Second report of a Nocardia beijingensis infection in the United States: nodular scleritis with in vitro imipenem resistance

Abstract

SummaryWe describe the case of a 52-year-old woman with scleritis caused by an imipenem-resistant strain of Nocardia beijingensis. The patient presented with pain, redness, and nodules on the sclera of 8 weeks' duration. A Gram stain from a nodule on the superonasal aspect of the globe was initially negative. After empiric treatment for an autoimmune etiology, cytopathology confirmed filamentous bacteria. A presumptive diagnosis of Nocardia scleritis was made, and medical management was based on a literature review on treatments for Nocardia infections. Cultures returned confirming Nocardia beijingensis. Antibiotic sensitivity testing confirmed the correct initial management. The patient's scleritis resolved with a good visual outcome.

Nocardia beijingensis brain abscesses in an HIV-infected individual

“…It was first described by a French veterinarian [4] in 1888 as an uncommon gram positive bacteria causing severe infection. It is an opportunistic pathogen most commonly affecting immunocompromised patients, although there are reports of nocardiosis in immunocompetent patients as well [5] , [6] , [7] . Patients at highest risk are those with HIV infection, malignancy, on chronic glucocorticoid treatment, and solid transplant patients [2] , [6] .…”

Stroke like presentation of disseminated CNS Nocardia beijingensis infection in an immunocompetent patient: Case report and review of the literature

“…The first reported case in an immunocompetent host occurred in Jacksonville, Florida in 2014 involving the lung and lymph node [ 14 ]. This was followed by additional reports of pulmonary Nocardiosis [ [15] , [16] , [17] , [18] ] and one case of scleritis in immunocompetent hosts [ 19 ]. The first case reports of CNS involvement in immunocompetent patients were reported in 2019 and again in 2020 [ [20] , [21] , [22] , [23] , [24] ].…”

Nocardia beijingensis Isolated From an Adrenal Abscess in a Diabetic Host

“…As in infections with other Nocardia spp, pulmonary and central nervous system (CNS) disease are most commonly reported. A literature review of N beijingensis infections in immunocompetent hosts yielded 3 documented pulmonary cases [ 12 , 19–21 ], 2 cases of CNS abscesses [ 22 , 23 ], 1 overlap case presenting with both pulmonary and CNS disease [ 24 ], 1 case of a subfascial paravertebral abscess [ 25 ], and 1 case of scleritis [ 26 ] ( Table 1 ).…”

“…Identification of Nocardia spp remains an important step in treatment as antimicrobial susceptibility patterns vary between species. Most documented N beijingensis infections have responded to treatment with TMP-SMX, carbapenems, amikacin, and/or third-generation cephalosporins [ 24 ], although imipenem nonsusceptibility has been observed in 1 example [ 26 ]. As there are no available trials to guide the treatment of Nocardia infections, the recommended duration of therapy for systemic nocardiosis is typically 6–12 months based on expert opinion [ 3 , 17 , 27 ].…”