Renán-Pérez J, Falcón-Escobedo R, Matuk-Pérez Y, Rodríguez-Leyva I

Language: Spanish
References: 14
Page: 215-219
PDF size: 282.65 Kb.

ABSTRACT

Nocardiosis is a bacterial infection that has the potential to cause localized or systemic suppurated disease, with particular tropism for central nervous system and lung parenchyma. It appears as thin branched, gram-positive filaments that look similar to Actinomyces species (spp). Risk factors for acquiring nocardiosis are: glucocorticoid therapy, malignancies, immunosuppressive therapy, organ and hematopoietic stem cells transplantation, as well as HIV infection. There are no pathognomonic clinical signs, so the clinical manifestations can easily be confused with bacterial infections caused by Klebsiella spp., Pseudononas spp. and Mycobacterium spp., and fungal infections, parasites and malignant neoplasms. The diagnosis of nocardiosis requires isolation and identification of the microbial organism, often requiring invasive procedures. Sulfonamides are considered the standard therapy, but other schemes have been proposed due to the high resistance rate. This paper reports on a case of a 65-year-old woman with a history of rheumatoid arthritis treated with monoclonal antibodies. The patient developed disseminated Nocardiosis. Herein we describe the initial management and diagnosis reached by histopathology.

REFERENCES

1. Beaman BL, Burnside J, Edwards B, Causey W. Nocardial infections in the United States 1972-1974. J Infect Dis 1976; 134: 286.

2. Nocard E. Note sur la maladie des boeufs de la Guadaloupe: Connue sous le nom de farcin. Ann Inst Pasteur Microbiol 1888; 2: 293-307.

3. Hamal, P. Primary pulmonary nocardiosis: case report. Thorax 1974; 29: 382-6.

4. Sánchez-Herrera K, Coubleb A, Mounieeb D, Ramírez-Durán N, Uzcategui de Morillod M, Serrano JA, Bergeronb E, et al. Phenotypic and genotypic evaluation of 18 Nocardia isolates from human clinical samples in Mexico. Journal de Mycologie Médicale 2012; 22: 1-7.

5. Peleg AY, Husain S, Qureshi ZA, Silveira FP, Sarumi M, Shutt KA, Kwak EJ, Paterson DL. Risk factors, clinical characteristics, and outcome of Nocardia infection in organ transplant recipients: a matched case-control study. Clin Infect Dis 2007; 44: 1307-14.

6. Blaine B. Differential Binding of Nocardia asteroides in the Murine Lung and Brain Suggests Multiple Ligands on the Nocardial Surface. Infect Immun 1996; 64: 4859-62.

7. Lerner PL. Nocardiosis. Clin Infect Dis 1996; 22: 891.

8. Martínez TR, Menéndez VR, Reyes CS, Santos DM, Vallés TJM, Modesto AM, Gobernado SM. Pulmonary nocardiosis: risk factors and outcomes. Respirology 2007; 12: 394-400.

9. Palmer DL, Harvey RL, Wheeler JK. Diagnostic and therapeutic considerations in Nocardia asteroides infection. Medicine (Baltimore) 1974; 53: 391-401.

10. Lederman ER, Crum NF. A case series and focused review of nocardiosis: clinical and microbiologic aspects. Medicine (Baltimore) 2004; 83: 300-13.

11. Moeller MB, Gallis HA. Trimethoprim-sulfamethoxazole therapy for Nocardia infections. Arch Intern Med 1983; 143: 711-8.

12. Corti,M, Villafañe MF, Yampolsky C, Bianchi M, Negroni R, Costa N. Nocardial Brain Abscess Due to Nocardia asteroides sensu estricto type VI Successfully treated With Antibiotics Alone in an AIDS Patient. Infect Dis Clin Pract (Baltim Md) 2008; 16: 338-41.

13. Fleetwood IG, Embil JM, Ross IB. Nocardia asteroides Cerebral Abscess in Immunocompetent Hosts: Report of Three Cases and Review of Surgical Recommendations. Surg Neurol 2000; 53: 605-10.

14. Safdar N, Abad CL, Kaul DR, Saint S. Clinical problem-solving. Skin deep. New Engl J Med 2012; 366: 1336-40.