Nocardia Arthritis

Abstract

Nocardia are Gram-positive filamentous bacteria responsible for infections ranging from opportunistic life-threatening disseminated diseases to chronic skin and soft-tissue infections.Even if virtually all organs can be infected, articular involvement is rare. Therefore, we report 3 recent cases and performed a literature review of cases of Nocardia arthritis in order to describe clinical features, therapeutic challenges, and outcome of these patients.Among 34 patients (31 in the literature plus our 3 cases), 21 (62%) were due to hematogenous dissemination, 9 (26%) were due to direct bacterial inoculation through the skin, and in 4 cases, the mechanism of infection was unknown. Four out of these 34 cases occurred on prosthetic joints.Whereas hematogenous infections mostly occurred in immunocompromised hosts (17 of 21, 81%), direct inoculation was mostly seen in immunocompetent patients.Eighty-two percent of patients (28 out of 34) received trimethoprim-sulfamethoxazole-containing regimens and median antibiotic treatment duration was 24 weeks (range, 12–120) for hematogenous infections and 12 weeks (range, 6–24) for direct inoculations. Outcome was favorable in 27 cases despite unsystematic surgical management (17 cases) without sequelae in 70% of the cases.Nocardia arthritis is rare but its management is complex and should rely on a combined approach with rheumatologist, infectious diseases expert, and surgeon.

Identification of a novel drug-resistant community-acquired Nocardia spp. in a patient with bronchiectasis

“…Bacteriological analysis revealed that GZ2020 T exhibited positive Gram staining and weak acid-fast staining, and microscopic examination showed that the bacteria tended to be beaded and to have a rod shape with branching filaments (Supplementary Figure 2), which is consistent with the common characteristics of Nocardia [ 1 , 2 , 6 , 25 ]. However, further phylogenetic analysis and physiological examinations ( Figure 4 and Supplementary Tables 1–4) revealed that it belonged to the Nocardia species but was different from known strains, which indicated that GZ2020 T is a novel pathogen.…”

“…Compared with other pathogens, these bacteria are common pathogens in immunosuppressed patients and can sometimes cause high mortality [ 3 , 4 ]. However, in recent years, an increasing number of reports have indicated that patients with chronic lung diseases (CLDs), such as chronic obstructive pulmonary disease (COPD) and bronchiectasis, can be affected [ 5 , 6 ]. Due to the increasing number of people at risk and the development of molecular diagnostic methods, a gradual increase in the incidence of Nocardia infection has been observed [ 5 , 7 ].…”

Invasive Nocardiosis: Disease Presentation, Diagnosis and Treatment – Old Questions, New Answers?

“…Virtually all organs can be involved in disseminated nocardiosis, leading to thyroid abscess, endophthalmitis, arthritis, liver or kidney abscess, and endocarditis, among others. 2,21 In disseminated disease, 2-deoxy-2-[fluorine-18]fluoro-D-glucose ( 18 F-FDG) positron emission tomography (PET)/CT can be used to assess the extent of invasive nocardiosis and to guide biopsy. 22 As invasive nocardiosis mostly occurs among immunocompromised patients with no specific features, its diagnosis is challenging and requires a comprehensive microbiological workup, sampling all involved organs and eliminating possible differential diagnoses (see later).…”

“…Virtually all organs can be involved in disseminated nocardiosis, leading to thyroid abscess, endophthalmitis, arthritis, liver or kidney abscess, and endocarditis, among others. 2 , 21 In disseminated disease, 2-deoxy-2-[fluorine-18]fluoro-D-glucose ( 18 F-FDG) positron emission tomography (PET)/CT can be used to assess the extent of invasive nocardiosis and to guide biopsy. 22 …”

Menace Elbow: Disseminated Nocardiosis

“…Case series data suggest that most episodes are a result of hematogenous dissemination from a pulmonary infection. 2 However, pulmonary nocardiosis is frequently misdiagnosed—occasionally with catastrophic results.…”