Abstract
Skin and soft tissue infections have been well-documented after natural disasters; however, to the best of our knowledge, Nocardia brasiliensis (N. brasiliensis) is not included in the Centers for Disease Control and Prevention (CDC) list of environmental pathogens associated with tropical storms. In this report, we describe two cases of N. brasiliensis lymphadenitis that occurred four to six weeks after Hurricane Irma hit Manatee County, Florida. Since N. brasiliensis skin and soft tissue infections are typically very uncommon in our patient population, we concluded that cases of N. brasiliensis could increase after tropical storms, and we suggest that this pathogen is to be included in the CDC’s list of environmental pathogens associated with natural disasters.
Highlights
An increase in skin and soft tissue infections has been well-documented after natural disasters [1,2]
We present two cases of N. brasiliensis lymphadenitis that occurred in West Florida after being hit by Hurricane Irma in September 2017
Laboratory testing, including a complete blood count and comprehensive metabolic panel, was non-revealing, except for mild leukocytosis with a left shift. Since this patient presented within a couple of weeks after Hurricane Irma, and given that we encountered a similar presentation earlier (Case 1), our suspicion that this might be another case of Nocardia was high and the decision was made to take the patient to the OR immediately for incision and drainage
Summary
An increase in skin and soft tissue infections has been well-documented after natural disasters [1,2]. A 75-year-old immune-competent male with a medical history significant for essential hypertension, gastroesophageal reflux disease, and hyperlipidemia presented to the emergency department approximately four weeks after Hurricane Irma with an abscess on his left forearm and pain and erythema extending from his forearm to his axilla He did not have any associated fever or chills. Laboratory testing, including a complete blood count and comprehensive metabolic panel, was non-revealing, except for mild leukocytosis with a left shift Since this patient presented within a couple of weeks after Hurricane Irma, and given that we encountered a similar presentation earlier (Case 1), our suspicion that this might be another case of Nocardia was high and the decision was made to take the patient to the OR immediately for incision and drainage. The patient was switched to oral sulfamethoxazole/trimethoprim alone to continue for six weeks after discharge, which resulted in the resolution of the lesion
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