Lymphocutaneous nocardiosis caused by <i>Nocardia brasiliensis</i> in an immunocompetent elderly woman

Sheffer, Sivan; Shreberk‐Hassidim, Rony; Olshtain, Karen; Maly, Alexander; Zlotogorski, Abraham; Ramot, Yuval

doi:10.1111/ijd.12988

Cited by 9 publications

(7 citation statements)

References 5 publications

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“…Other alternatives would be amikacin, third generation cephalosporins, minocycline, imipenem, and linezolid [ 6 , 7 , 8 , 10 , 11 , 12 ]. It is worth to point out that, in the case described, as well as in other reports in the literature [ 9 , 15 , 20 , 21 ], the patients did not show an immediate improvement when medicated previously with other antibiotics due to lack of correct identification of Nocardiosis spp.…”

Section: Discussionmentioning

confidence: 48%

Cutaneous Nocardiosis Simulating Cutaneous Lymphatic Sporotrichosis

et al. 2017

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Sporotrichosis is the subcutaneous mycosis caused by several species of the Sporothrix genus. With worldwide occurrence, the State of Rio de Janeiro is presently undergoing a zoonotic sporotrichosis epidemic. The form of lymphocutaneous nocardiosis is rare, being caused especially by Nocardia brasiliensis. It appears as a nodular or ulcerated lesion, with multiple painful erythematous nodules or satellite pustules distributed along the lymphatic tract, similar to the lymphocutaneous variant of sporotrichosis. We present a 61-year-old man who, after an insect bite in the left leg, developed an ulcerated lesion associated with ascending lymphangitis, nonresponsive to previous antibiotic therapies. The patient was admitted for investigation, based on the main diagnostic hypothesis of lymphatic cutaneous sporotrichosis entailed by the highly suggestive morphology, associated with the epidemiologic information that he is a resident of the city of Rio de Janeiro. While culture results were being awaited, the patient was medicated with sulfamethoxazole-trimethoprim to cover CA-MRSA and evolved with total healing of the lesions. After hospital discharge, using an ulcer fragment, an Actinomyces sp. was cultivated and N. brasiliensis was identified by molecular biology. The objective of this report is to demonstrate a case of lymphocutaneous nocardiosis caused by N. brasiliensis after a probable insect bite. Despite the patient being a resident of the State of Rio de Janeiro (endemic region for sporotrichosis), it is highlighted that it is necessary to be aware of the differential diagnoses of an ulcerated lesion with lymphangitis, favoring an early diagnosis and appropriate treatment of the illness.

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Section: Discussionmentioning

confidence: 48%

Cutaneous Nocardiosis Simulating Cutaneous Lymphatic Sporotrichosis

et al. 2017

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“…Most cases (60 to >80%) of nocardiosis occur in patients with severely impaired cellular immunity. 4,5,19,77 However, infections (sometimes fulminant and lethal) may occur in previously healthy hosts, 5,9,10,12,23,78 particularly in subtropical or tropical regions. 5,16 Nocardiosis is more common in males.…”

Section: Risk Factorsmentioning

confidence: 99%

“…73 Skin involvement is more common with N. brasiliensis. [21][22][23][24]165 Manifestations may include pustules (►Fig. 3), abscesses, necrosis, 166 and nodular pustular pyoderma with sporotrichoid spreading 22,29,37,57,72,167,168 ; infection may extend into contiguous tissues (e.g., muscle, 169 fascia, 170 bone, 29,168 and lymphatics).…”

Section: Clinical Features Pulmonarymentioning

confidence: 99%

“…16,18 Pulmonary nocardiosis may mimic communityacquired pneumonia, and this may be more common among individuals with agricultural or outdoor occupations in developing countries. 10,12,16 Nocardiosis primarily involves the lungs, 5,[19][20][21] but skin and soft tissue infections (SSTIs), [21][22][23][24][25][26][27][28][29] central nervous system (CNS) infection (brain abscesses, meningitis), 7,[30][31][32][33][34] and dissemination 4,11,12,21,35 may occur. Given the rarity of the disease, the diagnosis and initiation of appropriate antimicrobial therapy are often delayed.…”

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confidence: 99%

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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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“…Alternativ kommt die Anwendung von Amikacin, Cephalosporine der dritten Generation, Minocyclin, Imipenem und Linezolid in Betracht [6][7][8][10][11][12]. Hervorzuheben ist, dass es im beschriebenen Fall wie auch in anderen Berichten in der Literatur [9,15,20,21] unter der Behandlung mit anderen Antibiotika nicht zu einer raschen Besserung gekommen war, da die korrekte Identifizierung der Nocardiosis spp. fehlte.…”

Section: Diskussionunclassified

Simulation der kutanen lymphatischen Sporotrichose durch die kutane Nokardiose

et al. 2018

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Sporotrichose ist eine subkutane Mykose, die durch verschiedene Gattungen des Schimmelpilzes Sporothrix hervorgerufen wird. Die Infektion tritt weltweit auf, doch ist im Bundesstaat Rio de Janeiro derzeit eine zoonotische Sporotrichose-Epidemie zu beobachten. Die lymphokutane Form der vor allem durch Nocardia brasiliensis verursachten Nokardiose ist selten. Sie manifestiert sich in Form nodulärer oder ulzerierter Läsionen mit multiplen schmerzhaften erythematösen Knoten oder pustulösen Satellitenläsionen entlang der Lymphbahnen und ähnelt damit der lymphokutanen Variante der Sporotrichose. Wir berichten über einen 61-jährigen Mann, der nach einem Insektenstich am linken Bein eine ulzerierte Läsion mit aufsteigender Lymphangitis entwickelte, die auf die vorausgegangenen Antibiotika-Therapien nicht angesprochen hatte. Die stationäre Aufnahme des Patienten zur weiteren Abklärung erfolgte unter dem Verdacht auf eine lymphatische kutane Sporotrichose aufgrund der typischen Morphologie sowie der Angabe zum Wohnort des Patienten in Rio de Janeiro. Während der Wartezeit auf die Ergebnisse zu den Pilzkulturen erhielt der Patient eine antibiotische Versorgung gegen CA-MRSA (community-acquired MRSA) mit Sulfamethoxazol/Trimethoprim, unter der die Läsion vollständig abheilte. Nach der Entlassung wurde aus einer Gewebeprobe des Ulcus eine Actinomyces-Spezies kultiviert und mittels molekularbiologischer Untersuchung als N. brasiliensis identifiziert. Mit dem vorliegenden Bericht möchten wir einen Fall lymphokutaner Nokardiose vorstellen, die durch N. brasiliensis, wahrscheinlich nach Insektenstich, hervorgerufen wurde. Obwohl der Patient im Bundesstaat Rio de Janeiro, einer endemischen Region für Sporotrichose, wohnhaft ist, müssen differentialdiagnostisch auch andere Ursachen einer ulzerierten Läsion mit Lymphangitis in Betracht gezogen werden, um eine möglichst frühzeitige Diagnose und entsprechende Behandlung der Krankheit zu erreichen. Übersetzung aus Case Reports in Dermatology 2017;9:119-129 (DOI: 10.1159/000471788)

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Lymphocutaneous nocardiosis caused by Nocardia brasiliensis in an immunocompetent elderly woman

Cited by 9 publications

References 5 publications

Cutaneous Nocardiosis Simulating Cutaneous Lymphatic Sporotrichosis

Cutaneous Nocardiosis Simulating Cutaneous Lymphatic Sporotrichosis

Nocardia spp.: A Rare Cause of Pneumonia Globally

Simulation der kutanen lymphatischen Sporotrichose durch die kutane Nokardiose

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