<i>Nocardia</i>Infection in Solid Organ Transplant Recipients: A Multicenter European Case-control Study

Coussement, Julien; Lebeaux, David; Delden, Christian van; Guillot, Hélène; Freund, Romain; Marbus, Sierk; Melica, Giovanna; Wijngaerden, Eric Van; Douvry, B.; Laecke, Steven Van; Vuotto, Fanny; Tricot, L.; Fernández‐Ruiz, Mario; Dantal, Jacques; Hirzel, Cédric; Jaı̈s, Jean-Philippe; Rodríguez-Nava, Verónica; Lortholary, Olivier; Jacobs, Frédérique; Anstey, James; Antoine, Martine; Belhaj, Asmae; Boelens, Jerina; Beenhouwer, H. De; Greef, Julien De; Denis, C.; Ho, Erwin; Ieven, Margareta; Jonckheere, Stijn; Knoop, Christiane; Moine, Alaín Le; Rodriguez-Villalobos, Hector; Racapé, Judith; Roisin, Sandrine; Vandercam, Bernard; Zwalmen, Marie-Laure Vander; Vanfraechem, Gaëlle; Verhaegen, Jan; Vollaard, Albert M.; Wunderink, Herman F.; Boggian, Katia; Egli, Adrian; Garzoni, Christian; Hoffmann, Matthias; Hirsch, Hans H.; Khanna, Nina; Manuel, Oriol; Meylan, Pascal; Mueller, Nicolas J.; Posfay‐Barbe, Klara M.; Vu, Diem‐Lan; Weisser, Maja; Barrou, B.; Battistella, Pascal; Bergeron, Emmanuelle; Bouvier, Nicolas; Caillard, Sophie; Caumes, Éric; Chaussade, H.; Chauvet, C.; Crochette, Romain; Epailly, Éric; Essig, Marie; Gallien, Sébastien; Guillemain, R.; Herel, Canan; Hoën, Bruno; Kamar, Nassim; Gall, Thierry Le; Lionet, Arnaud; Longuet, Hélène; Matignon, Marie; Miel, Anaick; Morel, Hélène; Ammar, Salima Ould; Pattier, Sabine; Péraldi, Marie-Noëlle; Sayegh, Johnny; Scemla, Anne; Sénéchal, Agathe; Tourret, Jérôme

doi:10.1093/cid/ciw241

Cited by 208 publications

(244 citation statements)

References 32 publications

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“…We report 51 cases of Nocardia infection occurring in 14 HCT and 37 SOT recipients diagnosed at a single tertiary transplant center over an 18‐year period. The literature to date regarding nocardiosis in transplant consists primarily of retrospective case series or reports alongside a single center retrospective case‐control study in SOT patients in the United States and a more contemporary multicenter case‐control study in SOT patients in Europe . This study adds to the limited data that exists regarding nocardiosis following transplant.…”

Section: Discussionmentioning

confidence: 99%

Nocardia infections in the transplanted host

Hemmersbach‐Miller

Stout

Woodworth

et al. 2018

Transplant Infectious Dis

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Section: Discussionmentioning

confidence: 99%

Nocardia infections in the transplanted host

Hemmersbach‐Miller

Stout

Woodworth

et al. 2018

Transplant Infectious Dis

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“…[22,23] High-dose corticosteroid use, preceding cytomegalovirus infection, elevated calcineurin inhibitor levels and tacrolimus use have been shown to be independent risk factors for nocardiosis posttransplantation, all of which are indicators of severe immune suppression. [22–24] …”

Section: Discussionmentioning

confidence: 99%

“…This hypothesis is not borne out in the transplant population in which a substantial proportion who develop nocardiosis do so whilst receiving TMP-SMX prophylaxis. [9,21,23,24,30,31] The only patient in our study to be receiving TMP-SMX prophylaxis was a patient who was diagnosed with Nocardia brain abscess 2 years after allogeneic hematopoietic stem cell transplant and was receiving considerable immunosuppressive therapy with prednisolone, mycophenolate, and tacrolimus. Notably, this isolate remained susceptible to TMP-SMX.…”

Section: Discussionmentioning

confidence: 99%

“…[36] A recent large case series of nocardiosis in solid organ transplant patients has likewise found N farcinica to be the most prevalent organism when relying on 16s RNA sequencing for species identification. [24] N farcinica has a resistance pattern which can make treatment difficult, characteristically testing resistant to third-generation cephalosporins. [7,37] N asteroides was the most commonly isolated species in our review of published cases, accounting for 12 of the 34 speciated isolates, followed by N farcinica (11/35, 32.3%).…”

Section: Discussionmentioning

confidence: 99%

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Central nervous system nocardiosis in Queensland

et al. 2016

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Nocardia infection of the central nervous system (CNS) is an uncommon but clinically important disease, often occurring in immunocompromised individuals and carrying a high mortality rate. We present 20 cases of microbiologically proven CNS nocardiosis diagnosed in Queensland from 1997 to 2015 and review the literature from 1997 to 2016.Over 50% of cases occurred in immunocompromised individuals, with corticosteroid use posing a particularly significant risk factor. Nine (45%) patients were immunocompetent and 3 had no comorbidities at time of diagnosis. Nocardia farcinica was the most frequently isolated species (8/20) and resistance to trimethoprim–sulfamethoxazole (TMP-SMX) was found in 2 isolates. Overall, 35% of our patients died within 1 year, with the majority of deaths occurring in the first month following diagnosis. Interestingly, of the 7 deaths occurring at 1 year, 6 were attributed to N farcinica with the seventh isolate being unspeciated, suggesting the virulence of the N farcinica strain.

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“…This patient's clinical presentation was atypical. [12] This may be explained by long-term corticosteroid therapy masking the symptoms and signs of infection. Because of the absence of history of percutaneous inoculation, it was assumed that the patient may had inhaled N farcinica initially with dissemination to the skin.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary and cutaneous infection caused by Nocardia farcinica in a patient with nephrotic syndrome

Zhu

Zhu²,

Wang³

et al. 2017

Medicine

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Rationale:Nocardia species is known as conditional pathogenic bacteria. Disseminated infection caused by Nocardia species is rare and occurs primarily in immunosuppressed patients. Signs and symptoms of this infection are frequently nonspecific making early diagnosis and treatment difficult.Patient concerns:We report a case of subcutaneous and pulmonary nocardiosis due to Nocardia farcinica (N farcinica) in a patient with nephrotic syndrome who is undergoing long-term corticosteroid therapy. In this patient, systemic and pulmonary symptoms (usually found in nocaria infection) such as fever, cough, and expectoration were absent.Diagnoses:Early diagnosis was made by pus culture from subcutaneous abscesses and 16S rRNA gene sequencing, which confirm the diagnosis of N farcinica infection.Interventions:The patient was treated with combination therapy of cefatriaxone and trimethoprim-sulfamethoxazole (TMP-SMX) for 2 weeks, and the treatment with TMP-SMX continued to 6 months.Outcomes:The abscesses were cured in 4 weeks and a lesion in the upper lobe of left lung resolved in 3 months.Lessons:This case indicates that disseminated infection due to N farcinica could occur in patients with nephrotic syndrome, even during the period of maintenance therapy with a low-dose corticosteroid and common signs and symptoms of infections could be absent.

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NocardiaInfection in Solid Organ Transplant Recipients: A Multicenter European Case-control Study

Abstract: We identified 5 risk factors for nocardiosis after SOT. Low-dose cotrimoxazole was not found to prevent Nocardia infection. These findings may help improve management of transplant recipients.

Cited by 208 publications

References 32 publications

Nocardia infections in the transplanted host

Nocardia infections in the transplanted host

Central nervous system nocardiosis in Queensland

Pulmonary and cutaneous infection caused by Nocardia farcinica in a patient with nephrotic syndrome

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