Micetoma por Nocardia asteroides / Nocardia Asteroids Mycetoma

Introducción: En 1860 Henry Van Carter introdujo la definición del micetoma y desde 1884 se reportan los primeros casos en África (Sudán, Senegal). Estas infecciones afectan la piel, el tejido celular subcutáneo y, en ocasiones, los músculos, los huesos, y pueden diseminarse por la cavidad torácica, la abdominal, y por otras regiones del cuerpo. Objetivo: Presentar un caso de micetoma por Nocardia asteroides con evolución desfavorable y tratamiento. Presentación del caso: Paciente masculino de 47 años de edad que sufrió hace 18 años un trauma en la rodilla izquierda con herida avulsiva y evolución desfavorable por infección. Diez años después presentó en el mismo sitio múltiples lesiones fistulosas con drenaje activo, secreción serohemática escasa y no fétida. En varias ocasiones fue llevado al salón de operaciones para realizarle debridamientos quirúrgicos y toillete y recibió múltiples tratamientos antibióticos y antifúngicos. Se concluyó el caso como un micetoma y se aisló una Nocardia asteroides. El paciente estuvo en desacuerdo con la amputación de la extremidad como tratamiento quirúrgico definitivo. Llegó a nuestro centro en octubre del 2020 con mal estado general y extensión severa del proceso infeccioso en toda la extremidad. Se planificó una hemipelvectomía como tratamiento definitivo, pero desafortunadamente el paciente falleció antes, debido a complicaciones generales. Conclusiones: Ante la aparición del micetoma es importante definir el alcance de la infección para determinar el tipo de tratamiento a utilizar, ya que bien empleado y de forma oportuna, puede salvar la vida al paciente sin dejar graves secuelas(AU)

Introduction: In 1860, Henry Van Carter introduced the definition of mycetoma and since 1884 the first cases have been reported in Africa (Sudan, Senegal). These infections affect the skin, the subcutaneous cellular tissue and, sometimes, the muscles, the bones, and it can spread throughout the thoracic cavity, the abdominal cavity, and other regions of the body. Objective: To report a case of mycetoma due to nocardia asteroides with unfavorable evolution and treatment. Case report: We report the case of a 47-year-old male patient who suffered a left knee trauma 18 years ago with an avulsive wound and unfavorable evolution due to infection. Ten years later, he presented, in the same site, multiple fistulous lesions with active drainage, scant serohematic, non-fetid secretion. On several occasions he was taken to the operating room for surgical debridement and toilette and he received multiple antibiotic and antifungal treatments. The case was concluded as a mycetoma. Nocardia asteroides was isolated. The patient disagreed with limb amputation as definitive surgical treatment. He came to our treatment center in October 2020 with poor general condition and severe extension of the infectious process throughout the limb. A hemipelvectomy was planned as definitive treatment, but unfortunately the patient deceased before due to general complications. Conclusions: Before the appearance of mycetoma, it is important to define the extent of the infection to determine the type of treatment to use, since it can save the patient's life if properly used and in a timely manner without leaving serious sequelae(AU)

A case of atypical nocardia asteroides sclerouveitis resistant to fourth-generation fluoroquinolones / Um caso atípico de esclero-uveíte por Nocardia Asteroides resistente a fluorquinolona de quarta-geração

ABSTRACT We describe an unusual case of Nocardia spp scleritis in a health girl resistant to topical fourth-generation fluoroquinolones. Clinically, there was only partial response of the scleritis to initial therapy. Treatment was changed to meropenem intravenously and topical amikacin. Following several weeks of antibiotic treatment, the patient's infection resolved but her vision was reduced to no light perception. Nocardia asteroides must be considered as a possible agent in cases of necrotizing scleritis in patients without a clear source. Antibiotic sensitivity testing has a definitive role in view of the resistance to these new medications.

RESUMO Nós descrevemos um raro caso de esclerite por Nocardia spp em uma criança sadia resistente a utilização tópica de fluorquinolona de quarta-geração. Clinicamente, a paciente apresentou apenas uma resposta parcial do quadro de esclerite a terapêutica inicial. O tratamento foi então modificado para meropenem intravenoso e amicacina tópica. Após várias semanas de tratamento com antibiótico, o quadro infeccioso regrediu porém a visao da pacientes evoluiu para perda da percepção luminosa. Em casos de esclerite necrotizante em pacientes sem fatores de risco aparente é necessário considerer a Nocardia Asteroides como possível agente causador. Os testes de sensibilidade medicamentosa apresentam importância significativa em virtude do aparecimento de resistência aos novos medicamentos.

Nocardiosis diseminada en una paciente VIH negativa. A propósito deun caso de difícil tratamiento / Diseminated nocardiosis in a HIV-negative patient. A difficult to treat case

(AU)La nocardiosis diseminada es una enfermedad grave, especialmente cuando hay afectación del sistema nerviosocentral. Se presenta el caso de una mujer adulta, VIH negativa, que presentó nocardiosis diseminada conafectación pulmonar, muscular, articular, encefálica y ocular. Nocardia spp. fue cultivada a partir de biopsiade masa pulmonar. El manejo fue difícil debido a la falta de respuesta al tratamiento antibiótico tradicionalcon trimetropín-sulfametoxazol, amikacina, ceftriaxona y meropenem. Finalmente, mejoró con el tratamientoconjugado de linezolid, claritromicina y moxifloxacino durante varios meses. Se discuten aspectos relacionadoscon el tratamiento de esta enfermedad

Nocardiose cutânea em felino: relato de caso* / Feline cutaneous nocardiosis: case report

A nocardiose cutânea é uma condição supurativa a piogranulomatosa, que ocorre após penetração do agente em ferimentos na pele que foram expostas a água ou ao solo contaminado. A doença se manifesta com formação de abscessos localizados, com fístulas e úlceras necróticas que drenam uma secreção serossanguinolenta, atingindo membros ou abdômen. É rara em gatos, e nestes, a maior parte se deve a infecção por Nocardia asteroides. Este relato objetivou descrever o diagnóstico clínico e laboratorial de um felino doméstico com diagnóstico microbiológico de Nocardia asteroides, descrevendo o tratamento preconizado com base no antibiograma. Uma gata castrada, sem raça definida (SRD), com cinco anos de idade, desenvolveu lesão cutânea em forma de tratos fistulosos drenando secreção piossanguinolenta sob a região frontal da face, membros torácicos e abscesso em membro pélvico, além de inapetência, emagrecimento e apatia. Havia sido tratada anteriormente de forma empírica para infecção bacteriana com enrofloxacina, seguida de cefalexina após identificação bacteriana de Staphylococcus spp. Realizou-se coleta do exsudato para fins de cultura e antibiograma. O diagnóstico foi de nocardiose e o agente identificado como Nocardia asteroides e os micro-organismos foram sensíveis apenas a amicacina, neomicina e canamicina. Foi instituído tratamento com amicacina (10 mg/kg, a cada 12 horas), passando após sete dias a ser administrado a cada 24 horas devido a cilindrúria constatada através de urinálise. A remissão dos sinais ocorreu com 20 dias de uso contínuo do antibiótico, o qual foi mantido por mais três semanas sem outras complicações com resolução da cilindrúria.

The cutaneous nocardiosis is a suppurative to pyogranulomatous condition that occurs after penetration of the agent on wounds in the skin that were exposed to contaminated water or soil. The disease is manifested with formation of localized abscess, with necrotic fistula and ulcers that draining a serosanguineous secretion, reaching limbs or abdomen. It is rare in cats, and in these, the most are due to infection by Nocardia asteroides. This report aimed to describe the clinical and laboratory diagnosis of a domestic feline with microbiological diagnosis of Nocardia asteroides, describing the recommended treatment based on antibiogram. A spayed female cat, mongrel, with five years of age, developed cutaneous lesions in the form of fistulous tracts draining piosanguinolenta secretion on the frontal region of the face, forelimb and abscess in hind limb, and loss of appetite, weight loss and apathy. It had previously been treated empirically for bacterial infections with enrofloxacin, followed by cephalexin after bacterial identification of Staphylococcus spp. Held collection of exudate for culture and antibiogram. It was diagnosed nocardiosis and the identified agent as Nocardia asteroides and microrganisms were sensitive only to amikacin, kanamycin and neomycin. Treatment with amikacin (10 mg / kg every 12 hours) was introduced, and seven days after being administered once every 24 hours due to cilindruria detected by urinalysis. The remission of the signs occurred 20 days of continuous use of the antibiotics, which was maintained for three weeks without further complications with resolution of the cilindruria.

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.

Sub-cutaneous abscess caused by Nocardia asteroides in renal transplant recipient.

Nocardia is a significant opportunistic pathogen in patients with compromised immunity. Nocardia asteroides was isolated from subcutaneous abscesses on the left thigh and shoulder of a renal transplant recipient. Direct examination of the aspirated pus showed branching filaments that were gram-positive and acid fast. The abscesses were drained and the patient responded to high dose co-trimoxazole therapy.

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.

Pleural nocardiosis.

Pleural involvement in nocardiosis is rarely documented in India. We report two cases of pleural nocardiosis. In both the cases, the aetiologic agent was isolated from pleural fluid and was later identified as Nocardia asteroides in one case and as Nocardia brasiliensis in the second case. The former case of pyopneumothorax died before the diagnosis was made and the latter with pleural effusion showed excellent response to six months of therapy with trimethoprim-sulfamethoxazole.

Nocardiosis: an overview and additional report of 28 cases in cattle and dogs / Nocardiose: visão geral e relato de 28 casos em vacas e cães

Phenotypic characteristics, antimicrobial susceptibility profile, and clinical-epidemiological features of 28 Nocardia strains isolated from 19 cases of bovine mastitis, eight cutaneous-subcutaneous lesions and one case of pneumonia in dogs were evaluated. Microbiological, biochemical, cytological and scanning electron microscopy methods were used in diagnosis. Nocardia asteroides type IV, Nocardia otitidiscaviarum,Nocardia nova (type III) and Nocardia farcinica (type V) were isolated from bovine milk, bronchial lavage and/or cutaneous-subcutaneous abscesses in dogs. Nocardial bovine mastitis was diagnosed predominantly in clinical cases, in dairy herds with poor environmental hygienic conditions between milking and inappropriate intramammary therapy. Canine nocardiosis was observed commonly in animals co-infected with distemper virus. Sulphamethoxazole-trimethoprim (92.8 percent), amikacin (92.8 percent) and ceftiofur (92.8 percent) were the most effective drugs in 28 isolates. Multiple drug resistance to three or more and five or more antimicrobials was observed in ten (35.7 percent) and three (10.7 percent) strains, respectively, predominantly with use of cloxaxillin, cefoperazone and ampicillin. The species (type) classification, clinical-epidemiological characteristics, diagnosis, multiple-drug resistance and public health considerations in Nocardia strains isolated from cattle and dogs in Brazil are discussed, with special reference to report of bovine mastitis by N. otitidiscaviarum by first time in Brazil and the similarity between Nocardia species isolated from human and animal origin.

A caracterização fenotípica, perfil de sensibilidade aos antimicrobianos e aspectos clínico-epidemiológicos foram avaliados em 28 linhagens de Nocardia isoladas de 19 casos de mastite, oito lesões tegumentares e um caso de pneumonia em cão. Foram utilizados no diagnóstico métodos microbiológicos, bioquímicos, citológicos e microscopia eletrônica de varredura. Nocardia asteroides tipo IV, N. otitidiscaviarum,N. nova (tipo III) e N. farcinica (tipo V) foram isoladas do leite de vacas com mastite, de material de lavado transtraqueal e de lesões cutâneas de cães. Nocardiose mamária bovina foi diagnosticada predominantemente sob a forma clínica, em propriedades com precárias condições de higiene na pré e pós-ordenha, e inadequado procedimento de terapia intramamária. Nocardiose canina foi diagnosticada comumente em animais co-infectados com o vírus da cinomose. Sulfametoxazole/trimetoprim (92,8 por cento), amicacina (92,8 por cento) e ceftiofur (92,8 por cento) foram os antimicrobianos mais efetivos frente às linhagens de Nocardia. Resistência múltipla a três ou mais e cinco ou mais antimicrobianos foram observadas, respectivamente, em dez (35,7 por cento) e três (10,7 por cento) linhagens, notadamente frente à cloxacilina, cefoperazona e ampicilina. A caracterização de espécies (tipo), aspectos clínico-epidemiológicos, diagnóstico, resistência múltipla aos antimicrobianos e reflexos em saúde pública de linhagens de Nocardia isoladas de bovinos e cães no Brasil foram discutidos. Foi destacada a similaridade entre as espécies de Nocardia isoladas de animais e do homem, e a primeira descrição no Brasil de N. otitidiscaviarum na etiologia da mastite bovina.

Disseminated nocardiosis with psoas abscess in a patient with AIDS: first reported case

Psoas muscle abscess is an uncommon infection that have been diagnosed increasingly in the last years. We present a case of a patient with advanced human immunodeficiency virus infection who developed a disseminated infection due to Nocardia asteroides sensu stricto type VI with psoas abscess. To our knowledge no other cases of Nocardia psoas abscess in the setting of HIV infection have been reported in the literature.

O abscesso do músculo psoas é uma infecção pouco comum que tem sido diagnosticada de maneira crescente nos últimos anos. Apresentamos um caso de paciente com infecção avançada pelo vírus da imunodeficiência humana (HIV) que desenvolveu uma infecção disseminada por Nocardia asteroides senso estrito tipo VI, com abscesso no psoas. Em nosso conhecimento, não foram relatados na literatura outros casos de abscesso do psoas por Nocardia, no contexto da infecção por HIV.

Necrotizing nocardial scleritis after combined penetrating keratoplasty and phacoemulsification with intraocular lens implantation: a case report and review of the literature

We report the history and clinical presentation of an 88-year-old female with Fuchs dystrophy who developed an acute anterior necrotizing scleritis in her left eye 23 months after an uncomplicated combined penetrating keratoplasty and phacoemulsification with intraocular lens implantation which progressed to slceral perforation with uveal prolapses. The patient underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis. Surgical specimens of the area of scleral perforation were sent for histology and microbiologic studies. Analysis of surgical specimens revealed the presence of culture-proven Nocardia asteroides as a causative agent for the patient's scleral perforation. Results of her systemic autoimmune work-up were not conclusive. Successful treatment with tectonic scleral reinforcement with donor corneal tissue and preserved pericardium, oral and topical trimethoprim-sulfamethoxazole and topical amikacin salvaged the globe and increased vision. The patient's final best-corrected visual acuity sixteen months after her last operation remains 20/70. Prompt surgical intervention with submission of appropriate specimens for pathological diagnosis and microbiology, along with consultation with rheumatologic and infectious disease specialists, are mandatory to minimize visual loss in cases of suspected infectious necrotizing scleritis.

Relato de caso de esclerite necrosante aguda, evoluindo para perfuração escleral com prolapso uveal, 23 meses após procedimento de ceratoplastia penetrante e facoemulsificação com implante de lente intra-ocular no olho esquerdo sem intercorrências.A paciente foi submetida à avaliação completa auto-imune para esclerite. Biópsia da área de perfuração escleral foi encaminhada para avaliação patológica e microbiológica. Análise de material cirúrgico revelou presença de cultura proveniente de Nocardia asteroides como agente causal da perfuração escleral. Resultados de exames do sistema auto-imune não foram conclusivos. Tratamento foi um sucesso com reforço escleral tectônico do tecido corneano doador, utilização de pericárdio preservado, associado ao uso sistêmico e tópico de sulfametoxazol-trimetropina e amicacina colírio. Apresentou melhora visual após o tratamento e a melhor correção visual final, 16 meses após o último procedimento cirúrgico foi de 20/70. Intervenção cirúrgica precoce, análise patológica e microbiológica do material, associados a consulta a especialistas na área de doenças infecciosas e reumatologia, são primordiais para minimizar perda visual em casos de suspeitas de esclerite infecciosa necrosante.

A Case of Nocardia asteroides type I Induced Pneumonia / 대한진단검사의학회지

Nocardia species are opportunistic pathogens that are known to affect mostly the immunocompromised patients. Recently, we experienced a young systemic lupus erythromatosus female patient having infected with Nocardia species, which we were able to isolate from her lung abscess. The patient is twenty-nine years old female who was diagnosed as having systemic lupus erythromatosus two years ago and is currently engaged with ongoing treatment. During her admission, new symptoms of fever and dyspnea along with a lesion in the apical lobe of her left lung found by simple chest X-rays were observed. Under lung biopsy examination, there were seen neutrophilic exudates that were gram-positive, AFB-negative, and modified AFB-positive. By culturing the biopsy material, we found gram-positive, AFB-negative, and modified AFB-positive branching hyphaes that were morphologically matched for Nocardia species. We have analyzed the Nocardia DNA by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method and found the organism to be Nocardia asteroides type I. Treatment of patient was done using sulfamethoxazole/trimethoprim and ceftriazone, and her clinical conditions as well as her radiological findings improved.

A Nocardial infection in a patient with systemic lupus erythematosus / 대한내과학회지

Nocardiosis is a rare opportunistic infection and only sporadic cases were reported in systemic lupus erythematosus (SLE). We report a case of a nocardial infection in a patient with SLE. A 37-year-old woman was admitted to our hospital because of general weakness and edema. She had been diagnosed as SLE in 1995 and was diagnosed as lupus nephritis (class IV, diffuse proliferative glomerulonephritis) in 1999, but had refused the treatment for SLE. After admission, she was diagnosed as active SLE with lupus nephritis based on clinical and laboratory findings. She was treated with methylprednisolone pulse (1 gx3 days) and cyclophosphamide pulse (750 mg) therapy followed by daily high dose oral prednisone (60 mg) and plasmapheresis (7 times). On 32 days after admission, chest radiograph revealed a massive pleural effusion. The pleural fluid was exudate and cultures for bacteria, fungi and tubercle bacilli were negative and pleural biopsy showed mesothelial thickening. The thoracentesis was done (1 L), but the effusion recurred within 3 days. Further four thoracentesis and thoracostomy were performed due to recurrent massive pleural effusion. On 60 days after admission, thoracostomy tube was removed, but 4 days later, fever occurred and Nocardia asteroides was cultured in pleural fluid. Treatment with oral trimethoprim/sulfamethoxazole (TMP-SMX, 160~800 mg) was started. After treatment with TMP-SMX, the pleural effusion decreased. On 76 days after admision, she was discharged and maintained on TMP-SMX (80~400 mg) for another 12 months. At present, her SLE activity is on control and has no pleural effusion.

Reactive Cutaneous Cytophagocytosis in Nocardiosis

Cutaneous nocardiosis, which usually manifests in the form of pustules, abscesses, or subcutaneous nodules, is occasionally found in immunocompromised patients. A 59-yr-old Korean man with myasthenia gravis and thymoma developed nodular skin lesions on his trunk. Histopathologically, abscess formation with a dense infiltrate of neutrophils and many cytophagic histiocytes were observed. Numerous filamentous organisms, which turned out to be Nocardia asteroides by culture, were also found. After sulfamethoxazole-trimethoprim therapy, all of the skin lesions rapidly decreased in size, with a marked diminution of the number of cytophagic histiocytes, and cleared up within four months. On reporting a case of cutaneous nocardiosis showing unusual histopathologic findings, we considered that reactive conditions should be included in the differential diagnosis of the cutaneous cytophagocytosis, and that nocardiosis could be one of the diseases showing reactive cytophagocytosis.

A Case of Nocardia asteroides Isolated from Subcutaneous Abscess in a Pneumonic Patient with a Rejected Transplant Kidney / 대한임상병리학회지

Opportunistic infections are common after a renal transplant as a result of immunosuppression. Nocardiosis is a rare but important cause of morbidity and mortality among renal transplant recipi-ents. Nocardiosis is a localized or disseminated infection, which is usually introduced through the respiratory tract resulting in pneumonia, and may develop a disseminated infection, in particular a subcutaneous abscess and/or central nervous system infection. Because effective therapy for these nocardiosis is available, an accurate and timely diagnosis is crucial. However, nocardiosis is an infrequent disease and many physicians are unfamiliar to it. In addition, in the laboratory, cul-tures may be discarded too early, which often delays an early diagnosis and treatment. The authors isolated Nocardia asteroides from an abscess of the skin in a rejected renal allograft patient suffering pneumonia. The patient was successfully treated with trimethoprim/sulfamethoxa-zole.

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.

Primary Cutaneous Nocardiosis Associated with Intramuscular Injection / 中华皮肤科杂志

Objective To investigate and report a group of patients with cutaneous nocardiosis occurring in China.Methods The skin lesion of twenty-three patients were examined and the pathogen was identified.The possible cause of this disease was also investigated.Results All the twenty-three patients belon g to a same village in a province.Skin lesions on buttoc ks manifested as nodules and abscesses whereas some other lesions as ulcers and draining sinuses,occurring 2-10mo nths after intramuscular injection.The pathogens were identified as Nocardia asteroides.Conclusion Twenty-three patients of cutaneous nocardiosis were related to intramu scular injection.