Updates on Nocardia Skin and Soft Tissue Infections in Solid Organ Transplantation

Hemmersbach‐Miller, Marion; Catania, Jelena; Saullo, Jennifer L.

doi:10.1007/s11908-019-0684-7

Cited by 20 publications

(17 citation statements)

References 91 publications

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“…[21][22][23][24]165 Manifestations may include pustules (►Fig. 3), abscesses, necrosis, 166 and nodular pustular pyoderma with sporotrichoid spreading 22,29,37,57,72,167,168 ; infection may extend into contiguous tissues (e.g., muscle, 169 fascia, 170 bone, 29,168 and lymphatics). 37,171 Chronic subcutaneous infections known as mycetomas can occur; these may have draining sinus tracts and result from skin inoculation by filamentous fungi or aerobic filamentous bacteria including Nocardia spp.…”

Section: Clinical Features Pulmonarymentioning

confidence: 99%

“…The organism may grow in culture within 2 to 7 days, but may take up to several weeks. 37,38 Culture of the primary site(s) of involvement should be done expeditiously. The microbiological laboratory should be alerted when Nocardia is a consideration, to assure optimal culture conditions given the potential need for longer incubation.…”

Section: Diagnosis Of Nocardiosismentioning

confidence: 99%

“…The microbiological laboratory should be alerted when Nocardia is a consideration, to assure optimal culture conditions given the potential need for longer incubation. 37 Gram stain shows beaded, branching gram-positive filaments that are partially acid fast (►Fig. 5).…”

Section: Diagnosis Of Nocardiosismentioning

confidence: 99%

“…The choice of antimicrobial agent(s) and duration of therapy must take into account the site and severity of infection, degree of immunodeficiency or immunosuppression, antimicrobial susceptibility tests, and tolerance or adverse effects of antimicrobials(s). Sulfonamides (typically TMP-SMX) have been the mainstay of therapy for nocardiosis for more than 60 years, 1,37,126 but alternative agents may be required in regions where TMP-SMX resistance is high 105 or for species with higher rates of resistance to sulfonamides (e.g., N. pseudobrasiliensis, N. transvalensis, and N. farcinica). 37,52,53,56,102,243,244 Additionally, intolerance to sulfonamides may be problematic in some patients, particularly HIV-infected and organ-transplant recipients; adverse effects of TMP-SMX may include myelosuppression, nephrotoxicity, and significant drug interactions.…”

Section: Therapymentioning

confidence: 99%

“…5,16,18,21 The diagnosis is often difficult, as the organism may take days to weeks to grow in culture. 37,38 Molecular biological techniques such as polymerase chain reaction (PCR) assays are more sensitive for diagnosis, and PCR and gene sequencing [39][40][41] also have greater accuracy for Nocardia species identification and have thus largely replaced conventional phenotypic laboratory procedures for determining species.…”

mentioning

confidence: 99%

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Nocardia spp.: A Rare Cause of Pneumonia Globally

Lynch

Reid

Clark

2020

Semin Respir Crit Care Med

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AbstractMembers of the Nocardia genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. Although rare as a cause of community-acquired pneumonia, Nocardia can have severe morbidity and mortality, particularly in patients with comorbidities or compromised immunity. Early diagnosis and timely initiation of therapy are critical to optimizing patient outcomes. Species identification is important in determining treatment, as is in vitro susceptibility testing. Sulfonamide therapy is usually indicated, although a variety of other antimicrobials may be useful, depending on the species and susceptibility testing. Prolonged therapy is usually indicated, for 6 to 12 months, and in some cases surgical debridement may be required to resolve infection.

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