Nocardia farcinica lung infection in a patient with cystic fibrosis: a case report

Fadi Bittar,Nathalie Stremler,Didier Raoult,Jacques Sarles,Jean-Pierre Audié,Jean-Christophe Dubus,Jean-Marc Rolain

doi:10.1186/1752-1947-4-84

Abstract

IntroductionRespiratory tract infections are the major causes of morbidity and mortality in patients with cystic fibrosis. Nocardia are rarely implicated in these infections and few reports of the involvement of this species are found in the literature.Case presentationWe describe a case of lung infection followed by chronic colonization of trimethoprim and sulfamethoxazole resistant Nocardia farcinica in a patient with cystic fibrosis. The chronic colonization of this uncommon bacterium in patients with cystic fibrosis was proved using a newly developed real-time polymerase chain reaction assay, which indicates that this bacterium, despite treatment, is difficult to eradicate.ConclusionOur case report confirms that this organism can be recovered in persons with cystic fibrosis. Its eradication is necessary especially if the patient is to undergo lung transplantation.

Highlights

Respiratory tract infections are the major causes of morbidity and mortality in patients with cystic fibrosis
Our case report confirms that this organism can be recovered in persons with cystic fibrosis
We reported a case of lung infection followed by chronic colonization of trimethoprim-sulfamethoxazole resistant N. farcinica in a patient with cystic fibrosis (CF)

Summary

Introduction

Since the early description of cystic fibrosis (CF), pulmonary infection has been recognized as having the greatest role in morbidity and mortality leading to premature death in 90% of patients reported [1,2]. Our patient subsequently received a three-week course of intravenous ciprofloxacin, amikacin, and trimethoprim-sulfamethoxazole One month later, his leukocyte count decreased to 6.4 × 109/L (50% PMNs), the culture was found negative, and our patient was declared clinically cured. Because of the difficulty in isolating Nocardia species in sputum samples, as well as the poor sensitivity of the culture method, we decided to investigate retrospectively all sputum samples available for our patient using a more sensitive assay (molecular detection). For this purpose we used a specific putative non-ribosomal peptide synthetase sequence [4,5] to develop an original real-time PCR assay with. Our patient’s medical record was rechecked as his clinical condition, including cough, haemoptysis, purulent mucoid expectoration, and elevated CRP and leukocytes (> 80% PMNs) worsened at that stage

Findings

Discussion

Conclusion