Nocardiosis: A 15-year experience in a tertiary medical center in Israel

Rosman, Yossi; Grossman, Ehud; Keller, Nathan; Thaler, Michael; Eviatar, Tali; Hoffman, Chen; Apter, S.

doi:10.1016/j.ejim.2013.05.004

Cited by 38 publications

(41 citation statements)

References 14 publications

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“…As reported in other studies (2,3,6–8), pulmonary disease was the most common presentation (85.0%) and 30.0% of cases had a disseminated disease. The most frequent chest CT results in the study group were airspace opacities, multifocal nodules or masses; cavitation was common in pulmonary nocardiosis.…”

Section: Discussionsupporting

confidence: 79%

“…The major risk factor in the study population was corticosteroid treatment, with 20 (50.0%) of the patients having received systemic corticosteroid therapy prior to the diagnosis of nocardiosis. Chronic corticosteroid treatment at a high dose has been reported to play a predisposing role in nocardiosis (2,3,6,13). However, the present study results revealed that even short-term corticosteroid treatment at a low dose (0.5–1 mg/kg, 3–6 weeks duration) may be a risk factor for nocardiosis.…”

Section: Discussionmentioning

confidence: 99%

“…Hematological diseases: aplastic anemia (1), autoimmune hemolytic anemia (2). Solid malignancy: thymoma (1), lung cancer (1).…”

Section: Figurementioning

confidence: 99%

“…Nocardia are rare opportunistic pathogens that particularly affect patients who are on immunosuppressive therapy or chemotherapy, post-transplant patients, and patients with human immunodeficiency virus (HIV) infection. There are few studies and case reports available on nocardiosis (2–9). Thus, there are no optimal antimicrobial regimens available to date.…”

Section: Introductionmentioning

confidence: 99%

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Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital

Yang

Wei

et al. 2014

Experimental and Therapeutic Medicine

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To the best of our knowledge, no Chinese case studies concerning Nocardia infection have been published to date. Therefore, the present study aimed to retrospectively evaluate the risk factors, clinical features, imaging results, laboratory abnormalities, treatments and outcomes of nocardiosis in a Chinese tertiary hospital. Data collected from patients with laboratory-confirmed nocardiosis were retrospectively analyzed. A total of 40 patients who had a positive culture of Nocardia were included. The median time between the onset of symptoms and diagnosis was 42 days. Underlying diseases were identified in 72.5% of the patients of which diabetes was the most common (32.5%). The most important risk factor was corticosteroid administration. Fever and cough were common clinical symptoms. The pleuropulmonary (85%) were the most frequently involved sites and the disseminated disease rate was 30.0%. Frequent chest computed tomography scans revealed the presence of airspace opacities, nodules and masses, in addition to cavitary lesions that were particularly common among the study group. Brain images revealed lesions associated with abscesses. The majority of the patients (71.1%) were treated with trimethoprim sulfamethoxazole alone or in combination with other drugs. The in-hospital mortality rate was 15.0%. Disseminated disease, immunocompromised patients, an older age, brain involvement and concomitant infections were associated with a poor prognosis. Nocardiosis is an uncommon but emerging disease. The present study reports the first case series on nocardiosis from China and provides important information on the clinical features and risk factors of nocardiosis. Early recognition of the disease and the initiation of appropriate treatment are essential for a good prognosis.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

“…Hematological diseases: aplastic anemia (1), autoimmune hemolytic anemia (2). Solid malignancy: thymoma (1), lung cancer (1).…”

Section: Figurementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital

Yang

Wei

et al. 2014

Experimental and Therapeutic Medicine

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“…1). A simple comparison of the outcome is difficult because the outcome is strongly affected by factors such as the patient background and timing of the investigation, but the outcome was poor compared with previously reported survival rates (40-100%) (6,8-13,28-30). Furthermore, the 1-year survival rate in the group treated with immunosuppressant agents was 41.7%, which was poorer than that (59.7%) in the untreated group (Fig.…”

Section: Discussionmentioning

confidence: 84%

Pulmonary Nocardiosis: A Clinical Analysis of 30 Cases

et al. 2017

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Objective Pulmonary nocardiosis frequently develops as an opportunistic infection in patients with malignant tumor and is treated with steroids. This study was performed to clarify the clinical features of pulmonary nocardiosis in Japan. Methods The patients definitively diagnosed with pulmonary nocardiosis at our hospital between January 1995 and December 2015 were retrospectively investigated. Results Nineteen men and 11 women (30 in total) were diagnosed with pulmonary nocardiosis. Almost all patients were complicated by a non-pulmonary underlying disease, such as malignant tumor or collagen vascular disease, or pulmonary disease, such as chronic obstructive pulmonary disease or interstitial pneumonia, and 13 patients (43.3%) were treated with steroids or immunosuppressors. Gram staining was performed in 29 patients, and a characteristic Gram-positive rod was detected in 28 patients (96.6%). Thirty-one strains of Nocardia were isolated and identified. Seven strains of Nocardia farcinica were isolated as the most frequent species, followed by Nocardia nova isolated from 6 patients. Seventeen patients died, giving a crude morality rate of 56.7% and a 1-year survival rate of 55.4%. The 1-year survival rates in the groups with and without immunosuppressant agents were 41.7% and 59.7%, respectively, showing that the outcome of those receiving immunosuppressants tended to be poorer than those not receiving them. Conclusion Pulmonary nocardiosis developed as an opportunistic infection in most cases. The outcome was relatively poor, with a 1-year survival rate of 55.4%, and it was particularly poor in patients treated with immunosuppressant agents. Pulmonary nocardiosis should always be considered in patients presenting with an opportunistic respiratory infection, and an early diagnosis requires sample collection and Gram staining.

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