Adult ; Anti-Bacterial Agents ; therapeutic use ; Humans ; Immunocompromised Host ; Male ; Nocardia ; drug effects ; pathogenicity ; Nocardia Infections ; diagnosis ; drug therapy ; Tetracyclines ; therapeutic use

Nocardia species are aerobic, gram-positive pathogens found worldwide in soil. Nocardia is considered an opportunistic pathogen, and its infection mostly occurs in immunocompromised patients. We report a case of Nocardia farcinica induced mediastinitis and pneumonia that occurred in a 64-year-old male patient who had no significant medical history except for hypertension. He visited another hospital with a complaint of dyspnea and left chest wall pain. The symptoms arose 7 days ago without any trauma and they worsened. A mediastinal mass was found on computed tomography scan. After being transferred to our hospital for further evaluation, he was diagnosed with mediastinitis and pneumonia. As N. farcinica was found to be the causative organism by 16S rRNA sequencing, proper antibiotic therapy including trimethoprim/sulfamethoxazole was initiated immediately. After this, the patient improved and he was discharged. If an infection has a disseminating course, nocardiosis cannot be excluded even in immunocompetent patients. Once the diagnosis is established, prompt antibiotic therapy should be performed based on the severity.
Diagnosis ; Dyspnea ; Humans ; Hypertension ; Immunocompromised Host ; Male ; Mediastinitis* ; Middle Aged ; Nocardia Infections ; Nocardia* ; Pneumonia* ; Soil ; Thoracic Wall

Nocardiosis is a rare but potentially life-threatening infectious disease caused by several species of the genus Nocardia (N.), which are aerobic, filamentous, gram-positive bacilli. A definitive diagnosis depends on the isolation and identification of Nocardia species. But identification from clinical specimens may involve performing invasive techniques on the patient and lengthy process (take up to 1 or 3 weeks) owing to slow growth, and require a professional microbiologist. Currently the genus Nocardia is best identified using 16S rRNA and 18S rRNA gene sequence analysis. Recently matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) has launched a new era in the routine microbiology laboratory. This method has proved its efficacy for the identification and diagnosis of microorganism. MALDI-TOF MS has potential for use as a rapid (within 1 hour) and dependable method for the identification of Nocardia species with reproducibility and cost effectiveness. We report a 76-year-old woman who suffered from ulcer with papules on her right wrist and forearm. A biopsy of the skin showed granulomatous inflammation with central suppuration. A bacterial isolate from the skin was identified to be N. brasiliensis on comparative 16S rRNA gene sequencing and MALDI-TOF MS. To the best of our knowledge, this is the first case of nocardiosis in Korea caused by N. brasiliensis identified on MALDI-TOF MS.
Aged ; Biopsy ; Communicable Diseases ; Cost-Benefit Analysis ; Diagnosis* ; Female ; Forearm ; Genes, rRNA ; Humans ; Inflammation ; Korea ; Mass Spectrometry* ; Methods ; Nocardia ; Nocardia Infections* ; Sequence Analysis ; Skin ; Suppuration ; Ulcer ; Wrist

Nocardia cerebral abscess is rare, constituting approximately 1-2% of all cerebral abscesses. Mortality for a cerebral abscess of Nocardia is three times higher than that of other bacterial cerebral abscesses, therefore, early diagnosis and therapy is important. Nocardia cerebral abscess is generally occur among immunocompromised patients, and critical infection in immunocompetent patients is extremely rare. We report on a case of a brain abscess by Nocardia farcinica in an immunocompetent patient who received treatment with surgery and antibiotics. This is the second case of a brain abscess caused by N. farcinica in an immunocompetent patient in Korea.
Anti-Bacterial Agents ; Brain Abscess* ; Brain* ; Early Diagnosis ; Humans ; Immunocompetence ; Immunocompromised Host ; Korea ; Mortality ; Nocardia Infections ; Nocardia*

Nocardiosis is an uncommon Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia spp. have the ability to cause localized or systemic suppurative disease in humans and animals. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of infected patients are immunocompetent. We report a rare case of pulmonary nocardiosis and a brain abscess caused by Nocardia asteroides in an elderly woman with a history of Crohn's disease. Radiographic imaging revealed a contrast-enhancing lesion with perilesional parenchymal edema that was preoperatively thought to be a neoplasm. The patient experienced aggressive disease progression simulating a metastatic brain tumor. Early diagnosis of norcadiosis, the absence of underlying disease, and the administration of appropriate antibiotics has a positive impact on prognosis. Familiarity with the magnetic resonance and computed tomography findings associated with CNS nocardiosis, such as those presented here, is essential for making an early diagnosis.
Actinobacteria ; Aged ; Animals ; Anti-Bacterial Agents ; Brain ; Brain Abscess ; Brain Neoplasms ; Crohn Disease ; Disease Progression ; Early Diagnosis ; Edema ; Female ; Gram-Positive Bacterial Infections ; Humans ; Magnetic Resonance Spectroscopy ; Nocardia ; Nocardia asteroides ; Nocardia Infections ; Opportunistic Infections ; Prognosis ; Recognition (Psychology)

A 52 year-old, contact lens-wearing man presented with progressive right eye pain and redness for one month. He had been evaluated and treated for necrotizing scleritis by multiple eye care specialists prior to presentation. He underwent a complete systemic work-up for both autoimmune and infectious causes of scleritis, including a culture. The culture revealed heavy growth of Nocardia asteroides complexes. The patient was treated with topical amikacin and oral Bactrim. Following several weeks of antibiotic treatment, the patient's infection resolved completely, and his visual acuity returned to baseline status. Nocardia is a rare but potentially devastating cause of necrotizing scleritis that may affect contact lens wearers without an associated keratitis. Prompt recognition and early treatment with appropriate antimicrobial agents are critical to achieve a favorable outcome.
Anti-Bacterial Agents/therapeutic use ; Contact Lenses/*adverse effects/*microbiology ; Humans ; Male ; Middle Aged ; Nocardia Infections/*diagnosis/drug therapy ; Nocardia asteroides/*isolation & purification ; Scleritis/drug therapy/*microbiology

Nocardia is aerobic gram positive bacteria, which is found in the soil. Cutaneous nocardiosis is divided into the primary skin infection and secondary infection due to systemic dissemination from the internal organ. Its clinical manifestations are mycetoma, lymphocutaneous infection and superficial infection, such as abscess or granuloma. In lymphocutaneous infection, it is important to make differential diagnosis with other diseases with sporotrichoid pattern, such as sporotrichosis, leishmaniasis and mycobacterial infection. In our case, 58 year old male who had history of chemotherapy due to lung cancer visited with granulomatous nodule on the left wrist, and following lymphangitis along the forearm for 2 months. Through a skin biopsy, culture, AFB stain and 16S rRNA gene sequencing, cutaneous nocardiosis by N. brasiliensis was diagnosed.
Abscess ; Biopsy ; Coinfection ; Diagnosis, Differential ; Forearm ; Genes, rRNA ; Gram-Positive Bacteria ; Granuloma ; Humans ; Leishmaniasis ; Lung ; Lung Neoplasms ; Lymphangitis ; Male ; Mycetoma ; Nocardia ; Nocardia Infections ; Skin ; Soil ; Sporotrichosis ; Wrist

Nocardia farcinica is an emerging pathogen in immunocompromised hosts. Even though several species of Nocardia have been reported as causative pathogens of catheter-related blood stream infections (CRBSI), CRBSI caused by N. farcinica has not been reported. A 70-yr-old man with a tunneled central venous catheter (CVC) for home parenteral nutrition was admitted with fever for two days. Norcardia species was isolated from the blood through CVC and peripheral bloods and identified to N. farcinica by 16S rRNA and rpoB gene sequence analyses. This report emphasizes the rapid and correct identification of causative agents in infectious diseases in the selection of antimicrobial agents and the consideration of catheter removal.
Aged ; Bacterial Proteins/genetics/metabolism ; Blood/microbiology ; Catheter-Related Infections/*diagnosis/microbiology/nursing ; Catheterization, Central Venous/*adverse effects ; Humans ; Immunocompromised Host ; Male ; Nocardia/classification/genetics/*isolation & purification ; Nocardia Infections/*diagnosis ; Parenteral Nutrition/nursing ; Polymerase Chain Reaction ; RNA, Ribosomal, 16S/genetics/metabolism ; Sequence Analysis, DNA

Infection of the central nervous system with Nocardia sp. usually manifests as supratentorial abscesses. Supratentorial and cerebellar abscesses from infection with Nocardia sp. following immunosuppression with long-term corticosteroids for idiopathic thrombocytopenia (ITP) have not been reported. An 83 years-old, human immunodeficiency virus (HIV)-negative, polymorbid male with ITP for which he required corticosteroids since age 53 years developed tiredness, dyspnoea, hemoptysis, abdominal pain, and progressive gait disturbance. Imaging studies of the lung revealed an enhancing tumour in the right upper lobe with central and peripheral necrosis, multiple irregularly contoured hyperdensities over both lungs, and right-sided pleural effusions. Sputum culture grew Nocardia sp. Neurological diagnostic work-up revealed dysarthria, dysphagia, ptosis, hypoacusis, tremor, dysdiadochokinesia, proximal weakness of the lower limbs, diffuse wasting, and stocking-type sensory disturbances. The neurological deficits were attributed to an abscess in the upper cerebellar vermis, myopathy from corticosteroids, and polyneuropathy. Meropenem for 37 days and trimethoprime-sulfamethoxazole for 3 months resulted in a reduction of the pulmonary, but not the cerebral lesions. Therefore, sultamicillin was begun, but without success. Long-term therapy with corticosteroids for ITP may induce not only steroid myopathy but also immune-incompetence with the development of pulmonary and cerebral nocardiosis. Cerebral nocardiosis may not sufficiently respond to long-term antibiotic therapy why switching to alternative antibiotics or surgery may be necessary.
Adrenal Cortex Hormones/*adverse effects/*therapeutic use ; Aged, 80 and over ; Cerebellar Diseases/*chemically induced/*diagnosis/pathology ; Humans ; Immunosuppression ; Male ; Muscular Diseases/*chemically induced/pathology ; Nocardia Infections/*diagnosis ; Purpura, Thrombocytopenic, Idiopathic/*drug therapy

Opportunistic infections are common after a renal transplant as a result of immunosuppression. Nocardiosis is a rare but important cause of morbidity and mortality among renal transplant recipi-ents. Nocardiosis is a localized or disseminated infection, which is usually introduced through the respiratory tract resulting in pneumonia, and may develop a disseminated infection, in particular a subcutaneous abscess and/or central nervous system infection. Because effective therapy for these nocardiosis is available, an accurate and timely diagnosis is crucial. However, nocardiosis is an infrequent disease and many physicians are unfamiliar to it. In addition, in the laboratory, cul-tures may be discarded too early, which often delays an early diagnosis and treatment. The authors isolated Nocardia asteroides from an abscess of the skin in a rejected renal allograft patient suffering pneumonia. The patient was successfully treated with trimethoprim/sulfamethoxa-zole.
Abscess* ; Allografts ; Central Nervous System Infections ; Diagnosis ; Early Diagnosis ; Humans ; Immunosuppression ; Kidney* ; Mortality ; Nocardia asteroides* ; Nocardia Infections ; Nocardia* ; Opportunistic Infections ; Pneumonia ; Respiratory System ; Skin