Rhodococcus equi—An Increasingly Recognized Opportunistic Pathogen:<i>Report of 12 Cases and Review of 65 Cases in the Literature</i>

Scott, Margie A.; Graham, Barney S.; Verrall, Rosemary; Dixon, Richard E.; Schaffner, William; Tham, Kyi T.

doi:10.1093/ajcp/103.5.649

Cited by 97 publications

(45 citation statements)

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“…and fibrinous exudates. Typically, the lesion is densely infiltrated with macrophages with an eosinophilic granular cytoplasm that is periodic acid-Schiff stain and GMS stain positive; these macrophages resemble those seen in Whipple's disease (526). Intracellular and extracellular cocci may be evident in Brown-Brenn-stained tissue sections.…”

Section: Laboratory Diagnosismentioning

confidence: 97%

The medically important aerobic actinomycetes: epidemiology and microbiology

1994

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The aerobic actinomycetes are soil-inhabiting microorganisms that occur worldwide. In 1888, Nocard first recognized the pathogenic potential of this group of microorganisms. Since then, several aerobic actinomycetes have been a major source of interest for the commercial drug industry and have proved to be extremely useful microorganisms for producing novel antimicrobial agents. They have also been well known as potential veterinary pathogens affecting many different animal species. The medically important aerobic actinomycetes may cause significant morbidity and mortality, in particular in highly susceptible severely immunocompromised patients, including transplant recipients and patients infected with human immunodeficiency virus. However, the diagnosis of these infections may be difficult, and effective antimicrobial therapy may be complicated by antimicrobial resistance. The taxonomy of these microorganisms has been problematic. In recent revisions of their classification, new pathogenic species have been recognized. The development of additional and more reliable diagnostic tests and of a standardized method for antimicrobial susceptibility testing and the application of molecular techniques for the diagnosis and subtyping of these microorganisms are needed to better diagnose and treat infected patients and to identify effective control measures for these unusual pathogens. We review the epidemiology and microbiology of the major medically important aerobic actinomycetes.

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Section: Laboratory Diagnosismentioning

confidence: 97%

The medically important aerobic actinomycetes: epidemiology and microbiology

1994

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“…The epidemiological and clinical characteristics of subjects infected with R. equi were analyzed for four European studies [11–13, 16] and three US studies including two studies in the literature [14, 15] and the present study.…”

Section: Resultsmentioning

confidence: 99%

“…Abstracts of these studies were reviewed and any study describing at least 10 cases was included in this study. There were four European studies [11–13, 16] and two United States (US) studies [14, 15] that satisfied this requirement. Antibiotic susceptibility data were not available in one of the two US studies [15].…”

Section: Methodsmentioning

confidence: 99%

Differences inRhodococcus equiInfections Based on Immune Status and Antibiotic Susceptibility of Clinical Isolates in a Case Series of 12 Patients and Cases in the Literature

Gundelly

Suzuki

Ribes

et al. 2016

BioMed Research International

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Rhodococcus equi is an unusual zoonotic pathogen that can cause life-threatening diseases in susceptible hosts. Twelve patients with R. equi infection in Kentucky were compared to 137 cases reported in the literature. Although lungs were the primary sites of infection in immunocompromised patients, extrapulmonary involvement only was more common in immunocompetent patients (P < 0.0001). Mortality in R. equi-infected HIV patients was lower in the HAART era (8%) than in pre-HAART era (56%) (P < 0.0001), suggesting that HAART improves prognosis in these patients. Most (85–100%) of clinical isolates were susceptible to vancomycin, clarithromycin, rifampin, aminoglycosides, ciprofloxacin, and imipenem. Interestingly, there was a marked difference in susceptibility of the isolates to cotrimoxazole between Europe (35/76) and the US (15/15) (P < 0.0001). Empiric treatment of R. equi infection should include a combination of two antibiotics, preferably selected from vancomycin, imipenem, clarithromycin/azithromycin, ciprofloxacin, rifampin, or cotrimoxazole. Local antibiograms should be checked prior to using cotrimoxazole due to developing resistance.

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“…Since the first case of R. equi infection in human beings was described in 1967,2 the incidence of this infection has risen and it has been recognised as an opportunistic pathogen among immunocompromised patients 3. Our literature search yielded only three prior to the reported cases of R. equi lung infection among haematopoietic stem cell transplant recipients 4 – 6. This would be the fourth reported case of R. equi lung infection in a haematopoietic stem cell transplant recipient.…”

Section: Introductionmentioning

confidence: 94%

Rhodococcus equipneumonia and sepsis in an allogeneic haematopoietic stem cell transplant recipient

Shahani

2014

BMJ Case Reports

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Rhodococcus equi is an aerobic facultative intracellular organism that is known to infect cells of the macrophage-monocyte lineage. It is a common veterinary pathogen; however, the incidence of this infection in humans has risen and it has been recognised as an emerging opportunistic pathogen among the immunocompromised patients. We present the case of a patient with chronic myeloid leukaemia who had received allogenic stem cell transplant and presented to the hospital with clinical picture of pneumonia. Her condition worsened on initial broad spectrum antimicrobials and 3 weeks into her hospitalisation, R. equi was isolated from her broncheoalveolar lavage and blood cultures. Based on the susceptibility, therapy was changed to four active antimicrobials; however, the patient failed to improve and eventually died. This case highlights the importance of considering the diagnosis of R. equi among immunosuppressed patients early in the right clinical setting due to the high virulence associated with this organism.

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Rhodococcus equi—An Increasingly Recognized Opportunistic Pathogen:Report of 12 Cases and Review of 65 Cases in the Literature

Cited by 97 publications

References 0 publications

The medically important aerobic actinomycetes: epidemiology and microbiology

The medically important aerobic actinomycetes: epidemiology and microbiology

Differences inRhodococcus equiInfections Based on Immune Status and Antibiotic Susceptibility of Clinical Isolates in a Case Series of 12 Patients and Cases in the Literature

Rhodococcus equipneumonia and sepsis in an allogeneic haematopoietic stem cell transplant recipient

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