The emergence of rare nocardiosis following allogeneic hematopoietic stem cell transplantation in the era of molecular taxonomy

Abstract

The purpose of this study was to describe the clinical features of nocardiosis after allogeneic hematopoietic stem cell transplantation (allo-HSCT), focusing on new Nocardia species. Methods: We retrospectively reviewed data from patients with nocardiosis after allo-HSCT treated at our hospital and documented cases in the medical literature. Results: Fifty-seven cases were identified from our institution and the literature review. Although 51 patients (89.5%) responded to initial treatment, 28 (49.1%) patients were switched over to other treatment regimens due to the recurrence of nocardiosis or adverse events of antimicrobials. Nocardiosis-attributed mortality occurred in ten patients (17.5%). Antimicrobial susceptibilities varied among intra-and inter-species except linezolid (LZD). In the present study, five species were newly discovered after 2000, including N. cyriacigeorgica, N. veterana, N. abscessus, N. aobensis, and N. mexicana. All isolates of N. cyriacigeorgica, N. veterana, N. abscessus, and N. aobensis were sensitive to trimethoprim/ sulfamethoxazole, amikacin (AMK), imipenem (IPM), and LZD; however, N. mexicana was resistant to AMK and IPM. Conclusion: Newly identified Nocardia species have various antimicrobial susceptibility patterns. Longterm maintenance therapy could be challenging due to the adverse events of antimicrobials, especially in the allo-HSCT setting. Prudent evaluation is crucial for selecting a second-line or further treatment options.

Molecular identification and antibiotic resistance pattern of actinomycetes isolates among immunocompromised patients in Iran, emerging of new infections

“…Our findings are not in agreement with other countries. For instance, a study conducted on hematopoietic stem cell transplant recipients in Japan 37 revealed the Nocardia farcinica (n = 3, 42.86%) as the leading species, similar to studies conducted in China with 42.1% 40 and 34.78% 38 of cases caused by this pathogen. However, in the United States 39 and Spain 40 , Nocardia nova has been reported as the most common species contributing to 28% and 29.57% of cases, respectively.…”

Successful allogeneic hematopoietic stem cell transplantation in a patient with acute myeloid leukemia and preexisting pulmonary nocardiosis

“…Nocardiosis in HSCT patients is usually associated with GVHD treatment and occurs several months after HSCT. [3][4][5] Dysfunction in cellular immunity, such as prolonged use of corticosteroids, is considered a major risk factor for nocardiosis. [5][6][7]9,10 In previous reports, the median daily dose of prednisolone was 20-25 mg when nocardiosis developed.…”

Brain Abscess Due To Asian Nocardia in a 63 Years-Old Patient with Adult Still´S Disease: A Rare Case Report and Literature Review

“…Nocardiosis is an opportunistic infection in immunocompromised patients. It can disseminate to lung, skin and affect the CNS producing abscess formation [6,9,10,11]. The genus Nocardia is composed of 85 species.…”