A French multicentric study and review of pulmonary Nocardia spp. in cystic fibrosis patients

Abstract

Some bacterial species recovered from the airways of cystic fibrosis (CF) patients are indisputably associated with lung infections, whereas the clinical relevance of others, such as Nocardia spp., remains unclear. Sixteen French CF cases of colonization/infection with Nocardia spp. were reviewed in order to evaluate the epidemiology, the clinical impact and the potential treatment of these bacteria, and results were compared to those of the literature. Five Nocardia species were identified, Nocardia cyriacigeorgica being the major species (50 % of cases). At first isolation, Nocardia was the sole pathogen recovered in six patients. Seven patients presented pulmonary exacerbation. For 12 patients, antimicrobial treatment against Nocardia was started immediately, mainly based on cotrimoxazole (6 of the 12 cases). In this study, we highlight the heterogeneity of the clinical management of Nocardia spp. in CF. Guidelines for the clinical management of Nocardia infections in CF patients are proposed.

Nocardiosis in the south of France over a 10-years period, 2004–2014

“…29 All patients in the present study received antibiotics active against Nocardia spp and other pathogens isolated in the sputum. The duration of treatment has not been established, and has varied from 3 weeks to 3 months, with a good prognosis, as reported by Rodriguez-Nava et al 30 In the bronchial form, in patients with chronic lung disease, chest radiological examinations appear to be sufficient.…”

NocardiaInfection in Solid Organ Transplant Recipients: A Multicenter European Case-control Study

“…Direct inoculation through the skin is possible [2], but most Nocardia infections occur via the respiratory tract, with possible subsequent dissemination to other tissues, such as brain, skin and subcutaneous tissues [1]. Nocardia can infect immunocompetent patients, but invasive nocardiosis is mainly observed in patients with immune deficiency [3], including that associated with corticosteroid therapy, transplantation, human immunodeficiency virus (HIV) infection [4,5], cancer [6], chronic granulomatous disease [7] or presence of auto-antibodies against granulocyte-macrophage colony stimulating factor [8] and/or in patients with chronic lung disease [9,10].…”

Clinical Assessment of a Nocardia PCR-Based Assay for Diagnosis of Nocardiosis

“…Clinical and radiological features are diverse and nonspecific and include pneumonia, cutaneous or subcutaneous infections, and brain or other solid organ abscesses. Nocardiosis mainly affects immunocompromised patients, including patients receiving immunosuppressive therapy, post-organ transplantation or post-stem cell transplantation patients, patients with primary immunodeficiencies, and patients with chronic bronchopulmonary disease (1)(2)(3)(4). A positive microbiological culture from an infected site remains the diagnostic gold standard.…”