BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdia...BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.展开更多
This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and...This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and therapeutic complexities in the context of advanced age,comorbidities,and immunocompromised populations.The study’s strengths included its integration of immunological profiling and precision medicine,demonstrating that a tailored low-dose trimethoprimsulfamethoxazole regimen with pharmacokinetic monitoring can improve outcomes in geriatric patients with chronic renal insufficiency while mitigating nephrotoxicity risks.However,its limitations included a single-case design,reliance on phenotypic diagnostics,and the lack of information regarding comorbidity interactions.The findings support the use of advanced molecular tools for rapid pathogen identification and identification of co-infection.Future studies should prioritize elucidating the synergistic effects of chronic kidney disease-uremia and immunosuppression on Nocardia colonization,developing biomarkers for early detection,and conducting global epidemiological studies in endemic regions.This case underscores the importance of interdisciplinary collaboration and innovative diagnostics to optimize management of nocardiosis in vulnerable populations.展开更多
BACKGROUND Nocardia cyriacigeorgica (N. cyriacigeorgica) infection is uncommon in clinicalpractice. Pulmonary sequestration complicated with N. cyriacigeorgica has notbeen reported in the literature. Here, we present ...BACKGROUND Nocardia cyriacigeorgica (N. cyriacigeorgica) infection is uncommon in clinicalpractice. Pulmonary sequestration complicated with N. cyriacigeorgica has notbeen reported in the literature. Here, we present a case of pulmonary sequestrationcomplicated with N. cyriacigeorgica infection in an immunocom-petentwoman.CASE SUMMARYA 37-year-old woman complaining of a recurrent cough was admitted to ourhospital. Pulmonary sequestration in the lower lobe of the left lung wasdiagnosed by enhanced computed tomography. Bronchoalveolar lavage fluid wasthen collected, which showed gram positive bacilli with weakly positive modifiedacid-fast staining. The pathogen was identified as N. cyriacigeorgica after bacterialculture and mass spectrometry analysis. The patient was diagnosed withpulmonary sequestration complicated with N. cyriacigeorgica infection, and hersymptoms quickly improved following anti-infective therapy.CONCLUSION Nocardiosis is considered to be an opportunistic infection. This is the first reportof pulmonary sequestration complicated with N. cyriacigeorgica infection in apatient with normal immunity.展开更多
BACKGROUND Nocardia pneumonia shares similar imaging and clinical features with pulmonary tuberculosis and lung neoplasms,but the treatment and anti-infective medication are completely different.Here,we report a case ...BACKGROUND Nocardia pneumonia shares similar imaging and clinical features with pulmonary tuberculosis and lung neoplasms,but the treatment and anti-infective medication are completely different.Here,we report a case of pulmonary nocardiosis caused by Nocardia cyriacigeorgica(N.cyriacigeorgica),which was misdiagnosed as community-acquired pneumonia(CAP)with repeated fever.CASE SUMMARY A 55-year-old female was diagnosed with community-acquired pneumonia in the local hospital because of repeated fever and chest pain for two months.After the anti-infection treatment failed in the local hospital,the patient came to our hospital for further treatment.Enhanced computed tomography showed multiple patchy,nodular and strip-shaped high-density shadows in both lungs.A routine haematological examination was performed and showed abnormalities in CD19+B cells and CD4+T cells.Positive acid-fast bifurcating filaments and branching gram-positive rods were observed in the bronchoalveolar lavage fluid of the patient under an oil microscope,which was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry as N.cyriacigeorgica.The patient’s condition quickly improved after taking 0.96 g compound sulfamethoxazole tablets three times a day.CONCLUSION The antibiotic treatment of Nocardia pneumonia is different from that of common CAP.Attention should be given to the pathogenic examination results of patients with recurrent fever.Nocardia pneumonia is an opportunistic infection.Patients with CD4+T-cell deficiency should be aware of Nocardia infection.展开更多
Rationale:Nocardia is a soil saprophyte,which can cause disseminated infection in immunocompromised patients.Early diagnosis and treatment can greatly improve prognosis.Patient concern:A 26-year-old male presented wit...Rationale:Nocardia is a soil saprophyte,which can cause disseminated infection in immunocompromised patients.Early diagnosis and treatment can greatly improve prognosis.Patient concern:A 26-year-old male presented with repeated episodes of fever,cough and breathlessness for 3 months.Diagnosis:Mixed infection of Nocardia(N.)farcinica and N.cyriacigeorgica with diabetes and Cushing’s syndrome.Interventions:N.cyriacigeorgica was isolated from empyema fluid and N.farcinica from blood.Based on antimicrobial susceptibility,he was treated with imipenem,cotrimoxazole and amikacin.Outcome:Patient expired due to infection and delayed diagnosis.Lesson:Several cases of infection due to N.farcinica or N.cyriacigeorgica have been reported.But mixed infection caused by these two species is rare.Pulmonary and disseminated nocardiosis is associated with high mortality,especially in immunocompromised hosts.So early diagnosis and prompt treatment is needed.展开更多
Human nocardiosis,caused by Nocardia spp.,an ubiquitous soil-borne bacteria,is a rare granulomatous disease close related to immune dysfunctions.Clinically can occur as an acute life-threatening disease,with lung,brai...Human nocardiosis,caused by Nocardia spp.,an ubiquitous soil-borne bacteria,is a rare granulomatous disease close related to immune dysfunctions.Clinically can occur as an acute life-threatening disease,with lung,brain and skin being commonly affected.The infection was classically diagnosed in HIV infected persons,organ transplanted recipients and long term corticosteroid treated patients.Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario.Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings.We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals.Eleven cases of nocardiosis associated with anti-tumor necrosis factor(TNF) prescription(9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease(IBD),4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients,lung disease in 4 patients,hepatic in one and disseminated disease in 3 patients.From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine.In conclusion,nocardiosis requires high levels of clinical suspicion and experience of laboratory staff,in order to establish a timely diagnosis and by doing so avoid worst outcomes.Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential.The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated.展开更多
Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients.We reported a case of 36 year o...Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients.We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever,cough with scanty sputum,hemoptysis,left sided chest pain and exertional dyspnea for two weeks.There was no past history of tuberculosis,diabetes mellitus or steroid therapy.Chest X-ray showed homogenous peripherally based opacity in the left upper zone.Bronchoscopy was done and brushing sent for culture,which showed colonies with features of Nocardia species after 48 hours.Further phenotypic characterization revealed it to be Nocardia otitidiscaviarum.Patient was treated with cotrimaxazole for six months after which complete recovery was evidenced symptomatically and radiologically.We report this case to emphasize the fact that among the Nocardia species,Nocardia otitidiscaviarum as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals.展开更多
BACKGROUND Streptococcus suis(S.suis)is an anthropozoonotic pathogen that shows clinical manifestations of meningitis,septicemia,and arthritis in infected humans.Nocardia is another type of anthropozoonotic bacteria,w...BACKGROUND Streptococcus suis(S.suis)is an anthropozoonotic pathogen that shows clinical manifestations of meningitis,septicemia,and arthritis in infected humans.Nocardia is another type of anthropozoonotic bacteria,with clinical manifestations of skin,lung,and brain abscesses in infected humans.Few intracranial infections caused by S.suis or Nocardia have been reported.To the best of our knowledge,no study has reported a patient with simultaneous intracranial infection by S.suis and Nocardia.CASE SUMMARY A 66-year-old male presented at Liaocheng People’s Hospital(Liaocheng,Shandong Province,China)reporting dizziness with nausea and vomiting.Metagenomic next-generation sequencing(m NGS)was performed on cerebrospinal fluid for examination,and the patient was diagnosed with suppurative meningitis caused by S.suis infection.He received anti-infection treatment with penicillin sodium and ceftriaxone.The patient’s condition initially improved but then deteriorated.Further m NGS of cerebrospinal fluid revealed both S.suis and Nocardia.Imaging examination revealed a brain abscess.Furthermore,a mixed infection of S.suis and Nocardia was detected in the patient’s central nervous system.The patient was treated with antibiotics and sulfamethoxazole.He was discharged after his condition improved.CONCLUSION This case shows that the disease can be recurrent in patients with intracranial infection of a rare pathogen.The possibility of mixed infection should also be considered,especially in patients treated with immunosuppressive agents.m NGS of cerebrospinal fluid is a supplement to conventional microbial pathogen identification methods.Patients with unknown pathogen diagnosis,early extensive use of antibiotics and infection with rare pathogens can be diagnosed by the combination of conventional methods and m NGS of cerebrospinal fluid.展开更多
Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts.Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for t...Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts.Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for two days.Diagnosis: Disseminated nocardiosis due to Nocardia otitidiscaviarum. Interventions: Initial antimicrobial therapy with imipenem and trimethoprim/sulfamethoxazole was switched to 6 weeks of trimethoprim/sulfamethoxazole, linezolid and tigecycline after sensitivity test results were available. Thereafter, the patient was switched to maintenance trimethoprim/sulfamethoxazole and moxifloxacin. Prednisolone was gradually tapered.Outcomes: Soft tissue swelling and pain disappeared and the patient was discharged uneventfully.Lessons: Disseminated nocardiosis due to Nocardia otitidiscaviarum should be suspected in immunocompetent hosts with risk factors such as medication with prednisolone. Early identification of the causative species and susceptibility results is crucial given the diverse resistance patterns amongst various Nocardia species.展开更多
Objective:To isolate and identify Nocardiaspp. from soil in different regions of Isfahan province in the center of Iran.Methods:This study was conducted in 32 districts(16 cities and 16 villages)in Isfahan province du...Objective:To isolate and identify Nocardiaspp. from soil in different regions of Isfahan province in the center of Iran.Methods:This study was conducted in 32 districts(16 cities and 16 villages)in Isfahan province during two years. A total of 800 soil samples from these regions were studied by using kanamycin. The isolated Nocardiaspecies were examined by gram and acid-fast staining and were identified biochemically and morphologically. The frequency and distribution of Nocardia spp. were determined in relation to different factors such as soil pH and temperate climate.Results:From 153(19.1%)Nocardiaisolates identified,Nocardia asteroids(N. asteroids)complex(45.5%) andNocardia brasiliensis(N. brasiliensis)(24.7%) were the most frequently isolated species, followed by Nocardia otitidiscaviarum (2.2%),Nocardiopsis dassonvillei,Actinom adura actinomadura(each 1.7%) and Nocardia transvalensis(1.1%) and also unknown spp.(23.0%). In this study, most species(54.4%) of Nocardia, especially N. asteroides complex were isolated fromsoils with pH: 7.01-8, whereas in pH: 8.01-9 more N. brasiliensis was isolated. The most Nocardia spp. was detected from regions with semi-nomadic and temperate climate(41.1%).Conclusions:N. asteroids complex is more prevalent in Isfahan province and soil can be a potential source of nocardiosis infections. It is to be considering that climate and soil pH are involved in the frequency and diversity of aerobic Actinomy cetes.展开更多
Objective:To observe and compare the curative effect between the intrapleural-chemotherapy combined Nocardia rubra cell wall skeleton-injection and the Nocardia rubra cell wall skeleton-injection after control of the ...Objective:To observe and compare the curative effect between the intrapleural-chemotherapy combined Nocardia rubra cell wall skeleton-injection and the Nocardia rubra cell wall skeleton-injection after control of the malignant pleural effusion by chemotherapy.Methods:Every time after elimination of pleural effusion,we injected DDP and Nocardia rubra cell wall skeleton at the same time into pleural cavity;or after we emplaced an improved central vena catheter into pleural cavity then took out closed-drainage or eliminated the pleural effusion every day,then injected 5-FU 0.5 qd intrapleural-space.After the malignant pleural effusion had being controlled,800μg Nocardia rubra cell wall skeleton was injected intrapleural-space. (We call it as"improved following-therapy").Results:Using the improved following-therapy,the control rate of malignant pleural effusion increased:CR+PR,79.07%>65.79%(P<0.05),and the incidence rate of the encapsulated pleural effusion that would impact on patient’s respiratory faction decreased.Conclusion:Giving chemotherapy after closed-drainage or immediately after taking out pleural effusion everyday,then giving biotherapy after pleural effusion had been controlled,the curative effect would be enhanced and the side-reaction would be reduced.展开更多
Nocardiosis diagnosis is a major challenge. The clinical features and radiological findings are nonspecific. Traditionally, Nocardia identification is based on colonial and microscopical morphology and biochemical tes...Nocardiosis diagnosis is a major challenge. The clinical features and radiological findings are nonspecific. Traditionally, Nocardia identification is based on colonial and microscopical morphology and biochemical tests. However, molecular biology techniques allow a better characterization of species and biotypes. PCR-RFLP of the 65-kDa heat shock protein (HSP) gene provides a rapid, sensitive, and time and labor-efficient method for this proposal. Using this technique, six of eight isolates tested were identified as Nocardia asteroides type VI. PCR-RFLP of the 65-kDa HSP gene could be very useful for determining the incidence of this pathogen in different population groups and its association with susceptibility/resistance profiles to the drugs of choice for treatment. This work is the first molecular detection of Nocardia species in Cuba.展开更多
基金Supported by Zhejiang Provincial Traditional Chinese Medicine Science and Technology Program,No.2023ZF075.
文摘BACKGROUND Nocardiosis is a rare bacterial infection with unclear epidemiology,pathogenesis,and characteristics.Its clinical manifestations are diverse and nonspecific,making diagnosis prone to errors,including misdiagnosis and missed diagnosis.Additionally,this disease is difficult to treat,often requiring months or even years of antibacterial therapy,and can be fatal in patients with underlying conditions.CASE SUMMARY A 93-year-old male patient with chronic renal insufficiency sustained a skin injury at the tip of his right thumb.As a result of an initial misdiagnosis and inadequate treatment,the infection progressed,resulting in multiple rashes on his right upper limb.Local incision and drainage of pus,combined with oral antibiotics administered at a different hospital,yielded no significant improvement.Upon hospitalization,the patient’s immune function was assessed,and further local incision and drainage were performed.Cultures of the pus identified Nocardia brasiliensis.Treatment involved intravenous infusion of piperacillin-tazobactam sodium and oral administration of sulfamethoxazole-trimethoprim,leading to the patient’s recovery.After discharge,the patient continued to take sulfamethoxazole tablets for 6 months,with complete healing of the skin lesions and no recurrence.CONCLUSION Nocardiosis should be considered in patients with underlying conditions and compromised immunity.Prompt and accurate diagnosis is crucial.
文摘This letter discusses the critical yet underrecognized intersection of chronic renal insufficiency and Nocardia brasiliensis skin infection in the case reported by Zhang et al,emphasizing the diagnostic challenges and therapeutic complexities in the context of advanced age,comorbidities,and immunocompromised populations.The study’s strengths included its integration of immunological profiling and precision medicine,demonstrating that a tailored low-dose trimethoprimsulfamethoxazole regimen with pharmacokinetic monitoring can improve outcomes in geriatric patients with chronic renal insufficiency while mitigating nephrotoxicity risks.However,its limitations included a single-case design,reliance on phenotypic diagnostics,and the lack of information regarding comorbidity interactions.The findings support the use of advanced molecular tools for rapid pathogen identification and identification of co-infection.Future studies should prioritize elucidating the synergistic effects of chronic kidney disease-uremia and immunosuppression on Nocardia colonization,developing biomarkers for early detection,and conducting global epidemiological studies in endemic regions.This case underscores the importance of interdisciplinary collaboration and innovative diagnostics to optimize management of nocardiosis in vulnerable populations.
文摘BACKGROUND Nocardia cyriacigeorgica (N. cyriacigeorgica) infection is uncommon in clinicalpractice. Pulmonary sequestration complicated with N. cyriacigeorgica has notbeen reported in the literature. Here, we present a case of pulmonary sequestrationcomplicated with N. cyriacigeorgica infection in an immunocom-petentwoman.CASE SUMMARYA 37-year-old woman complaining of a recurrent cough was admitted to ourhospital. Pulmonary sequestration in the lower lobe of the left lung wasdiagnosed by enhanced computed tomography. Bronchoalveolar lavage fluid wasthen collected, which showed gram positive bacilli with weakly positive modifiedacid-fast staining. The pathogen was identified as N. cyriacigeorgica after bacterialculture and mass spectrometry analysis. The patient was diagnosed withpulmonary sequestration complicated with N. cyriacigeorgica infection, and hersymptoms quickly improved following anti-infective therapy.CONCLUSION Nocardiosis is considered to be an opportunistic infection. This is the first reportof pulmonary sequestration complicated with N. cyriacigeorgica infection in apatient with normal immunity.
文摘BACKGROUND Nocardia pneumonia shares similar imaging and clinical features with pulmonary tuberculosis and lung neoplasms,but the treatment and anti-infective medication are completely different.Here,we report a case of pulmonary nocardiosis caused by Nocardia cyriacigeorgica(N.cyriacigeorgica),which was misdiagnosed as community-acquired pneumonia(CAP)with repeated fever.CASE SUMMARY A 55-year-old female was diagnosed with community-acquired pneumonia in the local hospital because of repeated fever and chest pain for two months.After the anti-infection treatment failed in the local hospital,the patient came to our hospital for further treatment.Enhanced computed tomography showed multiple patchy,nodular and strip-shaped high-density shadows in both lungs.A routine haematological examination was performed and showed abnormalities in CD19+B cells and CD4+T cells.Positive acid-fast bifurcating filaments and branching gram-positive rods were observed in the bronchoalveolar lavage fluid of the patient under an oil microscope,which was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry as N.cyriacigeorgica.The patient’s condition quickly improved after taking 0.96 g compound sulfamethoxazole tablets three times a day.CONCLUSION The antibiotic treatment of Nocardia pneumonia is different from that of common CAP.Attention should be given to the pathogenic examination results of patients with recurrent fever.Nocardia pneumonia is an opportunistic infection.Patients with CD4+T-cell deficiency should be aware of Nocardia infection.
文摘Rationale:Nocardia is a soil saprophyte,which can cause disseminated infection in immunocompromised patients.Early diagnosis and treatment can greatly improve prognosis.Patient concern:A 26-year-old male presented with repeated episodes of fever,cough and breathlessness for 3 months.Diagnosis:Mixed infection of Nocardia(N.)farcinica and N.cyriacigeorgica with diabetes and Cushing’s syndrome.Interventions:N.cyriacigeorgica was isolated from empyema fluid and N.farcinica from blood.Based on antimicrobial susceptibility,he was treated with imipenem,cotrimoxazole and amikacin.Outcome:Patient expired due to infection and delayed diagnosis.Lesson:Several cases of infection due to N.farcinica or N.cyriacigeorgica have been reported.But mixed infection caused by these two species is rare.Pulmonary and disseminated nocardiosis is associated with high mortality,especially in immunocompromised hosts.So early diagnosis and prompt treatment is needed.
文摘Human nocardiosis,caused by Nocardia spp.,an ubiquitous soil-borne bacteria,is a rare granulomatous disease close related to immune dysfunctions.Clinically can occur as an acute life-threatening disease,with lung,brain and skin being commonly affected.The infection was classically diagnosed in HIV infected persons,organ transplanted recipients and long term corticosteroid treated patients.Currently the widespread use of immunomodulators and immunossupressors in the treatment of inflammatory diseases changed this scenario.Our purpose is to review all published cases of nocardiosis in immunomodulated patients due to inflammatory diseases and describe clinical and laboratory findings.We reviewed the literature concerning human cases of nocardiosis published between 1980 and 2014 in peer reviewed journals.Eleven cases of nocardiosis associated with anti-tumor necrosis factor(TNF) prescription(9 related with infliximab and 2 with adalimumab) were identified; 7 patients had inflammatory bowel disease(IBD),4 had rheumatological conditions; nocardia infection presented as cutaneous involvement in 3 patients,lung disease in 4 patients,hepatic in one and disseminated disease in 3 patients.From the 10 cases described in IBD patients 7 were associated with anti-TNF and 3 with steroids and azathioprine.In conclusion,nocardiosis requires high levels of clinical suspicion and experience of laboratory staff,in order to establish a timely diagnosis and by doing so avoid worst outcomes.Treatment for long periods tailored by the susceptibility of the isolated species whenever possible is essential.The safety of restarting immunomodulators or anti-TNF after the disease or the value of prophylaxis with cotrimoxazole is still debated.
文摘Nocardiosis is a localized or disseminated infection caused by soil-borne aerobic actinomycetes. Pulmonary nocardiosis is a rare infection mostly occurring in immunocompromised patients.We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever,cough with scanty sputum,hemoptysis,left sided chest pain and exertional dyspnea for two weeks.There was no past history of tuberculosis,diabetes mellitus or steroid therapy.Chest X-ray showed homogenous peripherally based opacity in the left upper zone.Bronchoscopy was done and brushing sent for culture,which showed colonies with features of Nocardia species after 48 hours.Further phenotypic characterization revealed it to be Nocardia otitidiscaviarum.Patient was treated with cotrimaxazole for six months after which complete recovery was evidenced symptomatically and radiologically.We report this case to emphasize the fact that among the Nocardia species,Nocardia otitidiscaviarum as causative agent of pulmonary disease is rarely reported even in immunocompromised individuals.
文摘BACKGROUND Streptococcus suis(S.suis)is an anthropozoonotic pathogen that shows clinical manifestations of meningitis,septicemia,and arthritis in infected humans.Nocardia is another type of anthropozoonotic bacteria,with clinical manifestations of skin,lung,and brain abscesses in infected humans.Few intracranial infections caused by S.suis or Nocardia have been reported.To the best of our knowledge,no study has reported a patient with simultaneous intracranial infection by S.suis and Nocardia.CASE SUMMARY A 66-year-old male presented at Liaocheng People’s Hospital(Liaocheng,Shandong Province,China)reporting dizziness with nausea and vomiting.Metagenomic next-generation sequencing(m NGS)was performed on cerebrospinal fluid for examination,and the patient was diagnosed with suppurative meningitis caused by S.suis infection.He received anti-infection treatment with penicillin sodium and ceftriaxone.The patient’s condition initially improved but then deteriorated.Further m NGS of cerebrospinal fluid revealed both S.suis and Nocardia.Imaging examination revealed a brain abscess.Furthermore,a mixed infection of S.suis and Nocardia was detected in the patient’s central nervous system.The patient was treated with antibiotics and sulfamethoxazole.He was discharged after his condition improved.CONCLUSION This case shows that the disease can be recurrent in patients with intracranial infection of a rare pathogen.The possibility of mixed infection should also be considered,especially in patients treated with immunosuppressive agents.m NGS of cerebrospinal fluid is a supplement to conventional microbial pathogen identification methods.Patients with unknown pathogen diagnosis,early extensive use of antibiotics and infection with rare pathogens can be diagnosed by the combination of conventional methods and m NGS of cerebrospinal fluid.
文摘Rationale: Disseminated nocardiosis due to Nocardia otitidiscaviarum is rarely reported in immunocompetent hosts.Patient concerns: A 59 year old male patient complained of painful soft tissue swellings and fever for two days.Diagnosis: Disseminated nocardiosis due to Nocardia otitidiscaviarum. Interventions: Initial antimicrobial therapy with imipenem and trimethoprim/sulfamethoxazole was switched to 6 weeks of trimethoprim/sulfamethoxazole, linezolid and tigecycline after sensitivity test results were available. Thereafter, the patient was switched to maintenance trimethoprim/sulfamethoxazole and moxifloxacin. Prednisolone was gradually tapered.Outcomes: Soft tissue swelling and pain disappeared and the patient was discharged uneventfully.Lessons: Disseminated nocardiosis due to Nocardia otitidiscaviarum should be suspected in immunocompetent hosts with risk factors such as medication with prednisolone. Early identification of the causative species and susceptibility results is crucial given the diverse resistance patterns amongst various Nocardia species.
基金financially supported by Teheran University of Medical Sciences(grant No.TUMS/HF-2446)
文摘Objective:To isolate and identify Nocardiaspp. from soil in different regions of Isfahan province in the center of Iran.Methods:This study was conducted in 32 districts(16 cities and 16 villages)in Isfahan province during two years. A total of 800 soil samples from these regions were studied by using kanamycin. The isolated Nocardiaspecies were examined by gram and acid-fast staining and were identified biochemically and morphologically. The frequency and distribution of Nocardia spp. were determined in relation to different factors such as soil pH and temperate climate.Results:From 153(19.1%)Nocardiaisolates identified,Nocardia asteroids(N. asteroids)complex(45.5%) andNocardia brasiliensis(N. brasiliensis)(24.7%) were the most frequently isolated species, followed by Nocardia otitidiscaviarum (2.2%),Nocardiopsis dassonvillei,Actinom adura actinomadura(each 1.7%) and Nocardia transvalensis(1.1%) and also unknown spp.(23.0%). In this study, most species(54.4%) of Nocardia, especially N. asteroides complex were isolated fromsoils with pH: 7.01-8, whereas in pH: 8.01-9 more N. brasiliensis was isolated. The most Nocardia spp. was detected from regions with semi-nomadic and temperate climate(41.1%).Conclusions:N. asteroids complex is more prevalent in Isfahan province and soil can be a potential source of nocardiosis infections. It is to be considering that climate and soil pH are involved in the frequency and diversity of aerobic Actinomy cetes.
文摘Objective:To observe and compare the curative effect between the intrapleural-chemotherapy combined Nocardia rubra cell wall skeleton-injection and the Nocardia rubra cell wall skeleton-injection after control of the malignant pleural effusion by chemotherapy.Methods:Every time after elimination of pleural effusion,we injected DDP and Nocardia rubra cell wall skeleton at the same time into pleural cavity;or after we emplaced an improved central vena catheter into pleural cavity then took out closed-drainage or eliminated the pleural effusion every day,then injected 5-FU 0.5 qd intrapleural-space.After the malignant pleural effusion had being controlled,800μg Nocardia rubra cell wall skeleton was injected intrapleural-space. (We call it as"improved following-therapy").Results:Using the improved following-therapy,the control rate of malignant pleural effusion increased:CR+PR,79.07%>65.79%(P<0.05),and the incidence rate of the encapsulated pleural effusion that would impact on patient’s respiratory faction decreased.Conclusion:Giving chemotherapy after closed-drainage or immediately after taking out pleural effusion everyday,then giving biotherapy after pleural effusion had been controlled,the curative effect would be enhanced and the side-reaction would be reduced.
文摘Nocardiosis diagnosis is a major challenge. The clinical features and radiological findings are nonspecific. Traditionally, Nocardia identification is based on colonial and microscopical morphology and biochemical tests. However, molecular biology techniques allow a better characterization of species and biotypes. PCR-RFLP of the 65-kDa heat shock protein (HSP) gene provides a rapid, sensitive, and time and labor-efficient method for this proposal. Using this technique, six of eight isolates tested were identified as Nocardia asteroides type VI. PCR-RFLP of the 65-kDa HSP gene could be very useful for determining the incidence of this pathogen in different population groups and its association with susceptibility/resistance profiles to the drugs of choice for treatment. This work is the first molecular detection of Nocardia species in Cuba.
