Pulmonary Nocardiosis as an Opportunistic Infection in COVID-19

Laplace, Marc; Flamand, Thomas; Ion, Ciprian; Gravier, Simon; Mohseni-Zadeh, M.; Debriel, D.; Augereau, Olivier; Gregorowicz, Guillaume; Martinot, M.

doi:10.12890/2022_003477

Cited by 6 publications

(7 citation statements)

References 6 publications

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“…With the rarity of Nocardia infections, there is a lack of formal guideline-directed treatment compared to other infections [ 2 ]. Although there are multiple studies and case reports published, there is a lack of clinical trials to determine optimal therapies and inconsistency with the in vitro and in vivo antibiotic susceptibilities [ 20 ]. Multiple studies reported treatment with sulfonamides, although antibiotic and anti-microbial susceptibility testing is recommended to identify specific Nocardia strains and determine susceptibility patterns.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies reported treatment with sulfonamides, although antibiotic and anti-microbial susceptibility testing is recommended to identify specific Nocardia strains and determine susceptibility patterns. Various Nocardia species have different resistance patterns, particularly with commonly used TMP-SMX [ 20 ]. Consequently, antibiotic treatment is prolonged or relapse with disease progression has been described in certain cases [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…Various Nocardia species have different resistance patterns, particularly with commonly used TMP-SMX [ 20 ]. Consequently, antibiotic treatment is prolonged or relapse with disease progression has been described in certain cases [ 20 ]. Further studies are needed to determine primary treatments for immunocompromised patients with nocardiosis.…”

Section: Discussionmentioning

confidence: 99%

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Unremitting Asthma as a Presentation of Pulmonary Nocardiosis: A Case Report

Khan,

Ignatowicz,

Balaji

et al. 2024

Cureus

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Severe, refractory asthma requires a combination of multiple maintenance inhalers and medications including high-dose inhaled corticosteroids and immunomodulators to achieve control of symptoms. The use of inhaled corticosteroids, however, increases the susceptibility of opportunistic bacterial infections, such as Nocardia , resulting in pulmonary nocardiosis. This case describes a 46-year-old patient with a history of severe, refractory asthma who presented with progressively worsening asthma exacerbation symptoms. She was treated with immunomodulators, high-dose inhaled corticosteroids and oral steroids, and several courses of antibiotics. CT imaging revealed bibasilar peri-bronchial thickening and tree-in-bud nodularity in the right lower lobe. Pulmonary cultures collected from bronchoscopy grew Nocardia nova complex. This was a rare case of persistent asthma exacerbation by N. nova complex bronchopulmonary infection. Broad differentials should be considered in patients with severe, refractory asthma who were previously controlled and were found to fail treatment therapies. Immunocompromised patients with chronic lung disease are at higher risk of severe infection with disseminated nocardiosis. These patients have a higher mortality and morbidity risk if early diagnosis of pulmonary nocardiosis does not occur.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Unremitting Asthma as a Presentation of Pulmonary Nocardiosis: A Case Report

Khan,

Ignatowicz,

Balaji

et al. 2024

Cureus

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“…An English literature review showed only other five reports of these associations. Data regarding these cases are shown [6][7][8][9][10].…”

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confidence: 99%

Pulmonary nocardiosis after covid-19 infection: case report and literature review

Ortiz¹,

Jover²,

Tabla³

et al. 2023

Rev Esp Quimioter

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hyperinflammation and cytokine storm syndrome in COVID-19 patients. In fact, a recent meta-analysis confirmed that systemic corticosteroids were associated with lower 28-day all-cause mortality compared with usual care or placebo in COVID-19 patients who received oxygen or invasive mechanical ventilation [4].Other conditions that have been associated with nocardiosis include diabetes mellitus, alcoholism, chronic granulomatous disease, alveolar proteinosis, structural lung disease, tumor necrosis factor-alpha inhibitor (e.g., infliximab) therapy, inflammatory bowel disease, chronic obstructive pulmonary disease, and tuberculosis.

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“…[2][3][4] High dose TMP-SMX combined with meropenem successfully treated N. cyriacigeorgica in our patient and has been reported as sufficient therapy for nocardiosis in several case studies of adult patients with PCD and other airway diseases with impaired mucociliary clearance. [3][4][5][6][7] Finally, some questions remain. There is no data on the optimal length and dosage of a treatment course.…”

mentioning

confidence: 99%