Invasive Nocardiosis in Transplant and Nontransplant Patients: 20-Year Experience in a Tertiary Care Center

Harris, Dana M.; Dumitrascu, Adrian; Chirilă, Răzvan M.; Omer, Mohamed; Stancampiano, Fernando; Hata, D. Jane; Villegas, Diana M. Meza; Heckman, Michael G.; Cochuyt, Jordan J.; Álvarez, Salvador

doi:10.1016/j.mayocpiqo.2020.10.009

Cited by 10 publications

(27 citation statements)

References 24 publications

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“…It is known that the immunosuppressant medications the patient was taking (corticosteroids, tacrolimus, mycophenolate) suppress T‐cell function and predispose to Nocardia sp. infections which occurs late after an organ transplant (12–34 months) 4,26–28 . N. farcinica , is one of the most commonly isolated species along with Nocardia nova complex and Nocardia cyriacigeorgica 29 .…”

Section: Discussionmentioning

confidence: 99%

“…are susceptible to TMP/SMZ, linezolid and amikacin, but the standard of practice recommends combination antibiotics for empiric therapy due to the seriousness of the infection. Of note, only 2% of species of N. farcinica are susceptible to doxycycline 4,29 . One year mortality in solid organ transplant patients is 15%–20% 30 .…”

Section: Discussionmentioning

confidence: 99%

“…Nocardia primarily causes pulmonary, central nervous system (CNS), or soft tissue infections. In one study, 110 patients with invasive nocardiosis were identified over a 20‐year period 4 . The rate of infection and mortality from nocardiosis was similar between transplant and non‐transplant patients.…”

Section: Introductionmentioning

confidence: 99%

“…The rate of infection and mortality from nocardiosis was similar between transplant and non‐transplant patients. Still, most non‐transplant patients with nocardiosis were immunosuppressed, had chronic obstructive lung disease, chronic kidney disease or diabetes 4 . The three main sites of infection were lung (73.6%), skin and soft tissue (23.6%), and brain (11.8%) with 20.9% of patients having disseminated nocardiosis.…”

Section: Introductionmentioning

confidence: 99%

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Cladophialophora bantiana and Nocardia farcinica infection simultaneously occurring in a kidney transplant recipient: Case report and literature review

Cortés

Hata

Libertin

et al. 2021

Immunity Inflam & Disease

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Solid organ transplant recipients are at increased risk of acquiring devastating infections with unusual pathogens. Nocardia are aerobic actinomycetes that affect the lungs, brain, skin and soft tissue. Cladophialophora species are dematiaceous fungi that overwhelmingly cause infections in the brain. Both organisms carry a high mortality rate. We present the first reported renal transplant case with Cladophialophora bantiana involving the renal allograft with concurrent invasive nocardiosis involving the lungs and brain.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cladophialophora bantiana and Nocardia farcinica infection simultaneously occurring in a kidney transplant recipient: Case report and literature review

Cortés

Hata

Libertin

et al. 2021

Immunity Inflam & Disease

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“…Secondary prophylaxis has been utilized, with one study citing as many as 60% of patients receive secondary prophylaxis with TMP‐SMX or azithromycin following primary therapy 1 . Primary prophylaxis has also been studied and may offer some protection, though breakthrough infections do occur 6,11–13 . Similarly, a study examining SOT recipients who received Pneumocystis prophylaxis agents other than TMP‐SMX found a higher rate of potentially preventable infection as compared to those who received TMP‐SMX, including Nocardia 14 .…”

Section: Introductionmentioning

confidence: 99%

Recurrent nocardiosis in solid organ transplant recipients: An evaluation of secondary prophylaxis

Yetmar

Wilson

Beam

2021

Transplant Infectious Dis

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Background Immunocompromised individuals are at risk for Nocardia infection, with a recurrence rate of approximately 5%. Solid organ transplant (SOT) recipients often receive secondary prophylaxis due to their requirement of lifelong immunosuppression. However, data supporting this practice is sparse. We sought to evaluate Nocardia recurrence in SOT recipients, specifically evaluating secondary prophylaxis. Methods We conducted a retrospective cohort study of SOT recipients diagnosed with nocardiosis from 2000 through 2020. We included adult SOT recipients who completed their course of Nocardia therapy and had at least 6 months of posttherapy follow‐up. The primary outcome was Nocardia recurrence, which included relapse and reinfection. Results One hundred two patients met inclusion criteria. Sixty‐six (64.7%) were male and mean age was 58.6 ± 11.7 years. Most common SOT types were kidney (46.1%), heart (18.6%), kidney‐pancreas (11.8%), and lung (10.8%). Most common sites of infection were lung (85.3%), skin (17.6%), and brain (14.7%). Secondary prophylaxis was utilized in 53 (52.0%) patients. Trimethoprim‐sulfamethoxazole (TMP‐SMX) single‐strength daily was the most common prophylaxis agent and dose. Five patients (4.9%) experienced Nocardia recurrence, three of which were receiving secondary prophylaxis at time of recurrence. Two recurrences were with the same Nocardia species. Factors associated with recurrence were lung transplantation (p = .011), chronic lung disease (p = .032), and treatment ≤120 days (p = .006). Time from treatment completion to recurrence ranged from 107 to 875 days. Conclusions Nocardia recurrence in SOT recipients is an uncommon event. TMP‐SMX secondary prophylaxis is incompletely protective and recurrence may be dependent upon other factors. Further study of secondary prophylaxis is warranted.

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Clinical characteristics, susceptibility profiles, and treatment of nocardiosis: a multicenter retrospective study in 2015-2021

Yang¹,

Ren²,

Wang³

et al. 2023

International Journal of Infectious Diseases

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Invasive Nocardiosis in Transplant and Nontransplant Patients: 20-Year Experience in a Tertiary Care Center

Cited by 10 publications

References 24 publications

Cladophialophora bantiana and Nocardia farcinica infection simultaneously occurring in a kidney transplant recipient: Case report and literature review

Cladophialophora bantiana and Nocardia farcinica infection simultaneously occurring in a kidney transplant recipient: Case report and literature review

Recurrent nocardiosis in solid organ transplant recipients: An evaluation of secondary prophylaxis

Clinical characteristics, susceptibility profiles, and treatment of nocardiosis: a multicenter retrospective study in 2015-2021

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