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Disseminated Nocardiosis in an Immunocompetent Individual Infected With Nocardia Brasiliensis, an Opportunistic Agent Publisher



Mardani M1 ; Aslani N2 ; Geramishoar M3 ; Khodavaisy S3 ; Mohseni S4 ; Badali H5
Authors
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Authors Affiliations
  1. 1. Infectious Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  2. 2. Mazandaran University of Medical Sciences, Sari, Iran
  3. 3. Department of Medical Mycology and Parasitology, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Microbiology, Sari Branch, Islamic Azad University, Sari, Iran
  5. 5. Department of Medical Mycology and Parasitology /Invasive Fungi Research Centre (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

Source: Archives of Clinical Infectious Diseases Published:2017


Abstract

Introduction: Nocardia species are described as opportunistic pathogens that mainly cause pulmonary nocardiosis in immunocompromised individuals, particularly in patients with acquired immune deficiency syndrome (AIDS), intravenous drug abusers, strongly burned victims, the Cushing syndrome, the ones underlying transplantation, and prolonged use of corticosteroids. Case Presentation: The current paper reported a case of disseminated nocardiosis in a 28-year-old Iranian male who had type 2 diabetes mellitus with prolonged use of corticosteroid for the last 5 years. He was admitted to the department of infectious diseases at Shahid Beheshti hospital, Tehran, Iran, following a complaint of pneumonia (chest pain) and presented a subcutaneous purple nodule on the left thigh without pain. Direct microscopic examination revealed numerous filamentous branching and rod-shaped bacilli. The tentative diagnosis of chronic inflammation with nocardiosis was made. In addition, tiny, chalky white and irregular colonies emitting an earthy odor appeared on blood and chocolate agar and were identified as Nocardia brasiliensis by sequencing of 16S rRNA gene as a valuable method to identify clinical isolates. Combination therapy was performed by entire surgical excisions and intravenous TMP-SMX (160/800 mg/bid; IV) and meropenem 1g/tid. The patient’s condition improved after 8 days and he was discharged. Conclusions: Combination therapy with surgical excision has a synergistic effect and appears to be the best treatment for extended lesions. However, new potent antibacterial drugs mayhelp to improve the management of such infections when there are sufficient data on their in vitro activity. © 2016, Infectious Diseases and Tropical Medicine Research Center.
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