Clinical pharmaceutical practice of constructing mind map by clinical pharmacists for the consultation of pulmonary nocardiosis / 中国药房

OBJECTIVE To explore the construction of mind map by clinical pharmacists for the consultation of pulmonary nocardiosis and its application in clinical practice， and to provide reference for promoting the correct selection of nocardiosis treatment drugs in clinical practice and ensuring drug safety and efficacy. METHODS A total of 7 patients with Nocardia pulmonary infection from January 2017 to April 2022 in our hospital were collected. Based on evidence-based medicine， a consultation mind map （mainly including understanding the medical history， identifying infectious bacteria， identifying risk factors， developing treatment plans， and conducting evaluations） was constructed to address the difficulties of large differences in drug sensitivity among different strains of Nocardia and numerous adverse reactions of Compound sulfamethoxazole as a first-line drug. The treatment plan was developed for 7 patients with pulmonary nocardiosis， and whole-process pharmaceutical care was provided. RESULTS Combined with the mind map， different antibiotic combination regimens were given according to the drug sensitivity results of Nocardia， the different species of Nocardia， and the patient’s allergy history. Among them， 4 cases were treated with imipenem cilastatin， the patients receiving Compound sulfamethoxazole and linezolid for a long time were given full pharmaceutical care， and the adverse drug reactions were timely treated.CONCLUSIONS Clinical pharmacists apply the consultation mind map of pulmonary nocardiosis to the treatment of inpatients， take advantage of pharmacy， participate in clinical drug therapy， and really play a role in the clinical treatment team so as to promote rational drug use.

Multiple nodules accompanied by pulmonary nocardiosis in a patient with systemic lupus erythematosus

Background:A retrospective case series study was done onforearm diaphyseal fracture in adolescents treated with TENS (titanium elastic nailing system).Purpose of the study was analysis of functional outcome of TENS in forearm diaphyseal fractures in children between 12-18 year age group. Methods:We retrospectively evaluated 30 patients operated by same senior surgeon during the period from March 2014 to February 2015 with closed diaphyseal forearm fractures in age group 12–18 years treated with TENS in whom closed reduction could not be achieved. Nail diameter taken as 33-40% of narrowest diameter of diaphysys were introduced proximally in ulna and distally in radius under image intensifier in closed manner. Postoperatively, patients encouraged for active shoulder, elbow and finger movements and suture removal done after 2 weeks. Patients were followed up for minimum period of one year.Results:In terms of union and range of motion using Anderson et al criteria 24 patients had excellent results, 4 patients had satisfactory results and one patienthad poor result having non-union of ulna. Two patients had superficial infection at the nail entry site which eventually resolved. One patient lost for follow up.Conclusions:We conclude that TENS in both bone forearm fractures in adolescent age group interms of union and range of motion is a minimally invasive and effective method of fixation.

Pulmonary nocardiosis: Report of two cases from a tertiary care hospital

Pulmonary nocardiosis is an uncommon bacterial infection that may lead to severe disease in immunocompromised patients. The disease is rare in immunocompetent patients. Reported cases are few, and the literature is limited because disease recognition is difficult. We present a case report of two patients of pulmonary nocardiosis, who had different clinicoradiological presentations and also responded differently to treatment. Given the rising incidence of cancer, organ transplantation, and use of parenteral steroids, Nocardia is likely to attain a higher place among the causes of pulmonary infections.

Severe Sepsis and Empyema Caused by Nocardia / 대한내과학회지

Pulmonary nocardiosis is a rare opportunistic infection that commonly affects immunocompromised hosts, such as patients with organ transplants, acquired immunodeficiency syndrome, or prolonged immunosuppression. Recently, we encountered a case of pulmonary nocardiosis with empyema that progressed to severe sepsis. The patient was treated in the intensive care unit. Thereafter, medical thoracoscopy was performed to improve drainage of the pleural fluid. Nocardia was identified in the culture of the pleural fluid.

A fatal case of severe Nocardia farcinica pneumonia and literature review of 25 cases / 中国感染控制杂志

Nocardia is a genus of gram-positive,weakly acid-fast,filamentous aerobic actinomycetes,which mainly causes infection in immunocompromised persons. We reported a successfully treated fatal case of severe pneumonia caused by Nocardia farcinica in a hospital,then reviewed 25 domestic and abroad case reports about nocardiosis combined with severe pneumonia occurred since 2006,so as to improve health care workers'cognition on clinical manifestations,image features,pathogenic characteristics,and diagnostic and treatment schemes of se-vere pneumonia caused by Nocardia farcinica.

Coinfección de tuberculosis pulmonar y nocardiosis pulmonar / Co-infection of pulmonary tuberculosis and pulmonary nocardiosis

La coinfección entre Mycobacterium tuberculosis y Nocardia es poco frecuente, con una prevalencia entre el 1 y el 6%; es más frecuente en los pacientes infectados por el virus de la inmunodeficiencia humana. Las manifestaciones clínicas y radiológicas de la nocardiosis y la tuberculosis pulmonar suelen ser muy similares, lo cual dificulta el diagnóstico y puede retrasar el tratamiento específico. Existen pocos casos reportados en la literatura. Se reportan 3 casos de pacientes que presentaron datos compatibles con tuberculosis pulmonar, por lo que se realizó tinción de Ziehl-Neelsen en esputo, y se reportan bacilos ácido-alcohol resistentes compatibles con Mycobacterium tuberculosis y Nocardia, iniciándose tratamiento específico, con el cual presentaron mejoría clínica.

Coinfection with Mycobacterium tuberculosis and Nocardia is rare, with a prevalence between 1-6%, and is more frequent in patients infected with HIV. Clinical and radiological manifestations of nocardiosis and pulmonary tuberculosis are very similar, making difficult the diagnosis and delaying the specific treatment. There are few cases reported in the literature. We report 3 cases of patients who presented with pulmonary tuberculosis-compatible data, whose sputum Ziehl-Neelsen staining test revealed acid-fast bacilli compatible with Mycobacterium tuberculosis and Nocardia. Specific treatment resulted in clinical improvement.

Fatal Superadded Nocardia Infection in a Case of Pulmonary Aspergillosis.

Pulmonary nocardiosis is a severe opportunistic infection in which chronic lung disease along with long term steroid therapy is the most significant predisposing factor. Demonstration of Nocardia in even potentially contaminated sample like sputum, warrant strong warning signal of association of the organism with the clinical condition because Nocardia are rarely encountered as laboratory contaminants. Immediate initiation of appropriate treatment is absolutely essential since any delay in diagnosis or treatment may prove detrimental to the extent of complete fatal outcome.

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

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.

Pulmonary Nocardiosis in a Patient with Lupus Nephritis / 대한류마티스학회지

Nocardiosis is uncommon in healthy people, but occurs as an opportunistic infection in patients with connective tissue disease, solid organ transplantation, lung disease, malignancies, and the acquired immune deficiency syndrome (AIDS). Nocardia is a gram positive, variably acid-fast aerobic bacterium of the family Nocardiaceae characterized by branching and filamentous growth, with distinctive aerial hyphae. In systemic lupus erythematosus (SLE) patients, immunosuppressiion with cytotoxic drugs or corticosteroids, proteinuria, renal insufficiency, and active SLE itself are known as risk factors for serious bacterial infections and opportunistic infections. We report a case of pulmonary Nocardiosis in patient with lupus nephritis treated with cyclophosphamide and high dose corticosteroid.

Alcoholic Liver Cirrhosis with Multiple Pulmonary Consolidations / 결핵

Pulmonary nocardiosis is an infrequent but severe infection due to the microorganism, Nocardia spp, which may behave as both an opportunists and as a primary pathogens. Usually nocardiosis is found in patients under immunosuppressive regimens for organ transplans, chemotherapy for a malignancy and corticosteroids. The experience of pulmonary nocardiosis in the medical literature is limited to just case reports, with a few series including extrapulmonary nocardiosis. It is believed that the incidence of this infection has been increasing since 1960. The diagnosis is difficult because of the nonspecific clinical manifestations, the lack of laboratory evidence, and the non-specific radiographic findings. Here, we report a case of pulmonary nocardiasis in a 66 year-old patient with alcoholic liver cirrhosis who has suffered from acutely developed dyspnea and general edema. The nocardia species. was cultured from a specimen obtained by a percutaneous transthoracic needle biopsy.

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.