First reported case of disseminated<i>Nocardia kroppenstedtii</i>sp nov. infection presenting with brain abscess and endocarditis in an immunocompromised patient with mantle cell lymphoma: challenges in diagnosis and treatment

Majeed, Aneela; Abdullah, Hafez Mohammad Ammar; Ullah, Waqas; Mohajer, Mayar Al

doi:10.1136/bcr-2016-217337

Cited by 16 publications

(10 citation statements)

References 28 publications

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“…However, numerous case reports and case series have been reported [3-4]. Prevalence of Nocardia in Pakistan is not known and the publications regarding pulmonary nocardiosis in the medical literature are also limited to just case reports, with few case series, which also includes cases of extra-pulmonary nocardiosis [5-6].…”

Section: Introductionmentioning

confidence: 99%

Ten Year Review of Pulmonary Nocardiosis: A Series of 55 Cases

Zia¹,

Nafees²,

Faizan³

et al. 2019

Cureus

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Introduction Nocardiosis is a rare opportunistic bacterial infection usually seen in immunosuppressed patients. It is caused by gram-positive, aerobic actinomycetes of the Nocardia genus. The most common site of infection is lungs; but it may affect other organs or even disseminate into blood. Methods In this a 10-year retrospective review, all diagnosed cases of Pulmonary Nocardiosis in a tertiary care hospital were included. The clinical and radiological characteristics, course of complications and lifesaving interventions, and disease outcome were evaluated. Results Among the 55 identified cases, most common risk factor was chronic steroid therapy (n=38; 69.1%). Among respiratory diseases, chronic obstructive pulmonary disease (n=13; 23.6%) and tuberculosis (n=12; 21.8%) were the most common. On chest radiograph, pleural effusion (n=23; 41.8%) and consolidation (n=22; 40.0%) were the common findings. Complications were observed in 32 (58.2%) patients with septicemia and respiratory failure being the most common (n=15; 46.8% in each). Dissemination occurred in 10 (31.2%) patients. The mortality rate of Nocardia is 34.5% (n=19). Conclusion The disease burden of Nocardia is underestimated by clinicians and researchers. Pulmonary Nocardia should always be a differential diagnosis of signs of lower respiratory tract infection and must be excluded in patients not responding to treatment of chronic obstructive pulmonary disease (COPD) and pulmonary tuberculosis. Early recognition and individualized management plan can ensure successful recovery.

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Section: Introductionmentioning

confidence: 99%

Ten Year Review of Pulmonary Nocardiosis: A Series of 55 Cases

Zia¹,

Nafees²,

Faizan³

et al. 2019

Cureus

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“…Table 1 demonstrates that 10 (59%) of 17 cases of nocardial brain abscesses showed true restricted diffusion, i.e., hyperintensity on DWI and low signal on ADC maps. 1,6,11,21,27,32,36,39,41,42,46,47,[51][52][53][54] High signal intensity on DWI with low ADC values for cerebral abscesses was first reported by Ebisu et al, 15 with many subsequent studies reporting similar findings. 18,20 In a meta-analysis Xu et al 50 found that DWI had a high sensitivity (0.95) and specificity (0.94) for differentiating brain abscesses from other cystic brain masses, showing it is a reliable method in detecting pyogenic brain abscesses.…”

Section: The Role Of Neuroimaging In Brain Abscessesmentioning

confidence: 96%

Nocardia amikacinitolerans and cytomegalovirus: distinctive clinical and radiological characterization of the rare etiologies of brain abscesses: report of 2 cases

Quinoa¹,

Jumah²,

Narayan³

et al. 2019

Neurosurgical Focus

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Central nervous system infections in immunosuppressed patients are rare but potentially lethal complications that require swift diagnoses and intervention. While the differential diagnosis for new lesions on neuroradiological imaging of immunosuppressed patients typically includes infections and neoplasms, image-based heuristics to differentiate the two has been shown to have variable reliability.The authors describe 2 rare CNS infections in immunocompromised patients with atypical physical and radiological presentations. In the first case, a 59-year-old man, who had recently undergone a renal transplantation, was found to have multifocal Nocardia amikacinitolerans abscesses masquerading as neoplasms on diffusion-weighted imaging (DWI); in the second case, a 33-year-old man with suspected recurrent Hodgkin’s lymphoma was found to have a nonpyogenic abscess with cytomegalovirus (CMV) encephalitis.As per review of the literature, this appears to be the first case of brain abscess caused by N. amikacinitolerans, a recently isolated superbug. Despite confirmation through brain biopsy later on in case 1, the initial radiological appearance was atypical, showing subtle diffusion restriction on DWI. Similarly, the authors present a case of CMV encephalitis that presented as a ring-enhancing lesion, which is extremely rare. Both cases draw attention to the reliability of neuroimaging in differentiating an abscess from a neoplasm.

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“…153 Majeed et al reported a patient with mantle cell lymphoma with disseminated nocardiosis, including brain abscess and endocarditis. 154…”

Section: Hematological Malignanciesmentioning

confidence: 99%

“…Hence, the use of linezolid has been somewhat limited due to high cost and side effects, but has exceptional activity in vitro and efficacy has been impressive in some clinical series. 131,154,246 Similarly, TMP-SMX can be associated with severe nausea, hyperkalemia, [257][258][259] nephrotoxicity, 259 sudden death (in elderly patients on angiotensin converting enzyme inhibitors or angiotensin receptor blocker), 260 lactic acidosis, 261 and shock (rare allergic reaction), 262 and may not be well tolerated with prolonged use, particularly at high doses.…”

Section: Antimicrobial Susceptibilitymentioning

confidence: 99%

Nocardia spp.: A Rare Cause of Pneumonia Globally

Lynch

Reid

Clark

2020

Semin Respir Crit Care Med

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AbstractMembers of the Nocardia genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. Although rare as a cause of community-acquired pneumonia, Nocardia can have severe morbidity and mortality, particularly in patients with comorbidities or compromised immunity. Early diagnosis and timely initiation of therapy are critical to optimizing patient outcomes. Species identification is important in determining treatment, as is in vitro susceptibility testing. Sulfonamide therapy is usually indicated, although a variety of other antimicrobials may be useful, depending on the species and susceptibility testing. Prolonged therapy is usually indicated, for 6 to 12 months, and in some cases surgical debridement may be required to resolve infection.

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First reported case of disseminatedNocardia kroppenstedtiisp nov. infection presenting with brain abscess and endocarditis in an immunocompromised patient with mantle cell lymphoma: challenges in diagnosis and treatment

Cited by 16 publications

References 28 publications

Ten Year Review of Pulmonary Nocardiosis: A Series of 55 Cases

Ten Year Review of Pulmonary Nocardiosis: A Series of 55 Cases

Nocardia amikacinitolerans and cytomegalovirus: distinctive clinical and radiological characterization of the rare etiologies of brain abscesses: report of 2 cases

Nocardia spp.: A Rare Cause of Pneumonia Globally

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