Pulmonary Nocardiosis: Unusual Presentation in Intensive Care Unit

Singh, Ashok Kumar; Shukla, Aditya; Bajwa, Rajinder; Agrawal, Roshni; Srivastwa, Neha

doi:10.4103/ijccm.ijccm_472_17

Cited by 8 publications

(6 citation statements)

References 7 publications

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“…Less common is an acute presentation with symptoms such as dyspnea, pleuritic pain, and hemoptysis. 11 CNS nocardiosis is also variable in presentation, most often manifesting as focal neurologic deficits, headache, fever, and seizures. CNS nocardiosis appears as ring-enhancing lesions on brain imaging and is often initially misdiagnosed as tumor or abscess.…”

Section: Discussionmentioning

confidence: 99%

A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

Cathcart¹,

Stogsdill²,

Bell³

2020

Journal of Maine Medical Center

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Nocardiosis is an uncommon infection, typically encountered in immunocompromised patients. Only 5 cases have been reported in the United States. We present a case of disseminated Nocardia beijingensis involving the lung, subcutaneous tissue, and central nervous system of an immunocompetent patient.Clinical Findings: A 60-year-old immunocompetent male with no significant medical history presented to our hospital after a complicated medical course, beginning with vague respiratory complaints. His initial work-up revealed a large mass of unclear etiology in the right upper lung. A month later, he had a syncopal episode and then developed focal neurologic deficits.Sputum cultures obtained after the patient's syncopal episode grew gram-positive rods. Results of a computed tomography of the chest showed a new 17-mm subcutaneous mass. The mass was biopsied, which revealed gram-positive rods with partial acid-fast staining. Week later, results of magnetic resonance imaging of his brain showed multiple enhancing lesions with vasogenic edema scattered throughout. A tissue culture from his chest mass was sent to the Mayo Clinic and ultimately grew Nocardia beijingensis. The patient was started on the appropriate antibiotic therapy and has made significant clinical improvement. Conclusions:Though Nocardia is often associated with an immunocompromised state, it can also occur in patients with pulmonary findings and evidence of disseminated disease, particularly central nervous system manifestations, regardless of immune status. A high index of suspicion is needed, as definitive diagnosis often takes weeks due to the slow-growing nature of Nocardia species.

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Section: Discussionmentioning

confidence: 99%

A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

Cathcart¹,

Stogsdill²,

Bell³

2020

Journal of Maine Medical Center

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“…Interestingly, in every case, it was nearly missed. [33][34][35][36][37] Due to its rarity and complexity of its detection, there is no clear recommendation nor protocol for its screening and therapy in HIV-positive patients.…”

Section: Unique Cases Of Co-infections With Hiv In the Kingdom Of Saudi Arabiamentioning

confidence: 99%

HIV in the Kingdom of Saudi Arabia: Can We Change the Way We Deal with Co-Infections

Al-Mozaini

Alrahbeni

Dirar

et al. 2021

IDR

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The first incidence of acquired immunodeficiency syndrome (AIDS) from the Kingdom of Saudi Arabia (KSA) was reported back in 1984, and by the end of 2013, around 1509 patients were diagnosed with HIV infection. Recently in 2018, the Saudi ministry of health released that the incidence of HIV in Saudi Arabia is 3 cases of HIV for every 10,000 of the population. Having said that, the surveillance of HIV will face a range of challenges in KSA despite proper medical care, counseling, family planning, diagnostic, evaluation, and the use of effective anti-retroviral therapy. Patients who underwent anti-retroviral therapy showed significant reduction in morbidity as well as mortality. On the other hand, further targeted treatment and preventive strategies are warranted to control HIV co-infections in the KSA. In addition, progress towards meeting the WHO 90-90-90 goals for HIV not only at KSA but at the MENA region too, which is that of the population, 90% are diagnosed, 90% undergoing treatment, and 90% under viral control, is not being systematically monitored. In this review, we discuss the common co-infections with HIV infections that are reported in KSA, which when compared to international trends, it is similar for both viral hepatitis and tuberculosis. Although those co-infections exist, they are presented in different ratios and percentages when compared to the international reported data. These differences mandates defining and introducing new resilient methods of treatment and preventive measures. In this review, we offer an insight into healthcare policymakers to be compliant with UNAIDS 2020 vision program. We also discuss some of the gaps and recommendations to achieve the WHO 90-90-90 goal.

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“…Clinical and radiological manifestations are just like tuberculosis or malignancy, which include pneumonia and infiltrative or nodular lesions, which may be accompanied by cavitation, abscess formation, pleural effusions, or empyema and sometimes mass-like lesions. 47 The major differentials in diagnosis are pneumonia, tuberculosis, bronchogenic carcinoma, or lung abscess. Immunocompromised patients are significantly more likely to experience dissemination, bloodstream infection, prolonged hospitalization, and death.…”

Section: Organs Affectedmentioning

confidence: 99%

“…44 If the disease is not diagnosed in early stage, it disseminates to multiple organs such as brain, lymphoreticular system, or musculoskeletal system leading to high mortality of about 70 to 80%. 47…”

Section: Organs Affectedmentioning

confidence: 99%

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Uncommon Pathogens Causing Hospital-Acquired Infections in Postoperative Cardiac Surgical Patients

et al. 2019

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Bacterial infections are common causes of sepsis in the intensive care units. However, usually a finite number of Gram-negative bacteria cause sepsis (mostly according to the hospital flora). Some organisms such as Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus are relatively common. Others such as Stenotrophomonas maltophilia, Chryseobacterium indologenes, Shewanella putrefaciens, Ralstonia pickettii, Providencia, Morganella species, Nocardia, Elizabethkingia, Proteus, and Burkholderia are rare but of immense importance to public health, in view of the high mortality rates these are associated with. Being aware of these organisms, as the cause of hospital-acquired infections, helps in the prevention, treatment, and control of sepsis in the high-risk cardiac surgical patients including in heart transplants. Therefore, a basic understanding of when to suspect these organisms is important for clinical diagnosis and initiating therapeutic options. This review discusses some rarely appearing pathogens in our intensive care unit with respect to the spectrum of infections, and various antibiotics that were effective in managing these bacteria.

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Pulmonary Nocardiosis: Unusual Presentation in Intensive Care Unit

Cited by 8 publications

References 7 publications

A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

A case of Disseminated Nocardia beijingensis in an Immunocompetent Patient, Manifesting as Subcutaneous and CNS Nocardiosis.

HIV in the Kingdom of Saudi Arabia: Can We Change the Way We Deal with Co-Infections

Uncommon Pathogens Causing Hospital-Acquired Infections in Postoperative Cardiac Surgical Patients

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