Nocardiosis Following Renal Transplantation.
- Author:
Tae Hee KIM
1
;
Song Chol KIM
;
Joon Hong SOHN
;
Heung Sup SUNG
;
Mi Na KIM
;
Duck Jong HAN
Author Information
1. Department of General Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Nocardiosis;
Brain;
Allograft;
Pulmonary;
Subretinal abscess
- MeSH:
Abscess;
Allografts;
Amikacin;
Brain;
Brain Abscess;
Drug Therapy;
Humans;
Imipenem;
Immunosuppression;
Kidney Transplantation*;
Mortality;
Needles;
Nocardia;
Nocardia Infections*;
Organ Transplantation;
Pneumonia;
Soft Tissue Infections;
Sulfamethoxazole;
Transplantation;
Transplants
- From:The Journal of the Korean Society for Transplantation
2001;15(2):208-216
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
PURPOSE: Infection with Nocardia species is an uncommon yet important cause of morbidity and mortality in renal transplant recipients. METHODS: We experienced 6 cases of nocardiosis among 239 renal transplant recipients maintained on tacrolimus- or cyclosporine-based immunosuppression from May 1999 to February 2001. RESULTS: All the six patients had pulmonary nocardiosis from 36 to 220 (mean 82) days after renal transplantation. Due to a multiplicity of infection sites, cerebral abscess was detected in 2 patients, soft tissue abscess in 2, allograft abscess in 1 and subretinal abscess in 1. Comparing the routine trimethoprim/ sulfamethoxazole (TMP/SMX) prophylaxis after transplantation, 5 out of 6 patients took TMP/SMX for a mean of 1.8 months due to an increased AST/ALT. All the cases required invasive diagnostic procedures such as percutaneous needle aspiration (PC NA) or stereotactic aspiration. In the antimicrobial susceptibility test, isolates were sensitive to TMP/SMX, amikacin and imipenem. In the early stage of infection, we used triple chemotherapy (TMP/SMX, amikacin, imipenem) for cerebral nocardiosis and dual therapy (TMP/SMX, amikacin) for localized pulmonary infection. There were no mortality and all the graft maintained stable function. CONCLUSION: After organ transplantation, pneumonia accompanied with satellite soft tissue infection should be considered as a nocardiosis. Pro- phylactic use of TMP/SMX is crucial for effective prevention of nocardiosis.
