Pulmão dos criadores de aves complicado por nocardiose pulmonar / Bird fancier's lung complicated by pulmonary nocardiosis

Relatamos o caso de um paciente de 84 anos que foi hospitalizado devido a tosse persistente e dispneia. A radiografia de tórax inicial revelou infiltrados pulmonares. Nocardia asteroides foi detectada no escarro, e o paciente foi tratado com antibióticos; entretanto, seus sintomas não melhoraram por completo. O paciente foi hospitalizado várias vezes, e os sintomas reapareceram após cada alta. Houve a suspeita de pneumonite de hipersensibilidade, sendo o paciente diagnosticado com pulmão dos criadores de aves. É provável que a nocardiose pulmonar se desenvolva em pacientes com doenças pulmonares crônicas, como DPOC, e em hospedeiros imunossuprimidos. Até onde sabemos, este é o primeiro relato de um caso de pulmão dos criadores de aves complicado por nocardiose pulmonar.

We report the case of an 84-year-old male who was admitted to the hospital with persistent cough and dyspnea. An initial chest X-ray revealed pulmonary infiltrates. Nocardia asteroides was detected in sputum, and the patient was treated with antibiotics. However, his symptoms did not completely resolve. He was admitted multiple times, and his symptoms relapsed after every discharge. He was finally suspected of having hypersensitivity pneumonitis and was diagnosed with bird fancier's lung. Pulmonary nocardiosis is likely to develop in patients with chronic pulmonary disorders, such as COPD, as well as in immunosuppressed hosts. To our knowledge, this is the first report of a case of bird fancier's lung complicated by pulmonary nocardiosis.

Nocardia brasiliensis primary pulmonary nocardiosis with subcutaneous involvement in an immunocompetent patient.

This is a report of an unusual case of Nocardia brasiliensis causing primary pulmonary nocardiosis with disseminated subcutaneous lesions in an immunocompetent patient. This case highlights the importance of considering nocardiosis as a differential diagnosis in patients with pulmonary and cutaneous lesions and the need for vigorous management for complete cure.

Rare zoonosis (hemotrophic mycoplasma infection) in a newly diagnosed systemic lupus erythematosus patient followed by a Nocardia asteroides pneumonia

Systemic lupus erythematosus (SLE) is per se a disease characterized by suppressed immune response and thus susceptibility to various opportunistic infections. We describe the case of a 21-yearold woman who developed a rare zoonosis - hemotrophic mycoplasma infection in the initial stage of SLE, complicated with Nocardia asteroides pneumonia afterwards. Nocardia infection coincided with initiation of glucocorticoids and cyclophosphamide therapy for SLE. After the treatment she recovered completely. To our knowledge the only case of human hemoplasmosis (then referred to as eperythrozoonosis) in medical literature was the one described by a group of Croatian authors 22 years ago. No cases of a hemotrophic mycoplasma infection in a SLE patient have been published up to now.

Nocardiose pulmonar em portador de doença pulmonar obstrutiva crônica e bronquiectasias / Pulmonary nocardiosis in a patient with chronic obstructive pulmonary disease and bronchiectasis

Relatamos o caso de um paciente com doença pulmonar obstrutiva crônica e bronquiectasias, em uso crônico de corticosteróides, que desenvolveu nocardiose pulmonar, sob a forma de múltiplos nódulos pulmonares escavados. Os sintomas principais foram a tosse produtiva com escarro purulento, febre e dispnéia A radiografia simples e a tomografia computadorizada do tórax mostravam nódulos em ambos os pulmões, alguns escavados. O exame direto de escarro e a cultura mostraram a presença de Nocardia spp. A paciente foi tratada com imipenem e cilastatina, com excelente resposta clínica.

We report the case of a patient with chronic obstructive pulmonary disease and bronchiectasis, chronically using corticosteroids, who acquired pulmonary nocardiosis, which presented as multiple cavitated nodules. The principal symptoms were fever, dyspnea and productive cough with purulent sputum. Chest X-ray and computed tomography of the chest revealed nodules, some of which were cavitated, in both lungs. Sputum smear microscopy and culture revealed the presence of Nocardia spp. The patient was treated with imipenem and cilastatin, which produced an excellent clinical response.

Endocarditis infecciosa por nocardia en valvulas nativas aortica y tricuspide / Nocardia endocarditis in aortic and tricuspid native valves

La endocarditis infecciosa por Nocardia en válvula nativa es una infección excepcional, que afecta a pacientes inmunodeprimidos. Presentamos el caso de un varón de 51 años con diagnóstico de endocarditis infecciosa por Nocardia en válvulas nativas aórtica y tricúspide, que recibió terapia antimicrobiana específica y que requirió reemplazo valvular aórtico, con buena evolución clínica en el seguimiento a 6 meses.

Nocardia endocarditis in native valve is an uncommon infection that usually arises in immunodepressed patients. We report a 51-yearold man diagnosed as having Nocardia endocarditis in aortic and tricuspid native valves, which received antimicrobial therapy and required aortic valve replacement. In 6 month follow up the patient remained asymptomatic with good clinical evolution.

Nocardiosis in patients of chronic idiopathic thrombocytopenic purpura on steroids.

We present two cases of chronic idiopathic thrombocytopenic purpura (ITP) on prolonged steroid therapy who developed subcutaneous and brain abscesses due to Nocardia asteroides. The special diagnostic and therapeutic challenges encountered in the patients because of severe thrombocytopenia are being highlighted.

Nocardial hydropneumothorax.

Pleural involvement in nocardiosis is rarely reported from India. A case of hydropneumothorax due to Nocardia asteroides in a patient with diabetes mellitus is reported. Tube thoracostomy drainage and therapy with trimethoprim-sulphamethoxazole for seven months prevented reaccumulation of pleural fluid and improved the general condition but failed to expand the lung. Bronchoscopy may be useful if multiple sputum examinations are negative in diagnosing pulmonary nocardiosis.

Compressive myelopathy due to nocardiosis from dermal lesion.

Nocardiosis refers to locally invasive or disseminated infection associated with Nocardia species. Most infections enter through respiratory tract and then disseminate systemically. Rarely primary nocardial infection of the skin of the back may spread to contiguous structures including vertebrae. A 30 years male presented with indolent skin lesion in the upper dorsal region of the back for one year following an accident and subsequently developed features of spinal cord compression and parenchymal involvement of lung. The rarity of such type of spread in an immuno-competent individual has been highlighted.

Primary cutaneous nocardiosis with epidural abscess caused by Nocardia brasiliensis: a case report.

Dissemination of primary cutaneous nocardiosis is a rare event. An interesting case of a 20 year old female labourer with progressive weakness in both the lower limbs and large multiple subcutaneous abscesses over the back, since 4 years, is presented. MRI showed an epidural abscess compressing the cord. Histopathology of skin lesions suggested a chronic suppurative lesion. Microbiological tests on the aspirate from the skin lesion identified the causative organism as Nocardia brasiliensis.

Disseminated nocardiosis in an immunocompromised child with unknown cause

Disseminated nocardiosis [DN], is an infrequent and severe infection due to Nocardia species and defined as infection in two or more discontinuous organs. Most infections occur in the immunocompromised host or in persons with underlying disease. DN occurs rarely in children. In this report, we describe an 11-year-old immunecompromised child with nocardiosis involving the lung, skin, brain and bone. No predisposing factor nor any underlying disease was found to explain his immune deficiency. Diagnosis of nocardial infection is often cumbersome, resulting at times in wrong initial clinical diagnosis such as cancer and other bacterial infections [e.g. tuberculosis]. Therefore, it is important to consider nocardial infection in the differential diagnosis of children with combined brain and lung lesions

Infección por nocardia asteroides en un paciente con lupus eritematoso sistémico / Nocardia asteroides infection in a patient with systemic lupus erythematosus

Nocardia asteroides infection are unusually observed in sistemic Lupus erithematous (SLE) patients. They are generally associated to steroidal and immunosuppressive therapy. We report a 24 years old female with SLE diagnosed in 1994 who developed a severe preeclampsia in her first pregnancy requiring emergency caesarean section. Post partum acute renal failure and type IV lupus nephropathy were treated with hemodialysis, metilprednisolone, cyclophosphamide and prednisone. Three months later, while she was receving the fourth cyclophosphamide dose, she presented with a pleuro pneumonia and occipital abscess, both caused by Nocardia asteroides. She was treated with cotrimoxazole + cefixime and pleural decortication was required. Five months later, she developed Meningitis caused by Nocardia asteroides and hydrocephalus. She was treated with ceftriaxone, vancomycin, cotrimoxazole and ventricular shunting procedure. Two months later, a retroperitoneal abscess was diagosed and surgically drained but the patient died, due to a methicillin-resistant Staphylococcus aureus septicemia

Nocardiosis pulmonar asociada con el SIDA: presentación de un caso / Pulmonary nocardiosis in AIDS: report of one case

La nocardiosis es una infección oportunista localizada o diseminada, que puede comprometer el pulmón, la piel y los tejidos blandos y el sistema nervioso central. Sus agentes etiológicos, pertenecientes al género Nocardia, son bacterias filamentosas que en el examen microscópico directo se tiñen con la coloración de Kinyoun. La disfunción de la inmunidad celular es un factor de riesgo para la adquisición de la enfermedad. Se presenta el caso clínico de un paciente de sexo masculino con nocardiosis pulmonar y enfermedad avanzada debida a HIV-1

Nocardiosis encefálica en pacientes portadora de LES / Encephalic nocardiosis in a systemic lupus erythematosus

La finalidad del siguiente trabajo es mostrar una afección infectológica poco frecuente, por un germen oportunista como es la Nocardia en una paciente inmunodeprimida por su enfermedad de fondo (Lupus Eritematoso Sistérmico) y por el tratamiento realizado. La forma de presentación fue extrapulmonar con una localización encefálica y subcutánea. Se plantearon dificultades terapéuticas, dada su baja incidencia en nuestro medio

Pulmonary nocardiosis.

A case of pulmonary nocardiosis is described in a patient who had alcoholic cirrhosis of liver and portal hypertension. The patient also had diffuse proliferative glomerulonephritis and was on prednisolone treatment.

Nocardiosis en un paciente con trasplante renal / Nocardiosis in a renal transplanted patient

We report a unilateral pulmonary nocardiosis in a 51 years old male that received a renal allograft. The clinical picture appeared 68 days after transplantation and the culture of a bronchoalveolar lavage showed the presence of Nocardia ateroides. Cyclosporine and azathioprine were discontinued and trimethoprim-sulphamethoxazole was started with a good clinical response. Afterwards, azathioprine was restarted and the patient is asymptomatic at the present moment

Ocular lesions in AIDS: a report of first two cases in India.

Although 444 cases of AIDS have been officially registered till July 1993 from various parts of India, ocular lesions in these cases have not been reported. Till May 1994, ELISA test for HIV 1 and HIV 2 had been done in 12 cases of suspicious ocular lesions which include viral retinitis, endogenous endopthalmitis and active chorioretinitis. Two patients had seropositivity for HIV 1. Ocular lesions include subretinal yellow mass in the first case and cytomegalovirus retinitis and cotton-wool spots in the second case. These two patients also had several systemic infections which include tuberculosis in both and nocardia in one. To the best of our knowledge, these two cases are the first report of ocular lesions in AIDS from India.

Abscesso cerebelar por nocardia: relato de caso / Cerebellar abscess by Nocardia: a case report

A nocardiose do sistema nervoso central tem alcançado importante destaque no diagnóstico diferencial de patologias tumorais nos últimos anos pelo aumento da incidência de pacientes imunodeficiêntes (pacientes submetidos a quimioterapia, transplante de órgäos ou com a síndrome de imunodeficiência adquirida - SIDA. Os autores descrevem o caso de um paciente com SIDA que desenvolveu nocardiose cerebelar na sua forma tumoral. O paciente foi submetido a craniectomia de fossa posterior para diagnóstico e tratamento. Os achados de neuroimagem e patológicos bem como a conduta cirúrgica säo discutidos com base em revisäo da literatura