Severe pneumonia due to Nocardia otitidiscaviarum identified by mass spectroscopy in a cotton farmer

Abstract

Rationale:Nocardia species are aerobic saprophytic bacilli. Among Nocardia species, Nocardia otitidiscaviarum (N otitidiscaviarum) is rarely reported in pulmonary infection.Patient concerns:We reported a case of N otitidiscaviarum pneumonia in a cotton farmer.Diagnoses:N otitidiscaviarum pneumonia was identified by mass spectroscopy.Interventions:Combined treatments (amikacin, imipenem and trimethoprim-sulfamethoxazole) were administered after identification of N otitidiscaviarum.Outcomes:The patient eventually died from severe respiratory insufficiency in the hospital.Lessons:Early precise diagnosis and prompt combined therapy are of vital importance in severe Nocardia pulmonary infection.

Disseminated infection with Nocardia otitidiscaviarum in a patient under steroid therapy

“…Nocardia otitidiscaviarum has been described as an opportunistic pathogen in human . However, it has been reported in both immunocompromised and immunocompetent individuals causing pulmonary, primary cutaneous, and lymphocutaneous infections .…”

“…Nocardia otitidiscaviarum has been described as an opportunistic pathogen in human . However, it has been reported in both immunocompromised and immunocompetent individuals causing pulmonary, primary cutaneous, and lymphocutaneous infections . Individuals with weak immune system, such as patients suffering from chronic obstructive pulmonary disease, diabetes mellitus, mixed connective tissue disorder, ulcerative colitis, cirrhosis, human immunodeficiency virus infection, malignancies, those receiving long‐term corticosteroid therapy, and bone marrow or solid organ transplant, are at higher risk …”

“…The drug choice for Nocardia infection is cotrimoxazole, but some of the species are resistance to cotrimoxazole, imipenem, amoxicillin‐clavulanic acid, and other antibacterial agents (Table ) ; therefore, accurate identification at species level and antimicrobial susceptibility testing must be done . N otitidiscaviarum infection requires treatment for long duration, and also, it is suggested that antibiotic therapy should be continued for 6 months in immunocompetent patients and up to a year in immunosuppressed individuals …”

“…Most N otitidiscaviarum isolates are resistant to beta‐lactams like imipenem, ampicillin, and amoxicillin‐clavulanic acid but are susceptible to fluoroquinolones and amikacin . Meanwhile, some other studies have shown that N otitidiscaviarum complex is sensitive to linezolid in vitro; however, data from in vivo studies are lacking.…”

“…The US National Committee of Clinical Laboratory Standards has approved broth microdilution as antimicrobial susceptibility testing for both Actinomycetes and Nocardia . This may guide the treatment of N otitidiscaviarum , but the optimal treatment protocol of N otitidiscaviarum is still unknown.…”