Relapsing Systemic Infection Due to Rhodococcus equi in a Drug Abuser Seropositive for Human Immunodeficiency Virus

Sirera, Guillermo; Romeu, Joan; Clotet, B; Velasco, P.; Arnal, J; Rius, F.; M, Foz

doi:10.1093/clinids/13.3.509

Cited by 31 publications

(11 citation statements)

References 5 publications

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“…Infected patients have frequently had a history of contact with farm animals, soil (or both) (8, 19,24,44). Invasive pulmonary and fatal disseminated R. equi infections have been reported in patients with hematologic and other malignancies who have received chemotherapy (1,5,8,18,24,29,44), renal transplant recipients (24,32,37,40,44,46), patients who have received corticosteroids (19,22,27), a patient with a history of chronic alcoholism (26), and, most recently, in HIV-infected patients (6, 10,13,15,16,21,25,38,39,41,42,43,45,50). There have also been isolated reports of localized R. equi infections which have resulted from probable soil contamination in patients without any known immunological abnormality; R. equi has been the cause of post-traumatic cutaneous infection (9, 30), endophthalmitis (14,23); and peritonitis developed in a patient on continuous ambulatory peritoneal dialysis (17).…”

Section: Rhodococcus Equi (Formerly Corynebacterium Equi)mentioning

confidence: 99%

Distribution and antimicrobial susceptibility of Rhodococcus equi from clinical specimens

McNeil

Brown

1992

Eur J Epidemiol

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Rhodococcus equi, an unusual gram positive aerobic actinomycete, was first described as a respiratory pathogen of livestock in 1923. Reports of human clinical illness have emphasized R. equi as a cause of invasive pulmonary infection in severely immunocompromised patients and, recently, have implicated it as a cause of pneumonia, bacteremia and disseminated infection in HIV-infected patients. To determine the distribution of R. equi we evaluated 107 isolates referred to the Centers for Disease Control (CDC) during the period January 1973 through December 1990. The sites of these 107 isolates (101 patient and 6 animal isolates) were: blood (32 isolates), sputum (30), lung tissue (13) and other site (32). Before 1983, when the first R. equi isolate from an HIV-infected patient was received, CDC received a total of 52 patient isolates. In addition, during this 10 year period, R. equi isolates were received from more than one site from only one patient. However, during the two year period 1989-1990, we identified 8 patients with underlying HIV infection and R. equi pneumonia who accounted for 29 of 35 (83%) R. equi patient isolates; 6 of these patients also had bacteremia and three died with disseminated R. equi infection. No isolates were resistant to amoxicillin-clavulanate, ampicillin-sulbactam, gentamicin or imipenem, and few (less than 5%) isolates were resistant to erythromycin, rifampin, tetracycline, and trimethoprim-sulfamethoxazole. These results suggest that HIV-infected patients, in particular, are predisposed to develop invasive pulmonary, fatal disseminated R. equi infection (or both), and appropriate antimicrobial susceptibility testing of clinical isolates may improve the effectiveness of therapy of R. equi-infected patients.

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Section: Rhodococcus Equi (Formerly Corynebacterium Equi)mentioning

confidence: 99%

Distribution and antimicrobial susceptibility of Rhodococcus equi from clinical specimens

McNeil

Brown

1992

Eur J Epidemiol

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“…In humans, pneumonia and lung abscesses are the most frequent infections due to this facultative intracellular organism (8,12,14). However, nonpulmoniary infections such as endophthalmitis, osteomyelitis, and brain, kidney, and pelvis abscesses are also reported (5,10,11,14,23,27,29). All except two described cases of R. equi infection have been in immunocompromised patients (14).…”

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confidence: 99%

Therapy of Rhodococcus equi disseminated infections in nude mice

Nordmann

Kerestedjian

Ronco

1992

Antimicrob Agents Chemother

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Rhodococcus equi is a facultative, intracellular, gram-positive coccobacillus increasingly reported as an opportunistic pathogen in human immunodeficiency virus-positive patients. However, the optimal drug regimen for treating R. equi pulmonary or systemic infections is not yet known. Therefore, a model of intravenously infected nude mice with disseminated infection was created to study the efficacy of antibiotics alone or in combination as determined by the reduction of bacterial CPU per gram in the lungs and spleen after 4 and 11 days of treatment. The studied antibiotics possessing low MICs against R. equi strains were amikacin, ciprofloxacin, erythromycin, imipenem, minocycline, rifampin, and vancomycin. Vancomycin, imipenem, and rifampin were the most effective agents in monotherapy. On the other hand, amikacin, ciprofloxacin, erythromycin, and minocycline alone were not active in this model. The most active drug combinations were those including vancomycin. No antibiotic-resistant mutants were selected in vivo with treatment involving any drugs used alone or in combination. Although the treatment recommended until now for R. equi infections is rifamnpin plus erythromycin, this study suggests that antibiotic combinations which include vancomycin may be the most effective in vivo.

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“…About fifty cases of HIV patients infected with R. equi were found in the international literature up to the end of 1994, many of them in Mediterranean countries. R. equi is often the cause of the first opportunistic infection [46–49], especially when the patient's absolute CD4 lymphocyte count is less than 100 mm 3 . It has thus been suggested that isolation of R. equi is a diagnostic indication of AIDS, and R. equi might be included in CDC classification group 4C 1 .…”

Section: Discussionmentioning

confidence: 99%

Rhodococcus equi infection in non-HIV-infected patients. Two case reports and review

Farina¹,

Ferruzzi

Mamprin

et al. 1997

Clinical Microbiology and Infection

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OBJECTIVE: To review two recent cases in HIV-negative subjects in the light of literature reports (52 patients without HIV infection till 1994). METHODS: Epidemiology (animal contacts, risk factors, year, country), clinical presentation, diagnostic methods (X-ray, tomography, microbiological techniques), therapeutic approach (antibiotics, surgery) and outcome were evaluated on the basis of clinical literature reports. RESULTS: Tumors constituted an important predisposing factor and less frequently hepatobiliary pathology, rheumatologic diseases, iatrogenic causes, psychiatric pathology and trauma. Exposure to animals was reported by 55% of the patients. Pneumonia and pleurisy, without preferential localization, were detected in 50% of the patients. Etiologic diagnosis was usually obtained after an invasive collection. Combined medical therapy and surgery were required by 27.8% of the patients, and 16.7% of the patients died. CONCLUSIONS: In recent years the number of Rhodococcus equi cases has been rising also in HIV-negative patients. The infection is ubiquitous. Accurate diagnosis and the prompt selection of the most appropriate therapy depend on close cooperation between clinicians and microbiologists.

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Relapsing Systemic Infection Due to Rhodococcus equi in a Drug Abuser Seropositive for Human Immunodeficiency Virus

Cited by 31 publications

References 5 publications

Distribution and antimicrobial susceptibility of Rhodococcus equi from clinical specimens

Distribution and antimicrobial susceptibility of Rhodococcus equi from clinical specimens

Therapy of Rhodococcus equi disseminated infections in nude mice

Rhodococcus equi infection in non-HIV-infected patients. Two case reports and review

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