Co-infection with Mycobacterium tuberculosis and Nocardia farcinica in a COPD patient: a case report

Abstract

Background Chronic obstructive pulmonary disease (COPD) is a common respiratory disease characterized by persistent airflow limitation. Infection with either Mycobacterium tuberculosis or Nocardia in COPD patients has been reported. However, co-infection with Mycobacterium tuberculosis and Nocardia is rare. Herein, we described such a patient with COPD in a primary hospital, and the diagnosis process. Case presentation A 79-year-old female farmer with COPD was consecutively admitted to two hospitals with chief complaints of worsening cough, sputum and gasping since January10, 2022. Microbiological examination was not performed at the first hospital due to unknown reasons, and empirical antibiotic treatment was not effective. The patient was subsequently referred to our hospital. After screening the source of infection and the pathogen, she was diagnosed with tuberculosis. However, the patient did not benefit from antituberculosis treatment, with no remission of respiratory tract symptoms. Cerebrospinal fluid and bronchoalveolar lavage fluid specimens were subsequently sent for microbiological examination. The results indicated Mycobacterium tuberculosis and Nocardia.spp. After four days of bacterial culture, Nocardia.spp grew on medium, and Nocardia.farcinica was identified by the MALDI-TOF MS system and 16 s RNA. The patient was prescribed trimethoprim sulfamethoxazole (TMP/SMX) in combination with anti-tuberculosis drugs to treat the co-infection. She showed gradual improvement and was discharged from the hospital on February 19, 2022. However, the follow-up results were unclear. Conclusions Co-infection with Nocardia and Mycobacterium tuberculosis should be considered in COPD patients. Repeated microbiological and microscopy examinations are essential in primary hospitals.

Case report: From oral infection to life-threatening pneumonia: clinical considerations in Nocardia infection from a case

“…Besides, Nocardia belongs to the order actinomycetes, which was first isolated by Nocard in 1888 ( 16 ). It is similar to that of Mycobacterium tuberculosis ( 17 ). However, Nocardial mycelial ends did not show club-like expansion, different concentrations of decolorization solution were used for acid-fast staining, and the lower the concentration of decolorization solution used, the higher the positive rate of acid-fast staining ( 18 ).…”

TB or Not TB: Lung Nocardiosis, a Tuberculosis Mimicker

“…According to certain studies, pulmonary disease makes up around 80-85% of the cases [ 2 , 6 ]. Disseminated disease is responsible for 30% [ 11 ], while central nervous system involvement can be observed in 3-26% of individuals with nocardiosis [ 12 ]. Between 1950 and 1991, one-third of the 1000 cases of Nocardia occurred in patients with no identifiable underlying risk factors [ 1 ].…”

Airway microbiome signature accurately discriminates Mycobacterium tuberculosis infection status

“… 15 , 21 , 51 , 52 , 53 Actinomyces including Schaalia have also been described in M.tb -infection. 54 , 55 , 56 , 57 In other scenarios, these bacteria cause infections that mimic M.tb infection. 58 , 59 It is also worth mentioning that actinomycetes are notorious producers of antibiotics.…”