Clinical manifestations of nocardiosis: Study of risk factors and outcomes in a tertiary care hospital

Teena Wadhwa; Usha Baveja; Navin Kumar; Deepak Govil; Sharmila Sengupta

doi:10.4103/JLP.JLP_111_16

Journal of Laboratory Physicians, Table of Contents

CC BY-NC-ND 4.0 · J Lab Physicians 2017; 9(04): 288-295
DOI: 10.4103/JLP.JLP_111_16

Original Article

Clinical manifestations of nocardiosis: Study of risk factors and outcomes in a tertiary care hospital

Authors

Teena Wadhwa

Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
Usha Baveja

Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
Navin Kumar

Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
Deepak Govil

Department of Critical Care, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
Sharmila Sengupta

Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India

Abstract

PDF Download

Abstract

PURPOSE: The aim of this study is to evaluate the predisposing risk factors, clinical presentations, laboratory parameters, and treatments taken and outcomes in patients of nocardiosis in the span of 5 years in a tertiary care hospital.

MATERIALS AND METHODS: The patients whose specimens showed Nocardia like organism in Gram-staining, Kinyoun staining and characteristic colonies in culture were included in the retrospective analysis study. Retrospective analysis of associated risk factors, clinical presentations, and radiological findings was performed.

RESULTS: Of the thirteen patients, 11 (76.9%) had immunosuppressive pathologies including solid organ transplantation, autoimmune disease, use of steroids, and immunosuppressive drugs as important risk factors. Four types of clinical manifestations were observed, pulmonary (46.1%), cutaneous (23.07%), cerebral (15.3%), and bacteremia (15.3%). The most common presentation was pulmonary with steroid therapy as a significant risk factor. Consolidation and pleural effusion were the common radiological findings in these cases. In eight of the nine patients anti-nocrdial drugs were given. Cotrimoxazole as monotherapy was given in four cases (44.44%), cotrimoxazole in combination with meropenem in two cases (22.22%); minocycline and linezolid were given in one case each. The overall mortality was 36.36% and was seen in patients with pulmonary nocardiosis.

CONCLUSIONS: The study indicates that Nocardial infections are re-emerging on account of an increase in numbers of immunocompromised patients due to increased organ transplants, autoimmune diseases, malignancies, and use of immunosuppressive drugs and steroids. The diagnosis is often missed/not suspected and delayed because of the clinical resemblance to many other infections. Nocardial infection should be suspected and assessed particularly in immunocompromised patients not responding to treatment/improving clinically.

Key words

Immunosuppressant drugs - nocardiosis - solid organ transplant - steroids

PDF (406 kb)

References

References
1 Beaman BL, Burnside J, Edwards B, Causey W. Nocardial infections in the United States, 1972-1974. J Infect Dis 1976;134:286-9.
2 Ishihara M, Takada D, Sugimoto K, Oguro H, Gonoi T, Akiyama Y, et al. Primary brain abscess caused by Nocardia otitidiscaviarum. Intern Med 2014;53:2007-12.
3 McNeil MM, Brown JM. The medically important aerobic actinomycetes: Epidemiology and microbiology. Clin Microbiol Rev 1994;7:357-417.
4 Cattaneo C, Antoniazzi F, Caira M, Castagnola C, Delia M, Tumbarello M, et al. Nocardia spp infections among hematological patients: Results of a retrospective multicenter study. Int J Infect Dis 2013;17:e610-4.
5 Beaman BL, Beaman L. Nocardia species: Host-parasite relationships. Clin Microbiol Rev 1994;7:213-64.
6 Daly AS, McGeer A, Lipton JH. Systemic nocardiosis following allogeneic bone marrow transplantation. Transpl Infect Dis 2003;5:16-20.
7 Shearer C, Chandrasekar PH. Pulmonary nocardiosis in a patient with a bone marrow transplant. Bone Marrow Transplantation Team. Bone Marrow Transplant 1995;15:479-81.
8 Holt RI, Kwan JT, Sefton AM, Cunningham J. Successful treatment of concomitant pulmonary nocardiosis and aspergillosis in an immunocompromised renal patient. Eur J Clin Microbiol Infect Dis 1993;12:110-2.
9 Ramamoorthi K, Pruthvi BC, Rao NR, Belle J, Chawla K. Pulmonary nocardiosis due to Nocardia otitidiscaviarum in an immunocompetent host- a rare case report. Asian Pac J Trop Med 2011;4:414-6.
10 Yang M, Xu M, Wei W, Gao H, Zhang X, Zhao H, et al. Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital. Exp Ther Med 2014;8:25-30.
11 Tuo MH, Tsai YH, Tseng HK, Wang WS, Liu CP, Lee CM. Clinical experiences of pulmonary and bloodstream nocardiosis in two tertiary care hospitals in Northern Taiwan, 2000-2004. J Microbiol Immunol Infect 2008;41:130-6.
12 Matulionyte R, Rohner P, Uçkay I, Lew D, Garbino J. Secular trends of Nocardia infection over 15 years in a tertiary care hospital. J Clin Pathol 2004;57:807-12.
13 Kontoyiannis DP, Ruoff K, Hooper DC. Nocardia bacteremia. Report of 4 cases and review of the literature. Medicine (Baltimore) 1998;77:255-67.
14 Chedid MB, Chedid MF, Porto NS, Severo CB, Severo LC. Nocardial infections: Report of 22 cases. Rev Inst Med Trop Sao Paulo 2007;49:239-46.
15 Rosman Y, Grossman E, Keller N, Thaler M, Eviatar T, Hoffman C, et al. Nocardiosis: A 15-year experience in a tertiary medical center in Israel. Eur J Intern Med 2013;24:552-7.
16 Sorrell TC, Mitchel DH, Iredell JR, Chen SC-A. Nocardia Species. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8^th ed. Philadelphia: Elsevier Churchill Livingston; 2015. p. 2853-2863.
17 Wang HK, Sheng WH, Hung CC, Chen YC, Lee MH, Lin WS, et al. Clinical characteristics, microbiology, and outcomes for patients with lung and disseminated nocardiosis in a tertiary hospital. J Formos Med Assoc 2015;114:742-9.
18 Chopra V, Ahir GC, Chand G, Jain PK. Pulmonary nocardiosis mimicking pulmonary tuberculosis. Indian J Tuberc 2001;48:211.
19 Torres HA, Reddy BT, Raad II, Tarrand J, Bodey GP, Hanna HA, et al. Nocardiosis in cancer patients. Medicine (Baltimore) 2002;81:388-97.
20 Karumanchi D, Oommen S, Sivan Pillai PM, Angel J. Nocardiosis in central Kerala: A case series. Int J Med Public Health 2015;5:384-6.
21 Patil A, Cherian A, Iype T, Sandeep P. Nocardial brain abscess in an immunocompetent individual. Neurol India 2011;59:779-82.
22 Al Akhrass F, Hachem R, Mohamed JA, Tarrand J, Kontoyiannis DP, Chaftari AM, et al. Central venous catheter - Associated Nocardia bacteraemia in cancer patients. Emerg Infect Dis 2011;17:1651-8.
23 Barbara A. Brown-Elliott, June M. Brown, Patricia S. Conville, Richard J. Wallace Jr. Clinical and Laboratory Features of the Nocardia spp. Based on Current Molecular Taxonomy. Clin. Microbiol. Rev 2006;19:259-82.
24 Wauters G, Avesani V, Charlier J, Janssens M, Vaneechoutte M, Delmée M. Distribution of Nocardia species in clinical samples and their routine rapid identification in the laboratory. J Clin Microbiol 2005; 43:2624-8.