Disseminated infection with <i>Nocardia otitidiscaviarum</i> in a patient under steroid therapy

Sah, Ranjit; Khadka, Sundar; Neupane, Samikshya; Nepal, Gaurav; Singla, Sonam; Kumari, Pankhuri; Sah, Sanjit; Sah, Ranjana; Sah, Shyam Sundar; Adhikari, M. K.; Shah, Niranjan Prasad; Pokharel, Bharat; Rijal, Basista Prasad; Shah, Dibya Singh

doi:10.1002/ccr3.2640

Cited by 11 publications

(9 citation statements)

References 18 publications

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“…Ten articles described 24 cases that had sufficient individual patient data. Table S2 summarizes these publications ( Hwang et al., 2004 ; Sirijatuphat et al., 2013 ; Zhou et al., 2014 ; Chen et al., 2016 ; Zhu et al., 2017 ; Xu et al., 2018 ; Guo et al., 2020 ; Han et al., 2020 ; Sah et al., 2020 ; Yang et al., 2020 ). A total of 27 cases of nocardiosis with NS were assessed, including the three cases of nocardiosis in our hospital.…”

Section: Resultsmentioning

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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Section: Resultsmentioning

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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“…Moreover, some in ammatory parameters, including leukocytes, neutrophils, CRP, and PCT, possess a certain reference value. However, these indicators lack speci city and are usually indistinguishable from other bacterial infections, such as tuberculosis and fungal infections 22,29 .…”

Section: Discussionmentioning

confidence: 99%

The Clinical Characteristic and Management of Patients with Nocardiosis in a Tertiary Hospital in China

Liu

Wang

Jian

et al. 2023

J. Microbiol. Biotechnol.

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BackgroundNocardiosis is an uncommon opportunistic bacterial infection caused by Nocardia spp., and its incidence has increased signi cantly in recent years. This study aimed to summarize the clinical characteristics and management of nocardiosis to provide a reference for clinical diagnosis and treatment. MethodsThis retrospective study was conducted based on the medical records of nocardiosis patients between January 2015 and December 2021 in a tertiary hospital in China. ResultsOverall, 44 patients with nocardiosis were included in this analysis including 26 males and 18 females with a mean age of 50.4 ± 13.2 years. Connective tissue disease (CTD) was the most common underlying disease (16/44). Twenty-six patients were given immunosuppressive therapy. The most frequent infection sites were the lungs (17/44) and skin and soft tissue (8/44). Common symptoms included cough (23/44), expectoration (18/44), fever (15/44), and subcutaneous abscesses (15/44). Average microbiology laboratory detection time was 4.8 days. Twenty-nine patients were managed only with antimicrobial treatment, and 14 patients received both antimicrobial and surgical therapies.Trimethoprim-sulfamethoxazole (TMP-SMX) was the most commonly used antibiotic (31/44). Thirty-ve patients were cured or improved, 6 patients were discharged from the hospital due to poor prognosis, and 1 patient died. ConclusionClinicians should be alert to immunocompromised patients, especially those with CTD, and tend to pulmonary or cutaneous infections. Smear microscopic examination and prolonged culture time may aid Nocardia identi cation. Patients with nocardiosis can be treated with antimicrobials or surgical therapy. TMP-SMX remains the mainstay treatment, and its early and prompt use may improve nocardiosis outcome.

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“…Sah et al 33 2020 Nepal Disseminated infection (lung infection leading to cutaneous infection in right thigh) 4.…”

Section: Discussionmentioning

confidence: 99%

Ulceration by Nocardia Otitidiscaviarum: A case study

et al. 2023

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Nocardiosis is an acute, subacute or chronic infectious disease that occurs in cutaneous, pulmonary and disseminated forms. We present a case of Nocardiosis in a post-COVID-19 patient with cutaneous ulceration due to Nocardia otitidiscaviarum, managed with cotrimoxazole and linezolid. Early diagnosis and management proved crucial in preventing dissemination of the organism and improving the patient's outcome.

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Disseminated infection with Nocardia otitidiscaviarum in a patient under steroid therapy

Cited by 11 publications

References 18 publications

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

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

The Clinical Characteristic and Management of Patients with Nocardiosis in a Tertiary Hospital in China

Ulceration by Nocardia Otitidiscaviarum: A case study

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