Nocardia farcinica Spinal Osteomyelitis

Graat, Harm C.A.; Ooij, André van; Day, Gregory A.; McPhee, Ian

doi:10.1097/00007632-200205150-00021

Cited by 38 publications

(28 citation statements)

References 21 publications

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“…Less frequent locations are the ilium, fibula, metatarsal bones and mandible [17,18]. For detailed descriptions, the reader is referred to already published case-reports and reviews on primary Nocardia osteomyelitis [17,18]. Many of the reported patients with primary Nocardia osteomyelitis were immunocompetent like our patient, whose infection was most likely associated with her regular gardening activities.…”

Section: Discussionmentioning

confidence: 73%

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Primary sternal osteomyelitis caused by Nocardia nova: case report and literature review

Baraboutis¹,

Argyropoulou²,

Papastamopoulos³

et al. 2008

Braz J Infect Dis

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A 51 year old woman without significant past medical history or risk factors for Nocardia infection developed primary Nocardia nova sternal osteomyelitis with mediastinal abscess, diagnosed with open biopsy. She required prolonged antibiotic therapy and had a favorable outcome. Primary sternal osteomyelitis develops in the absence of a contiguous focus of infection, as opposed to secondary sternal osteomyelitis, which is usually a complication of sternotomy. Staphylococcus aureus probably still is the most common cause of both forms of sternal osteomyelitis. Nocardia species invade humans usually through the respiratory tract and can cause a variety of localized infections through the hematogenous route. Pulmonary involvement may or may not coexist. Immunosuppressed patients are more prone to infection by Nocardia species, although cases involving seemingly immunocompetent patients are not rare. This is the first reported case in the English literature of primary sternal osteomyelitis due to Nocardia nova or any other Nocardia species.

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Section: Discussionmentioning

confidence: 73%

“…Bones most frequently involved via the hematogenous route are the vertebral bodies, the femur and tibia. Less frequent locations are the ilium, fibula, metatarsal bones and mandible [17,18]. For detailed descriptions, the reader is referred to already published case-reports and reviews on primary Nocardia osteomyelitis [17,18].…”

Section: Discussionmentioning

confidence: 99%

Primary sternal osteomyelitis caused by Nocardia nova: case report and literature review

Baraboutis¹,

Argyropoulou²,

Papastamopoulos³

et al. 2008

Braz J Infect Dis

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“…Osteomyelitis due to nocardiae is uncommon. Only 12 cases of Nocardia osteomyelitis of the spine have been published over the past 40 years, and 4 of these were located at lumbar sites (8).…”

Section: Case Reportmentioning

confidence: 99%

“…Long-term antibiotic therapy for 6 months to a year or longer (8,12) is needed to treat Nocardia due both to the slow replication rate of the organisms and to its ability to become an intracellular pathogen that can persist as a cryptic form in the host. In addition, in patients with abscesses, surgical drainage may be required in order to ensure adequate penetration of antibiotics and clearance of the bacteria.…”

Section: Case Reportmentioning

confidence: 99%

Nocardia nova as the Causative Agent in Spondylodiscitis and Psoas Abscess

Hamdad¹,

Vidal²,

Douadi³

et al. 2007

J Clin Microbiol

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We describe here the first case of Nocardia nova spondylodiscitis accompanied by a psoas abscess due to spreading from pulmonary nocardiosis. Nocardia was cultured from all affected sites. After 1 year of an appropriate antimicrobial therapy and a surgical drainage of the abscess that was required, the patient's clinical condition had improved. CASE REPORTIn 2001, a 27-year-old female was admitted to the Department of Nephrology-Transplantation Section because of abdominal and back pain, accompanied by a high-grade fever. In 1991, she was diagnosed with end-stage renal disease due to focal segmental glomerular sclerosis. She was treated for 1 year using hemodialysis, and in 1992 she received her first renal cadaveric transplant, but it was rejected 1 year later. In March 2000, she received a second renal transplant. Because of several episodes of acute rejection despite treatment with prednisone, cyclosporine, and mycophenolate mofetil, the hemodialysis was restarted 6 months later, and the graft was removed. After this surgery, she developed Staphylococcus epidermidis septicemia and an Aspergillus fumigatus pulmonary infection. Immunosuppressive therapy was discontinued and, despite antimicrobial therapy directed against these two infections, 1 month later (October 2000) she developed a second pulmonary infection with high fever, nonproductive cough, and dyspnea. A chest X-ray and computed tomography showed multiple nodules without cavitations.Bronchial aspirate, bronchoalveolar lavage fluid, and a lung biopsy analyses were performed. Direct Gram-stained smears of all specimens showed branched gram-positive rods, and a modified acid-fast stain was positive. Cultures of all specimens grew a Nocardia species. Growth on blood agar and chocolate plates occurred within 3 days of inoculation and showed white opaque and dry colonies, which became chalky and orange with prolonged incubation. The presumptive diagnosis as Nocardia nova complex was obtained from a combination of growth characteristics, aerial hypha production, lysozyme resistance, and a drug susceptibility test performed by the disk diffusion method (5, 20).The patient became afebrile 7 days after the start of a 6-week treatment with intravenous antibiotics, including amikacin (500 mg once daily), imipenem (500 mg three times daily), and trimethoprim-sulfamethoxazole (80 mg of trimethoprim and 400 mg of sulfamethoxazole; two vials of 5 ml administered twice daily), followed by 2 months with the latter two antibiotics alone. Her clinical condition improved rapidly. She was discharged from the hospital and was treated by hemodialysis three times a week.In August 2001, she complained of abdominal and back pain and progressive fever. Her temperature was above 39°C with a normal physical examination except that her back was painful, with the pain was exacerbated when she moved. The spine was tender to palpation at the level of L4-L5 without neurological signs.The laboratory evaluation showed an elevated C-reactive protein (CRP) level of 115 mg/liter and leukoc...

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“…7 The involvement of the central nervous system (CNS) by Nocardia occurs in up to 20% of the patients, but solitary spinal abscess due to Nocardia is extremely rare. [8][9][10] Nocardia spinal abscesses are typically present as intra-medullary or epidural lesions, usually caused by N. asteroides. [8][9][10] We were able to find only three cases of N. nova CNS infection in the English language literature search (PubMed), including two cases of brain abscess and one of spondylodiscitis.…”

Section: Introductionmentioning

confidence: 99%

First case of Nocardia nova spinal abscess in an immunocompetent patient

Hong¹,

Han²,

Son³

et al. 2012

Braz J Infect Dis

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Abscess Spine RNA, ribosomal, 16S A B S T R A C TNocardia are a group of aerobic actinomycetes that are filamentous gram-positive, weakly acid-fast, and cause opportunistic infection in immunocompromised patients. PrimaryNocardia infection mostly involves lung, skin and less commonly, the central nervous system (CNS). Among Nocardia CNS infections, spinal infection is extremely rare. We describe the first case of a spinal abscess caused by Nocardia nova in an immunocompetent patient who experienced a penetrating facial injury six months earlier. Nocardia species were isolated from intradural spinal abscesses and identified by 16S rRNA, hsp65 and secA1 sequence analyses. Surgical excision and treatment with amikacin, cefotaxime, and oral erythromycin was successful.

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Nocardia farcinica Spinal Osteomyelitis

Cited by 38 publications

References 21 publications

Primary sternal osteomyelitis caused by Nocardia nova: case report and literature review

Primary sternal osteomyelitis caused by Nocardia nova: case report and literature review

Nocardia nova as the Causative Agent in Spondylodiscitis and Psoas Abscess

First case of Nocardia nova spinal abscess in an immunocompetent patient

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