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)

Métodos de identificación polifásica aplicados a la búsqueda de microorganismos con potencial industrial / Polyphasic identification methods applied in searching for microorganisms with industrial potential

Introducción: La bioprospección de metabolitos de interés antropogénico emplea métodos de recolección de microorganismos en ecosistemas extremófilos o endémicos. La microbiota aislada en estos lugares puede o no incluir microorganismos patógenos. Es imprescindible un enfoque interdisciplinario que permita abordar la búsqueda de las especies de interés mientras se preserva la buena salud de los investigadores. Objetivo: Identificar molecular, bioquímica y morfológicamente microorganismos patógenos humanos en cepas celulolíticas de importancia industrial almacenadas en el banco de cepas del Laboratorio de Investigación de la Facultad de Ingeniería Química de la Universidad Central del Ecuador, procedentes del Yasuní, la Antártida y Balzapamba. Métodos: Se realizó un estudio de bioprospección de bacterias celulolíticas empleando técnicas de microbiología ambiental. Se evaluaron las características morfológicas mediante tinciones, como por ejemplo Gram. Además, se realizaron pruebas bioquímicas y antibiogramas para bacterias Gram-negativas y Gram-positivas. Las pruebas moleculares utilizaron extracción de ADN bacteriano para la secuenciación Sanger del gen 16S. Resultados: Se encontraron las especies Klebsiella pneumoniae (Y2 y Y3r) y Nocardia asteroides (Y1 y Y3p) en las muestras de material lignocelulósico recolectadas en Yasuní, mientras que las especies aisladas en la Antártida y en Balzapamba corresponden a Bacillus subtillis. Conclusiones: Se identificaron cepas pertenecientes a diferentes géneros bacterianos. Las bacterias del género Klebsiella, en las muestras colectadas en Yasuní, podrían tener un potencial patógeno. Eso se puede corroborar con técnicas de genotipificación. Por lo tanto, puede existir riesgo para los seres humanos que realizan bioprospección en ese ecosistema y se deben tomar medidas de bioseguridad.

Abstract Background: The bioprospection of metabolites of anthropogenic interests employs methods of collecting microorganisms in extremophile or endemic ecosystems. The microbiota isolated in these places may or may not include pathogenic microorganisms. Therefore, an interdisciplinary approach is essential to address the search of the species of interest while the good health of the researchers is preserved. Objective: To identify in molecular, biochemical and morphologically ways some human pathogenic microorganisms in cellulolytic strains of industrial importance stored in the strain bank of the Research Laboratory of the Faculty of Chemical Engineering at the Central University of Ecuador, from Yasuní, Antarctic and Balzapamba. Methods: IA bioprospecting study of cellulolytic bacteria was performed using environmental microbiology techniques. Morphological characteristics were assessed by Gram staining. In addition, biochemical tests and antibiograms were performed for Gram-negative and Gram-positive bacteria. The molecular tests used extraction of bacterial ADN for 16S gene Sanger sequencing. Results: The species Klebsiella pneumoniae (Y2 and Y3r) and Nocardia asteroides (Y1 and Y3p) were found in samples of lignocellulosic material collected in Yasuni, while the isolated species in Antarctica and Balzapamba correspond to Bacillus subtillis. Conclusions: Strains belonging to different bacterial genera were identified. The bacteria of the genus Klebsiella from the samples collected in Yasuní could have a potential pathogen. This can be corroborated with genotyping techniques. Therefore, there could be a risk to humans who perform bioprospecting in that ecosystem and biosecurity measures should be taken.

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.

Nocardia abscessus brain abscess in an immunocompetent host

Nocardia brain abscesses typically occur in immunocompromised patients. Most cases of nocardiosis are caused by the Nocardia asteroides complex and Nocardia brasiliensis. Here, we present a patient with a Nocardia abscessus brain abscess. The diagnosis was confirmed by DNA sequencing, and the organism was susceptible to linezolid, clarithromycin, ceftriaxone, imipenem, tobramycin, amikacin, minocycline and sulfamethoxazole. The patient was successfully treated medically in combination with surgical excision

Contact Lens-associated Nocardial Necrotizing Scleritis

A 52 year-old, contact lens-wearing man presented with progressive right eye pain and redness for one month. He had been evaluated and treated for necrotizing scleritis by multiple eye care specialists prior to presentation. He underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis, including a culture. The culture revealed heavy growth of Nocardia asteroides complexes. The patient was treated with topical amikacin and oral Bactrim. Following several weeks of antibiotic treatment, the patient's infection resolved completely, and his visual acuity returned to baseline status. Nocardia is a rare but potentially devastating cause of necrotizing scleritis that may affect contact lens wearers without an associated keratitis. Prompt recognition and early treatment with appropriate antimicrobial agents are critical to achieve a favorable outcome.

Nocardia Brain Abscess Mimicking a Metastatic Brain Tumor: A Severe CNS Infection Requiring Aggressive Management

Nocardiosis is an uncommon Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia spp. have the ability to cause localized or systemic suppurative disease in humans and animals. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of infected patients are immunocompetent. We report a rare case of pulmonary nocardiosis and a brain abscess caused by Nocardia asteroides in an elderly woman with a history of Crohn's disease. Radiographic imaging revealed a contrast-enhancing lesion with perilesional parenchymal edema that was preoperatively thought to be a neoplasm. The patient experienced aggressive disease progression simulating a metastatic brain tumor. Early diagnosis of norcadiosis, the absence of underlying disease, and the administration of appropriate antibiotics has a positive impact on prognosis. Familiarity with the magnetic resonance and computed tomography findings associated with CNS nocardiosis, such as those presented here, is essential for making an early diagnosis.

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.

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.

Disseminated orbital actinomycetoma: A case report.

Mycetoma is a chronic granulomatous infection. Lower extremities are commonly involved. A 20-year-old male came with complaints of multiple sinuses on scalp, left eyelid swelling with a sinus and dystopia, since one year. On examination there was relative proptosis in left eye of 2 mm. Computed tomography scan showed soft tissue swelling of the pre-septal area of the left upper eyelid with orbital involvement. Magnetic resonance imaging showed increased left orbital volume and evident dystopia. Microbiology testing of the erosive scalp and lid lesions showed genus Nocardia, suggestive of actinomycetoma. This case is presented as it shows an unusual involvement of the orbit.

Nocardiosis pulmonar en un paciente con diabetes mellitus / Pulmonary nocardiosis in patient with diabetes mellitus

La enfermedad pulmonar es el hallazgo clínico predominante, casi el 90% de estos casos son causados por N. asteroides. Las manifestaciones clínicas de la infección instalada incluyen masa inflamatorias endobronquiales, neumonía, absceso pulmonar y enfermedad cavitaria. Se presenta un paciente con Nocardiosis pulmonar internado en el Hospital Nacional de Itauguá. Varón de 51 años, con antecedentes de Diabetes Mellitus de 6 mese de evolución, hipertenso conocido con enalapril. A las 2 semanas de internación se realiza broncoscopía con lavado bronqui alveolar, en donde se aisla N. asteroides, el paciente es tratado con trimetropin - sulfametoxazol con buena evolución del cuadro pulmonar...

Nocardial brain abscess in an immunocompetent host.

Nocardial infection of the central nervous system is rare and usually manifests as brain abscess. Here we describe an elderly gentleman who presented with signs and symptoms of an intracranial mass lesion localising to the frontal lobe. Clinical examination and CT scan suggested neoplasia as the probable diagnosis. A biloculated abscess was seen at surgery. Aspiration of the contents and examination of pus revealed Nocardia asteroides . Treatment included total excision and prolonged antibiotic therapy which resulted in an excellent outcome.

Sporotrichoid pattern of cutaneous nocardiasis due to Nocardia asteroids.

Cutaneous nocardiosis is a rare disease, only a few cases of which have been reported from the world as well as in India. This infection, when in the lymphocutaneous form, may clinically resemble sporotrichosis, hence causing a diagnostic dilemma. Here, we report a case of primary cutaneous, sporotrichoid pattern of cutaneous nocardiosis caused by Nocardia asteroides in immunocompetent host. The patient was a 32-year-old farmer, with no predisposing factors, who presented with cutaneous nocardiosis. The diagnosis was confirmed by culture of the biopsy, after which the patient was treated successfully with antibacterial agents.

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.

Evaluation of inhibitory effects of Iranian propolis against filamentous bacteria

To investigate the antibacterial activities of propolis in samples collected from Zanjan province IRAN, against 25 pathogenic strains of bacteria. In order to evaluate the biological properties of methanol extract of propolis using agar distribution methods [disk and drop plate]. Seven concentrations of methanolic extract of propolis were prepared and added drop wise to the bacterial seed layer cultured agar media individually. The diameter of the clear zone formed in each concentration was measured and correlated to the ability of the extracts to inhibit the growth of bacteria. Nocardia asteroides and N. brasiliensis has nearly shown the same susceptibility to various concentrations of propolis extract, and the complete clear zones revealed that this effect was quite remarkable. For other bacteria, different degrees of susceptibility to propolis were observed. We came to this conclusion that zones formed by 50mg/ml Amikacin in agar was similar to that of 5% concentration of propolis, and that the potency of propolis is 80% of Amikacin potency, which is the most effective antibiotic against Nocardia