resistant to ampicillin, ceftriaxone, imipenem, cotrimoxazole, erythromycin, tetracycline, and susceptible to amikacin, linezolid, and levofloxacin. The isolate was identified as Nocardia otitidiscaviarum using 16S rRNA gene sequencing. Culture from the chest wall drain grew Escherichia coli and Stenotrophomonas maltophilia. Subsequently, the patient developed sepsis, and paired blood cultures grew Candida guilliermondii. Unfortunately, the patient could not survive despite aggressive efforts and died after 40 days of admission.

Manifestations and Management of Trimethoprim/Sulfamethoxazole-Resistant Nocardia otitidiscaviarum Infection.

Nocardia can cause systemic infections with varying manifestations. Resistance patterns vary by species. We describe N. otitidiscavarium infection with pulmonary and cutaneous manifestations in a man in the United States. He received multidrug treatment that included trimethoprim/sulfamethoxazole but died. Our case highlights the need to treat with combination therapy until drug susceptibilities are known.

Ulceration by Nocardia Otitidiscaviarum: A case study.

Nocardiosis is an acute, subacute or chronic infectious disease that occurs in cutaneous, pulmonary and disseminated forms. We present a case of Nocardiosis in a post-COVID-19 patient with cutaneous ulceration due to Nocardia otitidiscaviarum, managed with cotrimoxazole and linezolid. Early diagnosis and management proved crucial in preventing dissemination of the organism and improving the patient's outcome.

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.

A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim-sulfamethoxazole: case report and literature review.

BACKGROUND: Disseminated nocardiosis still causes significant morbidity and mortality and is often caused by Nocardia asteroides, N. basiliensis, and N. farcinica and are often treated with trimethoprim-sulfamethoxazole (TMP-SMX). Nocardia otitidiscaviarum (N. otitidiscaviarum) rarely causes disseminated disease and resistance to TMP-SMX is even more rare. CASE PRESENTATION: A 37-year-old woman with metastatic breast cancer and right ear deafness with recent occupational gardening and manipulating soil, presented to the hospital with first time seizure and multiple skin nodules. Magnetic resonance imaging (MRI) showed ring enhancing lesions, biopsy of the skin and brain lesions grew N. otitidiscaviarum. She was empirically treated with TMP-SMX and Imipenem-Cilastatin, however, almost three weeks into therapy, susceptibility results revealed it to be resistant to both antimicrobials, she was subsequently changed to Amikacin, Linezolid, Moxifloxacin, and Doxycycline but ultimately died. CONCLUSIONS: This case report highlights the importance of suspecting a rare Nocardia species in patients at risk with proper occupational exposure, moreover, TMP-SMX resistance should be suspected with lack of clinical response, this may have important implications on clinical practice when facing similar infections.

Disseminated Nocardiosis in a Breast Cancer Patient Caused by Nocardia otitidiscaviarum: A Case Report of Tertiary Centre in Saudi Arabia.

Nocardiosis is a rare opportunistic disease that primarily affects patients with deficient immune systems. Nocardia otitidiscaviarum is one of the rare species of Nocardia and it represents less than 3% of all Nocardia cases. Clinical presentation can be varied according to the affected organ. This study describes a case of a breast cancer patient who is immunocompromised due to the chemotherapy. This patient presented with a feature of febrile neutropenia. Investigations of this case led to the diagnosis of Nocardia otitidiscaviarum . Treatment of this underlying infection required to hold the chemotherapy for good time and to adapt patient-specific cancer treatment according to the balance between both need of cancer control and infection treatment according to the susceptibility test as in our case.

Disseminated life threatening Nocardia otitidiscaviarum infection in a young female with newly diagnosed systemic lupus erythematosus, case report and review of literature.

Infection due to Nocardia is reported mainly in immunocompromised patients. It usually presents as a pulmonary or disseminated disease with a predilection for the brain. Infections are a rare etiology of intracranial vascular aneurysms. Herein we report a case of disseminated Nocardia otitidiscaviarum (N. otitidiscaviarum) in a young female newly diagnosed with systemic lupus erythematosus (SLE) complicated by the development of an infectious intracranial aneurysm. To the best of our knowledge this is the fourth case of nocardial infection-related intracranial aneurysm and the second case of N. otitidiscaviarum infection to be reported in a patient with systemic lupus erythematosus. Features of previously reported N. otitidiscaviarum related intracranial aneurysm are reviewed.

Multiple Brain Abscesses Due to Nocardia otitidiscaviarum: Case Report and Treatment Implications.

Nocardia infections typically present in immunocompromised hosts. Brain abscesses caused by species such as Nocardia  asteroides, farcinica, and abscessus are well-documented in the literature. We present a rare case of an immunocompetent patient with multiple brain abscesses due to Nocardia otitidiscaviarum requiring a decompressive fronto-temporoparietal craniectomy due to symptomatic intracranial hypertension. The patient was treated with intrathecal amikacin in addition to standard antibiotics with the resolution of the disease and good neurologic outcome. This is one of few case reports overall involving this species within the brain, and the second to report favorable outcomes. This case describes implications for treatment and adds to sparse literature regarding this particular pathogen.

Iatrogenic Nocardia otitidiscaviarum after PICC line placement.

BACKGROUND: Nocardia otitidiscaviarum is an aerobic, gram positive bacteria with low virulence and incidence. Despite being uncommon, N. otitidiscaviarum has been associated with skin, lung, and disseminated infections. CASE REPORT: A 56-year-old male with past medical history of type 2 diabetes mellitus and recent travel to the Bahamas presented to the emergency room with complains of abdominal pain, nausea, vomiting, and non-bloody diarrhea for four days. He ultimately required a PICC line for total parenteral nutrition. 2 days after line placement, he developed high fevers and severe right arm pain. Diagnostic imaging revealed venous thrombosis of cephalic vein and abscess formation within the soft tissue of right axilla with cultures ultimately growing Nocardia otitidiscaviarum. He underwent surgical incision and drainage of the abscess followed up with complete excision of the right cephalic vein and antecubital vein as well as sharp excisional debridement of skin, subcutaneous tissue and muscle fascia and was treated with trimethoprim-sulfamethoxazole for 3 months. CONCLUSION: Nocardia otitidiscaviarum treatment of cutaneous disease consists of trimethoprim- sulfamethoxazole for three to six months. While guidelines for surgical intervention for cutaneous infection are not specified, our patient required surgical incision and drainage of abscess, along with excision of vein due to necrosis in addition to antibiotic treatment for 3 months with successful outcomes.

Fatal pulmonary infection by trimethoprim-sulfamethoxazole resistant Nocardia otitidiscaviarum: report of two cases and review.

INTRODUCTION: Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients. METHODOLOGY: Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France). CONCLUSION: Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically ill patients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis.

Disseminated infection with Nocardia otitidiscaviarum in a patient under steroid therapy.

Corticosteroid recipients with lung infections should be suspected of having nocardiosis; however, nocardiosis can easily mimic malignancy, tuberculosis, or fungal infection. Though cultural identification is possible, it might be missed due to its slow growth pattern.. Therefore, if filamentous bacteria are seen during staining, plate incubation time should be extended.

Disseminated nocardiosis due to Nocardia otitidiscaviarum: A case report and literature review

Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts. Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for two days. Diagnosis: Disseminated nocardiosis due to Nocardia otitidiscaviarum. Interventions: Initial antimicrobial therapy with imipenem and trimethoprim/sulfamethoxazole was switched to 6 weeks of trimethoprim/sulfamethoxazole, linezolid and tigecycline after sensitivity test results were available. Thereafter, the patient was switched to maintenance trimethoprim/sulfamethoxazole and moxifloxacin. Prednisolone was gradually tapered. Outcomes: Soft tissue swelling and pain disappeared and the patient was discharged uneventfully. Lessons: Disseminated nocardiosis due to Nocardia otitidiscaviarum should be suspected in immunocompetent hosts with risk factors such as medication with prednisolone. Early identification of the causative species and susceptibility results is crucial given the diverse resistance patterns amongst various Nocardia species.

Disseminated nocardiosis due to Nocardia otitidiscaviarum: A case report and literature review

Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts. Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for two days. Diagnosis: Disseminated nocardiosis due to Nocardia otitidiscaviarum. Interventions: Initial antimicrobial therapy with imipenem and trimethoprim/sulfamethoxazole was switched to 6 weeks of trimethoprim/sulfamethoxazole, linezolid and tigecycline after sensitivity test results were available. Thereafter, the patient was switched to maintenance trimethoprim/sulfamethoxazole and moxifloxacin. Prednisolone was gradually tapered. Outcomes: Soft tissue swelling and pain disappeared and the patient was discharged uneventfully. Lessons: Disseminated nocardiosis due to Nocardia otitidiscaviarum should be suspected in immunocompetent hosts with risk factors such as medication with prednisolone. Early identification of the causative species and susceptibility results is crucial given the diverse resistance patterns amongst various Nocardia species.

Pulmonary Nocardiosis and Scrub Typhus in an Immunocompromised Host.

Pulmonary infections are not uncommon in patients with an underlying immunocompromised condition. Unusual combination of microorganisms causing concomitant infections among these patients has also been reported. However, certain rare dual occurrences are usually unanticipated as in the case we present here. This case highlights the importance of being aware of the possible coexistence of infections in immunocompromised patients. To the best of our knowledge, this is the first report of coinfection with Nocardia otitidiscaviarum and Orientia tsutsugamushi in a critically ill immunocompromised patient from South India.

Nocardia otitidiscaviarum meningitis in a diffuse large B-cell lymphoma patient with CD4-positive lymphocytopenia and persistent oligoclonal CD8-positive lymphocytes in the peripheral blood.

Nocardiosis, sometimes presenting with multiple granulomatous lesions, is a rare opportunistic infection occurring in immunocompromised patients. However, its immunological features remain largely unaddressed. We investigated the immunological characteristics of human nocardiosis and examined the component cells of the granulomatous lesions. A 66-year-old man with diffuse large B-cell lymphoma presented with fever and multiple nodules in the lung during chemotherapy. The blood culture formed white colonies, but their characterization was difficult by routine microbiological laboratory methods. Matrix-assisted laser desorption ionization-time of flight mass spectrometry identified the colonies as Nocardia otitidiscaviarum. Meanwhile, the patient suddenly experienced an epileptic seizure without a brain abscess. His cerebrospinal fluid (CSF) showed neutrophilic pleocytosis (108/mm3). The conventional agar culturing failed to isolate colonies, but culturing with brain-heart infusion agar generated colonies. These colonies were completely concordant with those from the blood, as confirmed by 16S rRNA gene sequencing. Therefore, the patient had developed meningitis through sepsis induced by N. otitidiscaviarum. His CD4-positive T-lymphocyte counts were low, and oligoclonal CD8-positive αß T-lymphocytes were present in the blood prior to the first and after three cycles of chemotherapy. He had bone marrow granulomatous lesions comprising lymphoma and CD8-positive αß T-cells. Treatment with sulfamethoxazole/trimethoprim relieved all of his symptoms. The combined analysis by microbiological and molecular methods determined the cause of his epileptic seizure. His immunological characteristics, including low CD4-positive or CD8-positive αß T-lymphocytes, may have contributed to the unusual clinical presentations by N. otitidiscaviarum, which rarely involves the central nervous system.

Unfolding of a Clinically Suspected Case of Pulmonary Tuberculosis.

Pulmonary nocardiosis caused by Nocardia mimics pulmonary tuberculosis in many aspects. Here, we report a case of suspected pulmonary tuberculosis turning into pulmonary nocardiosis following microbiological evaluation. Sputum sample of the patient grew Nocardia otitidiscaviarum. Identification was done by conventional methods and matrix assisted laser desorption ionization-time of flight. He was given co-trimoxazole based on susceptibility reports. Even though Nocardia is a rare entity, pulmonary nocardiosis should be ruled out before starting antitubercular treatment to avoid unnecessary burden to the patient and community.

Disseminated nocardiosis caused by Nocardia otitidiscaviarum in an immunocompetent host: A case report and literature review.

The aim of the present study was to summarize the clinical characteristics of nocardiosis caused by Nocardia otitidiscaviarum in order to improve the knowledge of nocardiosis. A case of dissemination nocardiosis caused by N. otitidiscaviarum in an immunocompetent host is reported and the associated literature reviewed. Informed consent for publication of this case report was provided by the patient. The present patient was a young immunocompetent man suffering from disseminated nocardiosis induced by infection with N. otitidiscaviarum. Following a poor response to ß-lactam antibiotic, a combination of sulfonamide with minocycline was administered, which successfully ameliorated the symptoms. Previous studies published in English were retrieved from PubMed with 'Nocardia otitidiscaviarum' used as the search keyword. A total of 23 articles were retrieved from the PubMed database, supporting the assertion that N. otitidiscaviarum is a rare Nocardia species. Among these 23 cases, there were 11 cases of lymphocutaneous (48%), 5 of pulmonary (22%), 2 of brain (9%) and 1 of pyothorax (4%) infection, and 4 cases of disseminated infections (17%). Analysis of the immune state of these patients demonstrated that 9 were immunocompetent (39%), 7 of whom had cutaneous infections (30%) with a predominant history of trauma (6/7), and 14 were immunosuppressed, 9 of whom were treated with prednisolone. Microbiology and histopathology were necessary in all cases for definite diagnosis. Among the 13 cases who underwent drug susceptibility testing, 10 cases were sensitive to trimethoprim-sulfamethoxazole (TMP-SMX) and 12 cases were sensitive to aminoglycoside. In conclusion, although N. otitidiscaviarum is one of the less commonly isolated species of Nocardia, it is capable of inducing localized or disseminated infection, even in an immunocompetent host. The majority of cases respond well to TMP-SMX and aminoglycoside, but the therapeutic action of cephalosporin is weak. Identification of bacteria and drug sensitivity tests for Nocardia is critical for guiding clinical treatment.

Lymphocutaneous nocardiosis caused by Nocardia otitidiscaviarum: A case report and review of literature.

Nocardia otitidiscaviarum is a rare clinical isolate of primary cutaneous infections. This report describes a case of lymphocutaneous nocardiosis caused by N. otitidiscaviarum. Analysis of 16S ribosomal RNA gene of the isolate and the type strain of N. otitidiscaviarum DSM 43242 showed 100% similarity. The partial gene sequence of 1439 bp was submitted to GenBank. (EU031786). The isolate was susceptible only to amikacin, minocycline, linezolid and resistant to remaining other routine anti-nocardial drugs. The patient was free of nocardiosis after 12 weeks of treatment with amikacin and linezolid. We reviewed four other cases of lymphocutaneous nocardiosis caused by N. otitidiscaviarum.