Lung &lt;i&gt;Nocardia elegans&lt;/i&gt; Infection Diagnosed on Matrix-assisted Laser Desorption Ionization-time of Flight Mass Spectrometry (MALDI-TOF MS)

Ooi, Yukimasa; Shiba, Hideyuki; Nagai, Koji; Higashiyama, Tomohiro; Nakanishi, Toyofumi; Nakano, Takashi; Ukimura, Akira; Gonoi, Tohru

doi:10.2169/internalmedicine.53.2387

Cited by 10 publications

(8 citation statements)

References 12 publications

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“…N africana was discovered in 2001 in Sudan in 8 patients with lung disease, 27 and N elegans has been isolated in sputum, skin abscess, and vitreous fluid. 28,29 The species found here is also close to N aobensis, which was discovered in Japan in 2004 from 5 pulmonary isolates. 30 In this case report, we highlight that empirical treatment strategy can be inactive because of antimicrobial resistance.…”

Section: Discussionsupporting

confidence: 61%

Fulminant Nocardiosis Due to a Multidrug-Resistant Isolate in a 12-Year-Old Immunocompetent Child

Sénard

Blanot²,

Jouvion

et al. 2018

Pediatrics

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Nocardiosis is a rare cause of infection that usually affects immunocompromised adult patients and might not be recognized by pediatricians. We report a fatal case of disseminated nocardiosis in a previously healthy child initially admitted for an abdominal mass with suspicion of a renal malignant tumor. The patient, originating from Mali without any medical history, displayed abdominal pain with progressive altered general status. Laboratory and imaging findings revealed lymphocytic meningitis and disseminated abscesses in the brain and the cerebellum and a large number of cystic lesions of the kidney. Despite being administered wide-spectrum antibiotics and antituberculous and antifungal therapies with an external ventricular drainage for intracranial hypertension, the patient died 6 days after his admission. spp was cultured from a renal biopsy and the cerebrospinal fluid. Species identification and antibiotic susceptibility were obtained later, revealing a multidrug-resistant isolate of the complex. This case reveals the difficulties of diagnosing nocardiosis, in particular in children not known to be immunocompromised, because we face multiple differential diagnoses and the importance of treating nocardiosis appropriately because of intrinsic resistance issues.

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Section: Discussionsupporting

confidence: 61%

Fulminant Nocardiosis Due to a Multidrug-Resistant Isolate in a 12-Year-Old Immunocompetent Child

Sénard

Blanot²,

Jouvion

et al. 2018

Pediatrics

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“…Only seven cases of nocardiosis caused by N. elegans have been reported to date. 2,[6][7][8][9][10][11] In general, N. elegans is very rarely isolated and accounts for only 0.3-0.6% of infections caused by Nocardia species. 2,10,12 Previous reports on the epidemiology of nocardiosis have not included any cases caused by N. elegans.…”

Section: Incidence Of N Elegansmentioning

confidence: 99%

“…Some reports regarding the antibiotic susceptibility of N. elegans show in vivo susceptibility to ST, IPM-CS, CAM, MINO, and LZD. 2,[6][7][8][9] Although previous studies have provided little information on the response to antimicrobial treatment, ST, carbapenems, aminoglycosides, and CAM have been used to successfully treat nocardial infections (Table 2). Importantly, resistance to ST was only seen in one case.…”

Section: Antimicrobial Susceptibility and Antimicrobial Treatment Of N Elegansmentioning

confidence: 99%

“…Importantly, resistance to ST was only seen in one case. 8 These antimicrobial agents were also selected based on susceptibility analysis in the present case; however, drug toxicity and resistance during therapy meant that treatment was ceased. In addition, decreasing susceptibility to other antimicrobial agents was observed during treatment.…”

Section: Antimicrobial Susceptibility and Antimicrobial Treatment Of N Elegansmentioning

confidence: 99%

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Nocardia elegans infection: a case report and literature review

Nakamura

Nagakura

Fujita

et al. 2017

International Journal of Infectious Diseases

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A case of disseminated nocardiosis caused by Nocardia elegans in a 72-year-old man with rheumatoid arthritis, treated with tacrolimus and prednisolone, is reported herein. The patient had impaired vision and was diagnosed with endophthalmitis and an abdominal skin abscess. He was started on trimethoprim-sulfamethoxazole treatment, followed by cefepime. The patient was then switched to a combination of imipenem-cilastatin and minocycline. Although the patient survived as a result of surgery and prolonged antibiotic treatment, he eventually lost vision after the infection became resistant to antibiotic treatment. Molecular analysis of samples from the abscess and vitreous fluid confirmed the extremely rare pathogen N. elegans, which accounts for only 0.3-0.6% of infections caused by Nocardia species. This organism is almost always associated with pulmonary infection, and disseminated infections are rare. As with previously reported norcardial infections, the current case was treated successfully with trimethoprim-sulfamethoxazole, carbapenems, and aminoglycosides. However, the clinical characteristics of this organism remain unclear. Further studies are therefore required to develop more effective treatment protocols for disseminated nocardiosis caused by this problematic pathogen.

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“…Following advances in the taxonomy of Nocardia species in recent years, N. elegans was first identified in Germany in 2005 (10) and classified as a N. nova complex, alongside N. africana, N. aobensis, N. kruczakiae, N. nova, and N. veterana (11). Reported cases of infection with N. elegans are limited, with just 13 reported to date (Table 2) (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Lung and Cerebral Nocardiosis Caused by <i>Nocardia elegans</i> in a Lung Transplant Recipient: A Case Report and Literature Review

et al. 2023

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Patients after lung transplantation are at risk for Nocardia infections. We herein report a case of lung and cerebral nocardiosis caused by Nocardia elegans, a rare species of Nocardia, in a lung transplant recipient. Antibiotic therapy, including sulfamethoxazole-trimethoprim (ST), and brain abscess drainage improved symptoms and imaging findings. A literature review of N. elegans infections showed that 12 of 14 cases (85.7%) were reported from East Asia, particularly Japan (9 cases, 64.2%). The lungs were the predominant site (12/14 cases, 85.7%), and most of the cases were susceptible to ST (9/10 cases, 90%).

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Lung <i>Nocardia elegans</i> Infection Diagnosed on Matrix-assisted Laser Desorption Ionization-time of Flight Mass Spectrometry (MALDI-TOF MS)

Cited by 10 publications

References 12 publications

Fulminant Nocardiosis Due to a Multidrug-Resistant Isolate in a 12-Year-Old Immunocompetent Child

Fulminant Nocardiosis Due to a Multidrug-Resistant Isolate in a 12-Year-Old Immunocompetent Child

Nocardia elegans infection: a case report and literature review

Lung and Cerebral Nocardiosis Caused by <i>Nocardia elegans</i> in a Lung Transplant Recipient: A Case Report and Literature Review

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