Clinical features and prognosis of nocardiosis in patients with connective tissue diseases

Yagishita, Mizuki; Tsuboi, Hiroto; Tabuchi, Daiki; Sugita, Takahisa; Nishiyama, Taihei; Okamoto, Susumu; Terasaki, Toshihiko; Shimizu, Masaru; Honda, Fumika; Ohyama, Ayako; Kurata, Izumi; Abe, Saori; Takahashi, Hiroyuki; Osada, Akira; Hagiwara, Shinji; Kondo, Yuya; Matsumoto, Isao; Sumida, Takayuki

doi:10.1080/14397595.2020.1823070

Cited by 12 publications

(15 citation statements)

References 27 publications

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“…The incidence of P. jirovecii in CTD is uncommon and quite difficult to diagnose. However, autoimmune rheumatic diseases significantly increased the overall risk of P. jirovecii infection compared to healthy individuals, especially SLE and DM/PM ( 19 , 20 ); it portends high mortality, yet is a largely preventable complication of rheumatic disease treatment ( 21 , 22 ). Still, it remains a grave concern in CTD patients due to its high mortality rate ( 22 – 24 ).…”

Section: Discussionmentioning

confidence: 99%

Application value of blood metagenomic next-generation sequencing in patients with connective tissue diseases

Yan

et al. 2022

Front. Immunol.

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ObjectiveThis study aimed to analyze the application value of blood metagenomic next-generation sequencing (mNGS) in patients with connective tissue diseases (CTDs) to provide a reference for infection diagnosis and guidance for treatment.MethodsA total of 126 CTD patients with suspected infections who were hospitalized in the Department of Rheumatology, the Second Hospital of Shanxi Medical University from January 2020 to December 2021 were enrolled in this study. We retrospectively reviewed the results of mNGS and conventional diagnostic tests (CDTs).ResultsSystemic lupus erythematosus (SLE) and polymyositis/dermatomyositis (DM/PM) had the highest incidence of infections. The positive pathogen detection rates of mNGS were higher than those of CDT. The virus infections are the most common type in CTD patients with single or mixed infection, especially Human gammaherpesvirus 4 (EBV), Human betaherpesvirus 5 (CMV), and Human alphaherpesvirus 1. The incidence of prokaryote and eukaryote infections is secondary to viruses. Bloodstream infections of rare pathogens such as Pneumocystis jirovecii should be of concern. Meanwhile, the most common mixed infection was bacterial–virus coinfection.ConclusionmNGS has incremental application value in patients with CTD suspected of co-infection. It has a high sensitivity, and a wide detection range for microorganisms in CTD patients. Furthermore, the high incidence of opportunistic virus infections in CTD patients should be of sufficient concern.

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Section: Discussionmentioning

confidence: 99%

Application value of blood metagenomic next-generation sequencing in patients with connective tissue diseases

Yan

et al. 2022

Front. Immunol.

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“…Infections that are common in lupus patients are also common in other patient populations and include infections caused by Staphylococcus aureus , Salmonella enterica , Escherichia coli , Streptococcus pneumoniae and mycobacteria. This is not a complete list of all bacteria that cause infections in lupus patients and infections have been reported with less common species such as Nocardia [ 167 ]. Mouse models of lupus have been used to investigate the roles of some bacterial species in lupus disease progression.…”

Section: Bacterial Infections In Lupusmentioning

confidence: 99%

Bacterial infections in lupus: Roles in promoting immune activation and in pathogenesis of the disease

Battaglia

Garrett‐Sinha

2021

Journal of Translational Autoimmunity

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“…However, Yagishita et al. ( Yagishita et al., 2021 ) reported that brain infection (35.7%, 5/14) was more than skin/cutaneous infection (28.6%, 4/14) in patients with connective tissue diseases. The possible explanation for this difference in the infected organs needs further studies.…”

Section: Discussionmentioning

confidence: 98%

“…The lung is the most common site of infection because inhalation is the primary entry route for Nocardia spp., accounting for 62-86% of infection. The frequently involved organs include the CNS and skin, and concerns 2%-42.9% and 8%-31% of patients with Nocardia infection, respectively ( Minero et al., 2009 ; Coussement et al., 2016 ; Haussaire et al., 2017 ; Yagishita et al., 2021 ). In our study, the NS patients did not have any trauma history, so it was assumed that the pathogen might infect patients through the respiratory tracts and then disseminate into the skin.…”

Section: Discussionmentioning

confidence: 99%

Nocardia Infection in Nephrotic Syndrome Patients: Three Case Studies and A Systematic Literature Review

Cheng

Wang

Yuan

et al. 2022

Front. Cell. Infect. Microbiol.

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ObjectiveThe multicenter literature review and case studies of 3 patients were undertaken to provide an updated understanding of nocardiosis, an opportunistic bacterial infection affecting immunosuppressed nephrotic syndrome (NS) patients receiving long-term glucocorticoid and immunosuppressant treatment. The results provided clinical and microbiological data to assist physicians in managing nocardiosis patients.MethodsThree cases between 2017 and 2018 from a single center were reported. Additionally, a systematic review of multicenter cases described in the NCBI PubMed, Web of Science, and Embase in English between January 1, 2001 and May 10, 2021 was conducted.ResultsThis study described three cases of Nocardia infection in NS patients. The systematic literature review identified 24 cases with sufficient individual patient data. A total of 27 cases extracted from the literature review showed that most patients were > 50 years of age and 70.4% were male. Furthermore, the glucocorticoid or corticosteroid mean dose was 30.9 ± 13.7 mg per day. The average time between hormone therapy and Nocardia infection was 8.5 ± 9.7 months. Pulmonary (85.2%) and skin (44.4%) infections were the most common manifestations in NS patients, with disseminated infections in 77.8% of patients. Nodule/masses and consolidations were the major radiological manifestations. Most patients showed elevated inflammatory biomarkers levels, including white blood cell counts, neutrophils percentage, and C-reactive protein. Twenty-five patients received trimethoprim-sulfamethoxazole monotherapy (18.5%) or trimethoprim-sulfamethoxazole-based multidrug therapy (74.1%), and the remaining two patients (7.4%) received biapenem monotherapy. All patients, except the two who were lost to follow-up, survived without relapse after antibiotic therapy.ConclusionsNephrotic syndrome patients are at high risk of Nocardia infection even if receiving low-dose glucocorticoid during the maintenance therapy. The most common manifestations of nocardiosis in NS patients include abnormal lungs revealing nodules and consolidations, skin and subcutaneous abscesses. The NS patients have a high rate of disseminated and cutaneous infections but a low mortality rate. Accurate and prompt microbiological diagnosis is critical for early treatment, besides the combination of appropriate antibiotic therapy and surgical drainage when needed for an improved prognosis.

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Clinical features and prognosis of nocardiosis in patients with connective tissue diseases

Cited by 12 publications

References 27 publications

Application value of blood metagenomic next-generation sequencing in patients with connective tissue diseases

Application value of blood metagenomic next-generation sequencing in patients with connective tissue diseases

Bacterial infections in lupus: Roles in promoting immune activation and in pathogenesis of the disease

Nocardia Infection in Nephrotic Syndrome Patients: Three Case Studies and A Systematic Literature Review

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