Disseminated Infection due to Nocardia transvalensis Coincident with Cryptococcus neoformans variety gattii Meningitis

Abstract

A case of meningitis due to Cryptococcus neoformans var. gattii coincident with disseminated Nocardia transvalensis infection is reported. Nocardia infection initially progressed despite high-dose antimicrobial therapy. Although a specific immunologic defect could not be defined, in vitro lymphocyte proliferation in response to stimulation with the Nocardia isolate was reduced. It is proposed that coinfection with Cryptococcus neoformans may have contributed to the observed impairment of lymphocyte function, leading to disseminated Nocardia disease and a suboptimal treatment response.

Clinical Manifestations of Cryptococcus gattii Infection: Determinants of Neurological Sequelae and Death

“…Possible explanations include failure to investigate for ICL previously or changes in host-or pathogen-related risk factors. Diagnosis of ICL is important because of increased risk of opportunistic coinfection; the 4 patients coinfected with Nocardia herein add to the experience of 2 previous cases, including 1 in a patient with impaired lymphocyte function [29,30]. As in a previous Australian study, most patients (85%) presented with CNS cryptococcosis, especially meningitis (76% vs 64%) [4], but the ratio of meningitis to brain infection decreased (1.5:1 vs 2.5:1), presumably because computed tomography scanning, which is less sensitive than MR imaging, was used in the first study.…”

Successful Treatment of Serial Opportunistic Infections Including Disseminated Nocardiosis and Cryptococcal Meningitis in a Patient with ANCA-associated Vasculitis

“…While two cases of dual infection have been reported in an immunocompetent host (8,9), these cases involved dual infection with Nocardia transvalensis (8) or N. farcinica (9) and Cryptococcus neoformans (8,9). Two reports have described concurrent infection in patients receiving corticosteroids (10,11); including cases of dual infection with Nocardia brasiliensis (10) or asteroides (11) and Cryptococcus neoformans (10,11).…”