Primary Cutaneous Nocardiosis Caused by Nocardia niigatensis / 대한피부과학회지

No abstract available.

Primary Cutaneous Nocardiosis Caused by Nocardia farcinica / 대한피부과학회지

The Nocardia species are aerobic Gram-positive filamentous bacteria found worldwide in soil and decaying organic plant matter. Primary cutaneous nocardiosis is a rare entity and most commonly caused by Nocardia brasiliensis (N. brasiliensis). However, it can rarely be caused by N. farcinica, which is recognized as a human pathogen. Here we report a case of a 54-year-old female patient who presented with erythematous nodules on her abdomen for 1 week. She had been treated with methotrexate and prednisolone due to systemic lupus erythematosus and rheumatoid arthritis. By bacterial culture and 16S ribosomal RNA gene sequencing, the patient was diagnosed with a primary cutaneous nocardiosis caused by N. farcinica, which has not previously been reported in the Korean dermatological literature.

Nocardiosis cutánea y sus formas clínicas / Cutaneous nocardiosis and its various presentations

La nocardiosis cutánea es una dermatosis infecciosa poco frecuente, que puede presentarse tanto en individuos inmunocompetentes como en inmunocomprometidos. A continuación se describen tres pacientes de sexo masculino inmunosuprimidos, en tratamiento con corticoesteroides, que presentaron diferentes formas clínicas de nocardiosis cutánea.

Cutaneous nocardiosis is a rare opportunistic infection found in bothimmunocompromised and immunocompetent patients. We describe three male immunocompromised patients who exhibited diff erent clinical forms of cutaneous nocardiosis. All of them were under corticosteroid regimen.

Nocardial infections: report of 22 cases

Twenty-two cases of nocardial infections were diagnosed in our city between 1977- 1998. All patients whose clinical specimens showed Nocardia spp. at Gram stain, which were further confirmed by culture, were selected to be included in the study. Data from patients who were cured were compared with those from patients who died by statistical tests using EPIINFO version 6.04 software. Six isolates were identified as Nocardia asteroides complex, one as Nocardia asteroides sensu stricto and other as Nocardia brasiliensis. We had 17 cases of lung nocardiosis, being one out of them also a systemic disease. Other four cases of systemic nocardiosis were diagnosed: nocardial brain abscesses (one); nocardiosis of the jejunum (one); multiple cutaneous abscesses (one); and a case of infective nocardial endocarditis of prosthetic aortic valve. One patient had a mycetoma by N. brasiliensis. Fifteen (68.2 percent) out of 22 patients were immunosuppressed, being most (93.3 percent) by high-doses corticotherapy. Mortality by nocardial infection was 41 percent; mortality of systemic nocardiosis was 60 percent. Nocardiosis has a bad prognosis in immunosuppressed patients and also in non-immunosuppressed patients if the diagnosis is delayed. We propose that the delay in diagnosis should be examined in larger series to document its influence in the prognosis of the disease.

São apresentados 22 casos de infecção por Nocardia species entre 1977 e 1998, apresentando-se seu quadro clínico e evolução. Todos os pacientes cujos espécimes clínicos mostraram microorganismos sugestivos de Nocardia spp. à coloração de Gram, confirmados posteriormente por cultura, foram incluídos no estudo. Os dados dos pacientes que obtiveram cura foram comparados com aqueles dos pacientes que foram a óbito pelo programa EPIINFO versão 6.04; nível de significância menor que 5 por cento foi considerado estatisticamente significativo. Foram obtidos 22 casos de infecção por Nocardia spp.: seis isolamentos identificados como Nocardia asteroides complex, um como Nocardia asteroides sensu stricto e outro como Nocardia brasiliensis, enquanto os restantes foram identificados como Nocardia spp. Tivemos 17 casos de nocardiose pulmonar (um com disseminação). Tivemos outros quatro casos de nocardiose sistêmica: múltiplos abscessos cerebrais (um); endocardite infecciosa de prótese valvular aórtica (um); nocardiose de intestino delgado (um); abscessos cutâneos múltiplos por Nocardia spp (um). Um paciente apresentou micetoma por Nocardia brasiliensis. Imunossupressão esteve presente em 15 pacientes (68,2 por cento), predominantemente por corticoterapia (93,3 por cento). Nossa mortalidade foi 41 por cento; a mortalidade dos pacientes com nocardiose sistêmica foi de 60 por cento. A nocardiose tem pior prognóstico em pacientes imunossuprimidos e em pacientes com nocardiose sistêmica.

A Case of Primary Cutaneous Sporotrichoid Nocardiosis Caused by Nocardia asteroides

We report a case of a 42-year-old woman who suffered from recurrent nodular skin lesions on her left foot. Sporotrichoid fungal infection was suspected and two linear nodular skin lesions that had occurred after trauma in a public pool were treated with itraconazole for 4 months. These nodular skin lesions were completely flattened. However, four months after complete flattening, a new lesion developed in the scar of a previous nodule. N. asteroides, which is extremely rare for sporotrichoid cutaneous nocardiosis, was cultured from the relapsed lesion. We treated this case with trimethoprim-sulfamethoxazole for 6 months under an emperical basis and this resulted in complete healing, and sensitivity of N. asteroide to trimethoprim-sulfamethoxazole was confirmed later. There has been no recurrence for 3 years. To our knowledge, our case is the first report in the english literature of primary sporotrichoid cutaneous nocardiosis caused by N. asteroides in terms of anatomic location below the knee and host immunocompetency.