Disseminated Nocardia farcinica infection in a patient with myasthenia gravis successfully treated by linezolid: a case report and literature review

Abstract

Nocardiosis is increasingly being diagnosed because of a growing population of immunocompromised hosts and improvements in the detection of Nocardia species in clinical laboratories. Historically, sulphonamides have been the first-line therapy for the treatment of nocardiosis, but sulphonamides tend to have a high rate of drug allergy in clinical settings. In this report, we described a disseminated Nocardia farcinica infection that occurred in a patient with myasthenia gravis who suffered from multiple drug allergies and was successfully treated using linezolid. We undertook a review of the literature of previously reported cases of nocardiosis treated with linezolid. To date, only 15 cases of nocardiosis treated with linezolid have been published. All cases exhibited long-term tolerance of linezolid, and 14 of 15 cases showed either an improvement in or complete clearance of the infection. According to the literature review, linezolid is an attractive alternative to trimethoprim-sulfamethoxazole for the treatment of disseminated nocardiosis, despite limited clinical evidence to support this claim.

First Case of Cerebral Abscess Due to a Novel Nocardia Species in an Immunocompromised Patient

“…However, a treatment failure has been described in three patients treated with minocycline for pulmonary nocardiosis, with the patients developing brain abscesses under treatment. Susceptibility testing was not available in two cases, but the strain was susceptible in vitro in the third patient (15,25). The use of minocycline as a second-line oral drug for CNS nocardiosis should be limited to patients with a susceptible isolate (MIC Ͻ 0.5 g/ml) and requires a close follow-up of efficacy.…”

Diversity and frequency of Nocardia spp. in the soil of Isfahan province, Iran

“…Increase in the infections caused by these organisms, with different clinical forms of systemic and disseminated forms of nocardiosis in transplant recipients, tuberculosis, liver cirrhosis, cancer, diabetes, AIDS and patients under treatment with immunosuppressive drugs and broad spectrum antibiotics in the world, reveals more importance of isolation and identification of these agents [2,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] . Various studies have shown that identification and isolation of these agents in soil of different areas help to diagnose nocardiosis [1] .…”

Blood culture positive Nocardia asteroides infection: a case report

“…Resistance patterns also depend on the exact species of Nocardia, which emphasizes the paramount importance of an accurate microbiological diagnosis. Recently, there have been favourable case reports of linezolid as an effective agent against nocardiosis [11]. Unfortunately, the duration of treatment with linezolid is limited due to the polyneuropathy it can cause.…”