Case of multi-drug resistant Nocardia nova as the causative agent of cervical spine osteomyelitis in an immunocompetent adult

Check, Larissa; Ragunathan, Aditya; Scibelli, Nicolina; Mangano, Andrew

doi:10.1016/j.idcr.2022.e01524

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…When the infection does involve the bone, it is often due to bacteremia or trauma. In the literature, it has been reported in the spine, sternum, femur, tibia, femorotibial interface, sacrum, and skull [5][6][7][8][9][10]. Osteomyelitis of the hip caused by a Nocardia species is very rare and has been reported only once recently in an elderly woman without known immunosuppression or characteristic respiratory or CNS infections resulting in dissemination to the pubis [11].…”

Section: Introductionmentioning

confidence: 99%

Immunosuppression and Opportunistic Infections: A Rare Case Report of Nocardia Osteomyelitis of the Pelvis

Suarez,

Polmann,

Del Pilar Bonilla

et al. 2023

Cureus

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Patients with a long-standing history of immunosuppression are at significantly increased risk of opportunistic infections. One such group of organisms that may cause these types of infections includes the Nocardia genus, a gram-positive, filamentous rod that demonstrates a branching pattern, is urease-producing and has acid-fast properties. The disease profile of Nocardia varies with manifestations ranging from cutaneous infection to severe pulmonary or central nervous system (CNS) infections, and rarely, osteomyelitis. In this case report, we present an 87-year-old female with persistent left gluteal and lumbar pain, generalized body aches, chills, and fevers diagnosed with Nocardia asiatica osteomyelitis of the pelvis, likely secondary to dissemination from pulmonary cavitary disease in an immunosuppressed host with chronic neutropenia. On magnetic resonance imaging (MRI), the patient was found to have heterogeneous enhancement, central necrosis, and loss of cortical margins of the left iliac wing, alongside a rim-enhancing soft tissue mass from the left iliac bone into the left gluteal soft tissues and left paraspinal musculature representing an abscess. She was promptly treated with surgical irrigation and drainage with surgical wound cultures growing Nocardia asiatica . She received treatment with trimethoprim-sulfamethoxazole antibiotics with symptom improvement and is following up with an infectious disease physician outpatient. Management of osteomyelitis, like in this case, involves long-term antibiotics with the potential need for surgical intervention. There are few reported cases of extrapulmonary Nocardia infections, particularly osteomyelitis, demonstrating the importance of their inclusion in the literature to better serve patients to allow for timely intervention for rare and life-threatening conditions. In immunocompromised hosts, the differential diagnosis should include opportunistic infections and less common pathogens, especially in those with atypical presentations, including gluteal and leg pain.

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Section: Introductionmentioning

confidence: 99%

Immunosuppression and Opportunistic Infections: A Rare Case Report of Nocardia Osteomyelitis of the Pelvis

Suarez,

Polmann,

Del Pilar Bonilla

et al. 2023

Cureus

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Meningitis and spondylodiscitis due to Nocardia nova in an immunocompetent patient

et al. 2023

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Background Disseminated nocardiosis is a very rare disease. By now only few cases of meningitis and spondylodiscitis have been reported. To our knowledge, this is the first case of meningitis caused by Nocardia nova. Case presentation We report on a case of bacteraemia, meningitis and spondylodiscitis caused by N. nova in an immunocompetent patient. We describe the long, difficult path to diagnosis, which took two months, including all diagnostic pitfalls. After nocardiosis was diagnosed, intravenous antibiotic therapy with ceftriaxone, later switched to imipenem/cilastatin and amikacin, led to rapid clinical improvement. Intravenous therapy was followed by oral consolidation with co-trimoxazole for 9 months without any relapse within 4 years. Conclusions Establishing a diagnosis of nocardiosis is a precondition for successful antibiotic therapy. This requires close communication between clinicians and laboratory staff about the suspicion of nocardiosis, than leading to prolonged cultures and specific laboratory methods, e.g. identification by 16S rDNA PCR.

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Metagenomic profiling for gut of indigenous poultry reared under free range system of management reveal prevalence of zoonotic pathogens in chicken, while predominating beneficial microbes in duck

Pal,

Debnath,

Chatterjee

2023

Preprint

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Zoonosis is an important phenomenon of disease transmission through livestock and poultry. In the current study, we explored gut metagenomics and identified a heavy percentage of pathogenic microbial loads in small intestine (duodenum) of chicken in comparison to duodenum of duck. Another important observation was that the percentage of pathogenic microbe decreases in large intestine (caecum), thereby reducing the chance of disease transmission through faeces. This may be the reason how indigenous duck and chicken were more hardy and resistant to common avian pathogens, that they have the ability to manage the reduction of the pathogenic microbes ingested through free range grazing with the help of beneficial microbes in caecum. Significant microbial load have been observed for Chlamydia abortus and Nocardia nova, with the every possibilities of transmission from chicken duodenum, so, handling of chicken need to be carried out with utmost care. We observed a remarkable finding that caecum of the gut reveal very less percentage of these pathogenic microbes, rather caecum is dominated by a beneficial microbe. 10 percent of the duck caecum is inhabited by Bacteroides spp (7 percent of Bacteroides sp OF04-15BH and 3 percent of Bacteriodes plebius), while it is almost negligible in chicken. This is the first report of this kind. This may be employed for the isolation and utilization as future probiotics from a ready source. Scavenging by indigenous poultry may serve as a useful tool for reducing pathogens prevailing in the environment.

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Case of multi-drug resistant Nocardia nova as the causative agent of cervical spine osteomyelitis in an immunocompetent adult

Cited by 3 publications

References 10 publications

Immunosuppression and Opportunistic Infections: A Rare Case Report of Nocardia Osteomyelitis of the Pelvis

Immunosuppression and Opportunistic Infections: A Rare Case Report of Nocardia Osteomyelitis of the Pelvis

Meningitis and spondylodiscitis due to Nocardia nova in an immunocompetent patient

Metagenomic profiling for gut of indigenous poultry reared under free range system of management reveal prevalence of zoonotic pathogens in chicken, while predominating beneficial microbes in duck

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