A 20‐year experience with nocardiosis in solid organ transplant (<scp>SOT</scp>) recipients in the Southwestern United States: A single‐center study

Majeed, Aneela; Beatty, Norman; Ahmad, Iftikhar; Mushtaq, Adeela; Fisher, Julia M.; Gaynor, Pryce; Kim, Jeeyong C; Márquez, José Luis; Mora, Francisco; Georgescu, Anca Meda; Zangeneh, Tirdad T.

doi:10.1111/tid.12904

Cited by 47 publications

(39 citation statements)

References 21 publications

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“…Of note, amikacin was the only tested drug with proven in vitro efficacy against all Nocardia abscessus isolates in this cohort. The study findings add to the available data on susceptibility testing and demonstrate increasing resistance to commonly recommended antibiotics (Minero et al, 2009;Uhde et al, 2010;Lebeaux et al, 2018;Schlaberg et al, 2014;Valdezate et al, 2017;McTaggart et al, 2015). In addition, the data are in line with those of a recent study from France, showing that N. farcinica is the most common species in human infection in Western Europe, with a distinct pattern of susceptibility (Lebeaux et al, 2018).…”

Section: Discussionsupporting

confidence: 89%

Pulmonary nocardiosis in Western Europe—Clinical evaluation of 43 patients and population-based estimates of hospitalization rates

Ott

Meier

Kolditz

et al. 2019

International Journal of Infectious Diseases

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Background: Pulmonary nocardiosis (PN) is an uncommon but potentially life-threatening infection. Most of our knowledge on PN is derived from case reports and small case series. Increasing incidence rates of PN have been reported recently. The aim of this study was to describe the clinical course of and risk factors for PN in four Western European countries and to estimate population-based annual hospitalization rates. Methods: This was a retrospective evaluation (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011) of the clinical course of and risk factors for PN in patients at 11 hospitals in four European countries (Germany, Austria, Switzerland, and the Netherlands). Population-based estimates of hospitalization rates for PN in Germany (2005 to 2011) were calculated using official German nationwide diagnosis-related groups (DRG) hospital statistics. Results: Forty-three patients fulfilled stringent criteria for proven (n = 8) and probable (n = 35) PN; seven had extrapulmonary dissemination. For these 43 patients, the major risk factors for PN were immunocompromising (83.7%) and/or pulmonary (58.1%; as only comorbidity in 27.9%) comorbidities. The median duration of PN targeted therapy was 12 weeks. Distinctive patterns of resistance were observed (imipenem susceptibility: Nocardia farcinica 33.3%; Nocardia asteroides 66.7%). The overall mortality rate was 18.9% (50% in disseminated PN). Over time, annual PN hospitalization rates remained unchanged at around 0.04/ 100 000, with the highest rate among men aged 75-84 years (0.24/100 000). Conclusions: PN is a rare, but potentially life-threatening disease, and mainly affects immunocompromised elderly males. Overall, annual hospitalization rates remained stable between 2005 and 2011.

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Section: Discussionsupporting

confidence: 89%

Pulmonary nocardiosis in Western Europe—Clinical evaluation of 43 patients and population-based estimates of hospitalization rates

Ott

Meier

Kolditz

et al. 2019

International Journal of Infectious Diseases

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“…Hence, due to the possibility of a resistant species (mainly N farcinica ), the benefits of synergistic therapy, and the high mortality that may be associated with nocardiosis, it might be beneficial to use a combination of agents as initial therapy in patients who are seriously ill and/or have disseminated or CNS disease . With regards to prophylaxis, TMP‐SMX for PJP in SOT recipients has not been consistently shown to prevent breakthrough nocardiosis, presumably due to its usage only 2‐3 times per week unlike daily . Our patient was on prophylaxis since the transplant and yet acquired the disease.…”

Section: Discussionmentioning

confidence: 96%

“…Among SOT recipients, the incidence of nocardiosis ranges from 0.04% to 3.5%, with the highest frequency in recipients of lung (3.5%), followed by recipients of heart (2.5%), intestine (1.3%), kidney (0.2%), and liver (0.1%) transplants . As per a retrospective European study, nocardiosis occurred at a median of 17.5 (range, 2‐244) months after transplant .…”

Section: Discussionmentioning

confidence: 97%

Isolated abdominal nocardiosis in a pediatric renal transplant recipient

Acharya

Amin

Rajderkar

et al. 2019

Pediatric Transplantation

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Nocardia infection after RT is uncommon. The most common modes of exposure are inhalation of dust containing nocardia or contaminated soil/water and surgical instruments. Isolated abdominal nocardiosis following RT has not been reported. We report an 11‐year‐old female who developed nocardia abscesses of the abdomen post‐RT. ESRD was secondary to FSGS and she had received multiple immunosuppressive agents prior to transplant. Induction immunosuppression consisted of thymoglobulin and maintenance was with tacrolimus, mycophenolate, and prednisone. There were construction activities in the hospital ward during her hospital stay. Due to immediate recurrence of FSGS in the allograft, she received plasma exchange, rituximab, and IVIG. Anti‐infective prophylaxis consisted of TMP‐SMX, valganciclovir, and nystatin. She developed multiple loculated fluid collections in the abdomen 6 weeks later. Histology of lesions demonstrated suppurative caseating granulomatous inflammation and the AFB culture showed Nocardia farcinica. With the reduction of immunosuppressive agents along with usage of TMP‐SMX, imipenem‐cilastatin, and linezolid, she had a partial recovery after 9 months with persistent small abscesses but remained asymptomatic clinically. There was no evidence of nocardia infection in lungs and brain. Repeat AFB culture from the lesions was negative. Allograft function remained stable throughout. She remains on oral TMP‐SMX therapy. We postulated that she could have acquired nocardia either from the contaminated air particles in the hospital from the construction activities or reactivation of nocardia from prior colonization. Nocardia infection should be suspected in immunocompromised patients with unexplained fever and abdominal pain.

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“…A recent large-scale study of 54 cases of nocardiosis in solid organ transplant patients found a similar proportion of heart transplant recipients among the cases (37%). 6 …”

Section: Discussionmentioning

confidence: 99%

Disseminated nocardiosis with infective endocarditis of a transplanted heart

Hazim

Mansoor²

2018

BMJ Case Reports

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Nocardiosis is caused by various species of Nocardia and typically occurs as an opportunistic infection. It frequently disseminates, most often involving the lungs, subcutaneous tissues and central nervous system. It has rarely been reported to affect native heart valves. We report the case of a 64-year-old man with disseminated nocardiosis involving the brain, lungs, muscle and tricuspid valve of a transplanted heart. Following antimicrobial therapy, the patient improved clinically and there was no evidence of residual infection on follow-up imaging. This case highlights the presentation of nocardiosis, current therapeutic guidelines and the question of prophylaxis against Nocardia in immunocompromised patients.

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A 20‐year experience with nocardiosis in solid organ transplant (SOT) recipients in the Southwestern United States: A single‐center study

Cited by 47 publications

References 21 publications

Pulmonary nocardiosis in Western Europe—Clinical evaluation of 43 patients and population-based estimates of hospitalization rates

Pulmonary nocardiosis in Western Europe—Clinical evaluation of 43 patients and population-based estimates of hospitalization rates

Isolated abdominal nocardiosis in a pediatric renal transplant recipient

Disseminated nocardiosis with infective endocarditis of a transplanted heart

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