Rhodococcus equi Sepsis in a Renal Transplant Recipient

Abstract

Rhodococcus equi is an unusual cause of infection in humans, but has emerged as an opportunistic pathogen among immunocompromised patients. Primary pulmonary involvement is the most common clinical presentation, although the spectrum of disease is broad. Diagnosing R. equi infections remains challenging, both from clinical and microbiological view, and no standard treatment has been established. In this report, we present a detailed case of a 57-year-old male renal transplant recipient who developed R. equi bacteremia with a concomitant Pneumocystis jirovecii pneumonia. We describe the clinical features of R. equi infections, highlight the importance of an early diagnosis, and briefly review treatment options for this rare infection.

Antimicrobial Resistance Spectrum Conferred by pRErm46 of Emerging Macrolide (Multidrug)-Resistant Rhodococcus equi

“…However, both aminoglycosides may be useful in combination to other antimicrobials. Although assumed to be largely resistant to -lactams based on the relatively high MICs (15,19,(67)(68)(69)(70)(71)(72)(73), the application of the RGM/NAA breakpoints may enable a wider the use of these antibiotics against MDR R. equi, eventually in combination with -lactamase inhibitors and other antimicrobials, as exemplified with the highly drug-resistant Mycobacterium abscessus (74). While -lactams do not concentrate intracellularly, they permeate into mammalian cells and display intracellular activity (75,76), as observed with ceftiofur and imipenem in equine monocytederived macrophages infected with R. equi (77).…”

Rhodococcus equi bacteremia with necrotizing pneumonia and brain abscess in a newly diagnosed HIV patient in Saudi Arabia: A case report and review of literature

“…This underscores the necessity for prolonged antimicrobial therapy in managing this organism, along with prophylactic measures, particularly in immunocompromised states. For instance, one case reported R. equi sepsis in a renal transplant patient who required treatment for up to 9 months, even in the absence of brain involvement [ 2 ]. To ensure R. equi eradication, clinicians should contemplate the restoration of the immune system in HIV patients by initiating antiretroviral therapy (ART).…”

“…Originally isolated from a human patient suffering from pulmonary infection and underlying autoimmune hepatitis while receiving steroid treatment in 1967 (Golub et al, 1967), it has since gained recognition as a zoonotic pathogen affecting foals. Over the years, the incidence of R. equi infections has risen among various patient groups, including those with HIV [ 1 ],transplant patients [ 2 ], and individuals with intact immune systems [ 3 ].While its primary target is the respiratory system, R. equi has demonstrated the capacity to disseminate to other bodily sites, including the brain, skin, soft tissues, bones, and bloodstream (Herath et al, 2013; Topino et al, 2010). Despite the absence of established treatment guidelines for this pathogen, its documented ability for intracellular multiplication and recurrence necessitates prolonged and combination antimicrobial therapy.…”

Necrotizing Pneumonia Due to Rhodococcus Hoagii in a Patient With Advanced Retroviral Disease

“…Rhodococcus hoagii is an aerobic, gram-positive, encapsulated, intracellular bacteria that varies in shape from coccoid to bacillary depending on the nutrient and growth environment. 2 It is typically found in environments associated with horse farms, such as soil and horse faeces. In most cases, transmission occurs through inhalation of the bacteria or ingestion of contaminated soil.…”