Prostate abscess caused by Nocardia farcina

Abstract

Nocardia farcinica usually infects the respiratory tract and can sometimes cause central nervous system infections; however, it rarely infects the prostate. Here we report the first case of N. farcinica detected in the purulence specimen drained from a prostate abscess. A 70-year-old Japanese male receiving steroid and cyclosporine treatment came to our department with chief complaint of turbid urine. Computed tomography revealed a low-density lesion in his prostate. Antibiotic administration and prostatic drainage were effective. N. farcinica was detected in the cultures of urine and prostatic drainage purulence specimens. Nocardiosis should be included in the differential diagnosis in immunosuppressive patients with prostate abscess.

Disseminated Nocardiosis: The Complexity of the Diagnosis

“…A switch to oral agents after 3 -6 weeks can occur depending on the evolution [7]. The choice of antimicrobials should be held on the regional AST [7]. In the case that we are discussing, there was evidence of Nocardia spp.…”

“…typically present as meningitis or sub-acute abscess and account for 1-2% of brain abscesses [ 1 , 3 , 6 ], with a mortality rate of 20% in immunocompetent patients [ 1 ], higher in those immunocompromised patients or those with known risk factors [ 1 , 7 ]. The median incubation time to detect Nocardia bacteriemia is 3 - 5 days [ 4 ], and a specific ribosomal ribonucleic acid (rRNA) sequencing is needed for the identification of the species [ 7 ], which is a challenge in the diagnosis in many hospitals. Dual intravenous antimicrobial therapy is the initial treatment according to AST available for most species.…”

Disseminated Infection of Nocardia farcinica in an Immunocompetent Adult

“…[ 1 ] Given the rarity of nocardiosis, nonspecific symptoms of the disease, and the need for a longer culture period, appropriate diagnosis and antimicrobial therapy are delayed easily. [ 2 3 4 5 6 ] However, molecular biological and genetic methods provide greater accuracy for the identification of Nocardia species compared with conventional laboratory procedures. As partially acid-fast branching bacteria, sometimes, acid-fast stained specimens can provide clues and remind us to screen for Nocardia.…”

“…According to the reported cases of infection with N. farcinica , it seems to be more disseminated and severe than infection by other species of the genus. [ 2 ] We speculate that the clinical features are related with the unique morphological characteristics of N. farcinica , which enable it to spread easily through hematogenous dissemination or contiguous spread from the primary site of infection. Besides, due to the morphological characteristics of N. farcinica , it is easy to be misdiagnosed as Mycobacterium tuberculosis , especially for acid-fast staining positive N. farcinica .…”

Brain abscess caused by Nocardia in patient with alveolar proteinosis

“…Puede presentarse como meningitis o abscesificada. Se considera una enfermedad severa que presenta una mortalidad global de hasta el 20% [ 6 ]. La especie Nocardia.…”