Primary cutaneous Nocardia asteroides infection with dissemination

Kahn, Frederick W.; Gornick, Charles C.; Tofte, Robert W.

doi:10.1016/0002-9343(81)90543-x

Cited by 40 publications

(24 citation statements)

References 8 publications

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“…This primary skin infection is rare, often with a subacute course, presenting as cellulitis, lymphocutaneous disease or mycetoma in the immunocompetent patient; nocardial mycetomas may be caused by most of nocardial species but more frequently by N. brasiliensis, as occurred with patient 6 of our series. Mycetoma usually remains a localized lesion, as in our patient, rarely disseminating to the lungs and normal skin 18 .…”

Section: Discussionmentioning

confidence: 54%

Nocardial infections: report of 22 cases

Chedid

Porto³

et al. 2007

Rev. Inst. Med. trop. S. Paulo

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SUMMARYTwenty-two cases of nocardial infections were diagnosed in our city between 1977-1998. All patients whose clinical specimens showed Nocardia spp. at Gram stain, which were further confirmed by culture, were selected to be included in the study. Data from patients who were cured were compared with those from patients who died by statistical tests using EPIINFO version 6.04 software. Six isolates were identified as Nocardia asteroides complex, one as Nocardia asteroides sensu stricto and other as Nocardia brasiliensis. We had 17 cases of lung nocardiosis, being one out of them also a systemic disease. Other four cases of systemic nocardiosis were diagnosed: nocardial brain abscesses (one); nocardiosis of the jejunum (one); multiple cutaneous abscesses (one); and a case of infective nocardial endocarditis of prosthetic aortic valve. One patient had a mycetoma by N. brasiliensis. Fifteen (68.2%) out of 22 patients were immunosuppressed, being most (93.3%) by high-doses corticotherapy. Mortality by nocardial infection was 41%; mortality of systemic nocardiosis was 60%. Nocardiosis has a bad prognosis in immunosuppressed patients and also in non-immunosuppressed patients if the diagnosis is delayed. We propose that the delay in diagnosis should be examined in larger series to document its influence in the prognosis of the disease.

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Section: Discussionmentioning

confidence: 54%

Nocardial infections: report of 22 cases

Chedid

Porto³

et al. 2007

Rev. Inst. Med. trop. S. Paulo

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“…There are reports of Nocardia spp. colonizing airway passages without inducing disease; however, on the basis of studies with animal models, these should probably be interpreted as representing subclinical infections rather than simple colonization (37, 59-61, 64, 67, 69-71, 74, 82, 89, 122, 203, 253, 254, 388, 566, 734 (18,38,186,198,203,237,247,253,254,393,395,478,486,506,527,623,703,734 [303,311,702], wood splinter [180], traumatic accident [352,378], bullet wound [283,463,468], insect bite [156,277], or animal bite [429]). Thus, when lesions are found at two or more locations within the body, the infection is defined as systemic or disseminated nocardiosis.…”

Section: Pulmonary Nocardiosismentioning

confidence: 99%

“…Thus, when lesions are found at two or more locations within the body, the infection is defined as systemic or disseminated nocardiosis. Any anatomic location can be involved, but the most common sites that become infected during dissemination include the CNS, cutaneous and subcutaneous tissues, eyes (especially the retina), kidneys, joints, bone, and heart (22,26,36,51,105,107,122,135,144,149,156,159,176,191,218,220,251,253,254,260,263,304,352,375,391,392,423,454,459,466,478,479,503,520,522,525,538,540,566,569,585,589,601,631,708,719,731,734).…”

Section: Pulmonary Nocardiosismentioning

confidence: 99%

Nocardia species: host-parasite relationships

1994

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The nocardiae are bacteria belonging to the aerobic actinomycetes. They are an important part of the normal soil microflora worldwide. The type species, Nocardia asteroides, and N. brasiliensis, N. farcinica, N. otitidiscaviarum, N. nova, and N. transvalensis cause a variety of diseases in both normal and immunocompromised humans and animals. The mechanisms of pathogenesis are complex, not fully understood, and include the capacity to evade or neutralize the myriad microbicidal activities of the host. The relative virulence of N. asteroides correlates with the ability to inhibit phagosome-lysosome fusion in phagocytes; to neutralize phagosomal acidification; to detoxify the microbicidal products of oxidative metabolism; to modify phagocyte function; to grow within phagocytic cells; and to attach to, penetrate, and grow within host cells. Both activated macrophages and immunologically specific T lymphocytes constitute the major mechanisms for host resistance to nocardial infection, whereas B lymphocytes and humoral immunity do not appear to be as important in protecting the host. Thus, the nocardiae are facultative intracellular pathogens that can persist within the host, probably in a cryptic form (L-form), for life. Silent invasion of brain cells by some Nocardia strains can induce neurodegeneration in experimental animals; however, the role of nocardiae in neurodegenerative diseases in humans needs to be investigated.

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“…Predisposing conditions include a compromised immune response for any reason, HIV infection, hematological malignancies, severe SLE, solid tumors, or long-term steroid or other immunosuppressive therapies. [5] Nocardia bacteremia is a rare presentation. In the present case, the nocardial infection originated on the skin and then spread hematogenously to the lungs and brain, with the lungs being the primary site of this type of infection in more than 66% of cases.…”

Section: Discussionmentioning

confidence: 99%

Multidrug-Resistant Disseminated Nocardia Farcinica Infection in a Systemic Lupus Erythematosus Patient

et al. 2013

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Bu makalede, hastanemize ateş ve sol bacakta ağrı yakınmalarıyla başvuran 40 yaşında bir kadın olgu sunuldu. Hasta lupus nefrit nedeniyle beş ay boyunca azatioprin ve prednizolon tedavisi almıştı. Nocardia farcinica ile ilişkili yaygın nokardiyoz (nodüler kutanöz lezyon, bakteriyemi, beyin apsesi ve miliyer tüberküloz gibi retikülo nodüler infiltrasyon) tanısı konulan hasta linezolid, netilmisin ve seftriakson ile tedavi edildi. Özellikle merkezi sinir sistemi tutulumu olan ve Nocardia farcinica gibi ilaca karşı yüksek düzeyde dirençli suşların enfeksiyonu durumunda Nocardial enfeksiyonlarının tedavisi zor olmaktadır, olgu bu açıdan önem taşımaktadır.Anahtar sözcükler: Yaygın nokardiyoz; Nocardia farcinica; sistemik lupus eritematöz.Herein, we present a 40-year-old female case who was admitted to our hospital with the complaints of fever and a painful left leg. She had a five-month history of treatment with azathioprine and prednisolone for lupus nephritis. The patient was diagnosed with disseminated nocardiosis (nodular cutaneous lesions, bacteremia, brain abscesses, and a reticulonodular miliary tuberculosis-like infiltration) associated with Nocardia farcinica and was treated using linezolid, netilmicin, and ceftriaxone. This case is important as treatment of Nocardia infections remains week particularly when they involve the central nervous system and when they are sustained by highly drugresistant species such as Nocardia farcinica.

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Primary cutaneous Nocardia asteroides infection with dissemination

Cited by 40 publications

References 8 publications

Nocardial infections: report of 22 cases

Nocardial infections: report of 22 cases

Nocardia species: host-parasite relationships

Multidrug-Resistant Disseminated Nocardia Farcinica Infection in a Systemic Lupus Erythematosus Patient

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