Clinical correlates of nocardiosis

Margalit, Ili; Goldberg, Elad; Ari, Yaara Ben; Ben‐Zvi, Haim; Shostak, Yael; Krause, Ilan; Muhsen, Khitam

doi:10.1038/s41598-020-71214-4

Cited by 34 publications

(29 citation statements)

References 35 publications

(42 reference statements)

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“…Patients with ICH had a higher risk of nocardiosis due to severe underlying diseases and use of glucocorticoids and/or immunosuppressants. 14 …”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Pulmonary Nocardiosis in Patients with Different Underlying Diseases: A Case Series Study

Zhong¹,

Huang²,

Zhan³

et al. 2022

IDR

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Objective To investigate the clinical features of pulmonary nocardiosis (PN) in patients with different underlying diseases. Methods Clinical, imaging, treatment and prognosis data from patients diagnosed with PN from July 2011 to June 2021 at the First Affiliated Hospital, Zhejiang University School of Medicine were collected and analyzed. According to different underlying diseases, patients were grouped into immunocompromised host (ICH) group and immunocompetent host (ICO) group, and clinical characteristics were compared between the two groups. Results There were 64 patients with PN, including 42 males, aged from 21 to 86 (57.1 ± 15.7) years. The most common clinical manifestations were cough, expectoration, fever. There were 41 cases in the ICH group and 23 cases in the ICO group. There were 11 cases with underlying pulmonary diseases in the ICH group, including 2 cases of bronchiectasis, 4 cases of chronic obstructive pulmonary disease (COPD), etc. There were 11 cases of underlying pulmonary basic diseases in ICO group, including 7 cases of bronchiectasis and COPD, 1 case of bronchiectasis, 1 case of COPD, etc. The proportion of patients with bronchiectasis and COPD in the ICO group was significantly higher (P < 0.05). Extrapulmonary nocardiosis infection occurred in 6 patients of the ICH group. During the period of hospitalization, 87.0% patients in ICO group received SMZ/TMP therapy, 73.2% of patients in ICH group received two drug combination therapy. In the ICH group, mortality at 28 days was 14.6% and 8.7% in the ICO group. Conclusion PN mainly occurred in ICH patients, but also occurred in the ICO cases to a lesser extent, especially in patients with bronchiectasis and/or COPD. Complicated with extrapulmonary infections mainly occurred in ICH population and combination of two antibiotics was often used in ICH group. The case fatality rates were 14.6% in ICH and 8.7% in ICO cases, respectively.

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“…Patients with ICH had a higher risk of nocardiosis due to severe underlying diseases and use of glucocorticoids and/or immunosuppressants. 14 …”

Section: Discussionmentioning

confidence: 99%

Clinical Features of Pulmonary Nocardiosis in Patients with Different Underlying Diseases: A Case Series Study

Zhong¹,

Huang²,

Zhan³

et al. 2022

IDR

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“…Multiple abscesses are seen in approximately half of all cases [30,31], and reach up to 80% among immunocompromised individuals [14]. While recent studies showed that brain imaging is not performed in 20e72% [2,5,6,14,15,24,32] of the patients, CNS nocardiosis can be asymptomatic in up to 43% of the cases [14] and unrecognized CNS involvement may potentially lead to treatment failure. Therefore, it is our opinion that routine contrast-enhanced brain imaging should be performed for all individuals diagnosed with nocardiosis, with the possible exception of immunocompetent patients with primary skin nocardiosis.…”

Section: Clinical Presentation Of Nocardiosismentioning

confidence: 99%

How do I manage nocardiosis?

Margalit

Lebeaux

Tishler

et al. 2021

Clinical Microbiology and Infection

Self Cite

117

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Background: Nocardiosis is a rare infection that is often difficult to treat and may be life-threatening. There is no consensus on its management. Objectives: Our aim was to provide the current evidence for the diagnosis and management of individuals with nocardiosis, and to propose a management approach for this uncommon infection. Sources: We systematically searched the medical literature on nocardiosis for studies published between 2010 and 2020 and describing ten or more individuals. Content: Nocardiosis, a primarily opportunistic infection which may occur in immunocompetent persons, most commonly involves the lungs and frequently disseminates to other sites including the central nervous system. The reference standard for Nocardia species identification is molecular biology, and the preferred method for antibiotic susceptibility testing (AST) is broth microdilution. Monotherapy seems appropriate for patients with primary skin nocardiosis or non-severe pulmonary disease; we reserve a multidrug regimen for more severe infections. Species identification and AST results are often missing at initiation of antibiotics. Trimethoprim-sulfamethoxazole is the preferred agent for initial therapy, because Nocardia is very often susceptible to this agent, and because it has been the keystone of nocardiosis treatment for years. Linezolid, to which Nocardia is almost always susceptible, may be an alternative. When combination therapy is required, the repertoire of companion drugs includes thirdgeneration cephalosporins, amikacin and imipenem. Therapeutic modifications should take into account clinical response to initial therapy and AST results. Treatment duration of 6 months is appropriate for most situations, but longer durations are preferred for disseminated nocardiosis and shorter durations are reasonable in low-risk situations. Secondary prophylaxis may be considered in selected individuals with permanent immunosuppression. Implications: We hereby provide the clinician with an easy-to-use algorithm for the management of individuals with nocardiosis. We also illuminate gaps in evidence and suggest future research directions.

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“…The positive association between SOT and nocardiosis was mitigated following adjustment for GC administration in a multivariate model. The association between taking GC and developing nocardiosis was stronger in patients with chronic pulmonary disease (OR: 5.74; 95%CI: 2.75-12.66; P < 0.001) than in the pooled analysis of all nocardiosis cases[ 69 ]. Another analysis on 112 patients with nocardiosis, among which 67 were immunocompromised patients, showed that pulmonary nocardiosis among immunocompromised patients was significantly associated with taking high-dose GC.…”

Section: Side Effectsmentioning

confidence: 99%

Current status of glucocorticoid usage in solid organ transplantation

Dashti‐Khavidaki¹,

Saidi²,

Lü³

2021

WJT

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Glucocorticoids (GCs) have been the mainstay of immunosuppressive therapy in solid organ transplantation (SOT) for decades, due to their potent effects on innate immunity and tissue protective effects. However, some SOT centers are reluctant to administer GCs long-term because of the various related side effects. This review summarizes the advantages and disadvantages of GCs in SOT. PubMed and Scopus databases were searched from 2011 to April 2021 using search syntaxes covering “transplantation” and “glucocorticoids”. GCs are used in transplant recipients, transplant donors, and organ perfusate solution to improve transplant outcomes. In SOT recipients, GCs are administered as induction and maintenance immunosuppressive therapy. GCs are also the cornerstone to treat acute antibody- and T-cell-mediated rejections. Addition of GCs to organ perfusate solution and pretreatment of transplant donors with GCs are recommended by some guidelines and protocols, to reduce ischemia-reperfusion injury peri-transplant. GCs with low bioavailability and high potency for GC receptors, such as budesonide, nanoparticle-mediated targeted delivery of GCs to specific organs, and combination use of dexamethasone with inducers of immune-regulatory cells, are new methods of GC application in SOT patients to reduce side effects or induce immune-tolerance instead of immunosuppression. Various side effects involving different non-targeted organs/tissues, such as bone, cardiovascular, neuromuscular, skin and gastrointestinal tract, have been noted for GCs. There are also potential drug-drug interactions for GCs in SOT patients.

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Clinical correlates of nocardiosis

Cited by 34 publications

References 35 publications

Clinical Features of Pulmonary Nocardiosis in Patients with Different Underlying Diseases: A Case Series Study

Clinical Features of Pulmonary Nocardiosis in Patients with Different Underlying Diseases: A Case Series Study

How do I manage nocardiosis?

Current status of glucocorticoid usage in solid organ transplantation

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