A case of endophthalmitis associated with limbal relaxing incision.

Limbal relaxing incisions (LRIs) are considered a relatively safe procedure with rapid stabilization and absence of infectious complications. Do we need to readdress this last impression? We report a case of nocardia endophthalmitis associated with an exudate at the site of an LRI in a patient who underwent routine cataract surgery. This case, to the best of our knowledge, is the first report of its kind, stressing the need for a cautious approach to the adoption of this method of astigmatic correction.

A rare case of pulmonary nocardiasis in an AIDS patient.

Nocardia infections are rare among normal individuals. Mostly they occur in immuno-compromised individuals. Here, we report a case of pulmonary nocardiosis in a person who was diagnosed as having pulmonary tuberculosis and was treated with anti-tuberculous treatment for 6 months. But the sputum smear was positive even after a complete course of treatment. The patient was seropositive to HIV-1 antibodies.

Pulmonary nocardiosis due to nocardia farcinica in a renal transplant recipient.

Nocardia farcinica is an infrequent cause of nocardiosis among the renal transplant recipients and it has not been reported so far from India. We report a case of pulmonary nocardiosis due to N. farcinica in a 32-year-old woman with hypothyroidism and post-renal transplant status, currently on immunosuppressive therapy (prednisolone, azathioprine and tacrolimus). The N. farcinica isolate was susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ), linezolid, imipenem, gentamicin but resistant to ceftriaxone, ciprofloxacin, tobramycin, erythromycin, amoxycillin-clavulanic acid and tetracycline. Treatment with TMP-SMZ and linezolid resulted in marked clinico-radiological improvement but after two weeks both of the drugs had to be stopped due to severe pancytopenia as adverse effect of their use. Currently, the patient is on imipenem and remains stable after four weeks of treatment. In N. farcinica infections, multi antibiotic resistance and toxicity of some specific drugs enhances the risk of therapeutic failure in renal transplant recipients.

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

Pulmonary nocardial infection and pseudomonas infection of the tongue in a patient with dermatomyositis.

Opportunistic infections in immunocompromised patients are common. We report the case of a 63 year old female patient with dermatomyositis who while on oral steroids developed nocardial infection of the lung and pseudomonas infection of the tongue simultaneously. Nocardial infections are not very commonly seen in patients with dermatomyositis. Pseudomonas infection of the tongue is a rarity. We report this case for its rarity as regards the type and site of infections and review the relevant literature.

Nocardiosis localizada / Cutaneous nocardia infections

La Nocardiosis cutánea primaria es de rara observación, se presenta en pacientes que han sufrido un traumatismo y se pusieron en contacto con la tierra, ya que este agente es un actinomiceto aeróbico cuyo hábitat es el suelo. Presentamos un caso de Nocardiosis localizada en tabaquera anatómica de la mano izquierda, en un paciente de sexo masculino de 52 años de edad y de profesión agricultor. Las lesiones, de tres años de evolución, presentaban al momento de la consulta, aspecto de placas cubiertas por costras, con numerosas bocas de superación, acompañadas de elementos, no dolorosos, y sin adenopatía regional. Se extrae material para estudio micológico directo y cultivo, y toma biopsia para el estudio histopatológico. Como antecedentes de la enfermedad actual el paciente relata haber sufrido un traumatismo en mano izquierda por manipuleo de herramientas en el momento de la cosecha.

Nocardiasis pulmonar en un paciente asmático / Pulmonary nocardiasis in asmathic patient

El asma bronquial es una enfermdedad altamente prevalente en nuestro medio. Con mucha frecuencia estos pacientes presentan crisis severas de broncoespamo que ameritan tratamientos farmacológicos agresivos, dentro de los que está el uso de esteroides con dosis altas y por tiempo prolongado, lo que puede producir efectos secundarios indeseables. Dentro de estos se encuentra la alteración de los mecanismos de defensa específicos, principalmente los dependientes de las células T. Esto lleva la aparición de infecciones oportunistas por gérmenes diversos, entre los cuales están las nocardias. Se presenta el caso de un paciente asmático adulto que recibía altas dosis de esteroides y en el que se demostró una neumonía por Nocardia así como linfopenia reversible de CD4+/CD8+. Se analizan los hallazgos y se hace una revisión del tema

Nocardiosis pulmonar en dos mujeres con enfermedad HIV/SIDA / Pulmonary nocardiosis in two women with HIV/SIDA

La nocardiosis es una enfermedad producida por un actinomiceto aerobio de la familia Nocardiaceae. Habita en suelos y, usualmente, penetra a través del tracto respiratorio de pacientes inmunocomprometidos. Los varones son afectados con frecuencia que las mujeres. Presentamos los dos primeros casos de pacientes de sexo femenino con infección HIV/SIDA/nocardiosis, diagnosticados en nuestro hospital. Ambas pacientes tenían un severo compromiso inmunológico, con cargas virales superiores a las 10.000 copias/ml, y en las dos, la forma de presentación fue pulmonar. El diagnóstico de nocardiosis se realizó en las dos enfermas a partir del examen directo y cultivos de esputo. Una de las pacientes recibió cotrimoxazol+amikacina y la otra fue tratada con cefalosporinas. Ambas tuvieron una evolución satisfactoria de sus lesiones pulmonares. Se concluye afirmando que debe incluirse a la nocardiosis en el diagnóstico diferencial de las neumonías extrahospitalarias en pacientes HIV positivos, en especial en aquellas neumopatías de curso subagudo o crónico

Nocardiose linfocutânea / Lymphocutaneous nocardiosis

Os autores descrevem um caso raro de infecçäo linfocutânea pela Nocardia brasiliensis simulando esporotricose. É feita revisäo bibliográfica sobre o assunto e se dá ênfase ao diagnóstico diferencial desta entidade com outros agentes da dita "sindrome cancriforme" (Wilson, 1963)

Infecçäo osteoarticular por Nocardia brasiliensis em paciente aidético: registro de uma observaçäo / Osteoarticular infection by Nocardia brasiliensis in patients with AIDS: case report

Os autores registram observaçäo de nocardiose osteoarticular por Nocardia brasiliensis em paciente aidético. O doente foi a óbito com manifestaçöes concomitantes de tuberculose pulmonar, retinopatia pelo citomegalovirus, diarréia crônica com desnutriçäo grave e complexo AIDS demencial. De fragmento ósseo do fêmur foi isolado, em cultura pura, actinomiceto identificado como Nocardia brasiliensis (Lindenberg. 1909) Castellani et Chalmers, 1913. Revisäo da literatura sobre este tipo de infecçäo foi realizada, mostrando a raridade da mesma em pacientes aidéticos

Nocardiosis pulmonar primaria: presentación de un caso

Informamos el caso de una mujer de 46 años con tos no productiva, disnea CF II, hipoxemia y pérdida de peso. Los Rx de tórax mostraban opacidades de tipo insterticial bilaterales. Se le diagnostica nocardiosis pulmonar primaria mediante cultivo del lavado broncoalveolar y de la biopsia pulmonar a cielo abierto. Presentamos los principales hallazgos clínicos, radiológicos, bacteriológicos y de patología.

Pulmonary Nocardiosis in a Renal Transplant Patient

Nocardia is a significant opportunistic pathogen in patients with compromised immunity. The authors isolated N. asteroides from an abscess of the axilla and from respiratory specimens of a renal allograft patient with pneumonia. Direct smear of the sputum and bronchial washing specimens showed many branching, filamentous forms which were gram-positive and acid fast. Culture yielded slow growing small white colonies which became orange on further incubation. Aerial hyphae were produced. Identification of the species was based on typical cultural and biochemical tests. The isolate was susceptible to amikacin, minocycline and rifamipicin. The patient became afebrile after 8 weeks of treatment with cotrimoxazole and brief treatment with other antimicrobial agents.

Nocardiosis pulmonar: actualización de conceptos y presentación de 10 casos / Pulmonary nocardiosis: new concepts and review of 10 cases

Ten cases of well documented pumonary nocardiosis were seen in the citu of Medellin, Colombia, between 1975 and 1984. Among them there were 5 men and 5 women. All 10 patients had respiratory symptoms and some type of immunosupresive disease. The radiological findings in this group were similar to those described: pulmonary infiltrates, lung abscesses and calcifications, pleural effusions, pneumothorax and empyema. The authors on pulmonary emphasize the scarcity of colombian literature on pulmonary nocardiosis and the fact that it can be easily diagnosed if adequate techniques are available

Actinomicetoma / Actinomycetoma

Se presenta el caso de un actinomicetoma localizado en la rodilla de un paciente de 17 anos; la sospecha diagnostica se concreto gracias a la presencia simultanea de edema, fistulas y granulos en el examen directo del material purulento; el agente etiologico fue la N. Brasiliensis. El tratamiento combinado de TMP - SMT y cirugia ortopedica trajo gran mejoria del paciente