Nocardiosis: A Review of 16 Cases

• Main Authors: Günel GULİYEVA, Hüsnü PULLUKÇU, Mehmet Sezai TAŞBAKAN, Dilek Yeşim METİN, Oğuz Reşat SİPAHİ, Tansu YAMAZHAN, Meltem TAŞBAKAN
• Format: Article
• Language: English
• Published: Bilimsel Tip Yayinevi 2016-06-01
• Series: Flora Infeksiyon Hastalıkları ve Klinik Mikrobiyoloji Dergisi
• Subjects: Nocardia; Actinomycetales; Opportunistic infections; Nocardiosis
• Online Access: http://www.floradergisi.org/getFileContent.aspx?op=REDPDF&file_name=2016-21-02-057-063.pdf
• ISSN: 1300-932X; 1300-932X

Introduction: Nocardia spp. are gram-positive bacteria from the aerobic Actinomycelates family with low level acid resistance, in thin filamentous structure, branches out in bead shapes. The mechanisms of pathogenesis are complex, not fully understood, and include the capacity to evade or neutralize the myriad microbicidal activities of the host. Nocardia spp. have the ability to cause localized or systemic suppurative disease in humans and animals. Nocardiosis is typically regarded an opportunistic infection, but approximately one-third of the infected patients are immunocompetent. In this study, patients in whom Nocardia spp. had been isolated were clinically evaluated in terms of underlying illnesses, laboratory findings and response to therapy. Materials and Methods: Cases whose microbiologic samples yielded Nocardia spp. as the cause of infection between the years 2008 and 2015 were evaluated retrospectively via the analysis of hospital records. Results: A total of 16 cases whose microbiologic cultures yielded Nocardia spp. (4 females, 12 males; mean age 52.5 ± 18.0 years; range 19-76) were included into the study. Thirteen patients presented with lung involvement, whereas one had dermal nocardiosis, one had osteomyelitis and one had cranial abscess. Clinical samples that yielded Nocardia spp. included sputum (n= 7), bronchialaspiration sample (n= 3), deep tracheal aspiration (n= 2), tissue biopsy culture (n= 2), abscess material (n= 1) and bronchoalveolar lavage fluid (n=1). Underlying diseases were malignity (n= 4), chronic obstructive pulmonary disease (n= 2), systemic connective tissue disease (n= 3), interstitial lung disease (n= 2), heart transplantation (n= 1), cirrhosis (n= 1), Cushing disease (n= 1), Down syndrome (n= 1), and Fahr’s syndrome (n= 1). Fever, cough and sputum were the most common symptoms. Eight patients had consolidation in the thorax computer tomography, ten patients had high CRP, seven patients had leukocytosis, and ten patients had high erythrocyte sedimentation rate. Eight of the patients were treated with trimethoprim sulfamethoxazole, two with carbapenem, one with a combination of trimethoprim sulfamethoxazole and imipenem, one with imipenem and linezolid, one with piperacillin tazobactam, and one with clarithromycin. One patient with heart transplantation died at the time of microbiological diagnosis and one patient died due to aspergillus infection. Conclusion: It is important that Nocardia spp. can cause opportunistic infections particularly in immunosuppressed patients. Since the bacteria may grow in 2-7 days in clinical samples, incubation time must be prolonged for not to be unnoticed and early treatment must be started. It must be kept in mind that within the case of late treatment, the disease may cause mortality.