Aerobic Actinomyces Research Articles

P1771NOCARDIOSIS IN RENAL TRANSPLANT RECIPIENTS- TEN YEARS OF SINGLE CENTER EXPERIENCE

Abstract Background and Aims Nocardiosis is a localized or disseminated bacterial infection caused by aerobic Actinomyces that commonly affects immunocompromised hosts. This study aimed to retrospectively review the clinical course and outcome of nocardiosis in renal transplant recipients at our center Method Data was obtained from hospital records retrospectively. Sixteen cases of nocardiosis were identified in a series of more than 1800 consecutive renal transplants performed at Sir Ganga Ram Hospital in the last decade from the year 2010 to 2019. Results Thirteen out of Sixteen patients(81.25%) had developed nocardiosis within a 1-year post-renal transplant. The diabetic population constituted 31.3%. CMV disease was present in 25% of patients six months prior to the diagnosis of Nocardiosis.56.3% of patients were on Trimethoprim-sulfamethoxazole prophylaxis while they were diagnosed with nocardiosis. Pleuropulmonary nocardiosis was the most common form of infection(68.75%). Primary cutaneous nocardiosis was identified in one patient(6.25%). cerebral nocardiosis and disseminated nocardiosis was diagnosed in two patients each(12.5%).In the last 3 years with the introduction of MALDI-TOF led to the identification of the subspecies of Nocardia which was not possible earlier. In the last 3 years, 6 patients were diagnosed with nocardiosis, in which 4 were infected with Nocardia farcinica, one patient with Nocardia Asiatica and one with Nocardia cyrigeorgica. Nocardia farcinica was resistant to cotrimoxazole, which used to be first-line therapy against Nocardiosis before subspecies identification and sensitivity testing. With the help of proper identification of subspecies by MALDI-TOF and antibiotic susceptibility by E-testing, 5 out of 6 patients could be treated while earlier 6 out of 10 patients could be treated. Conclusion Nocardiosis is a rare, difficult-to-diagnose-and-treat infection following kidney transplantation. Trimethoprim-sulfamethoxazole prophylaxis was not effective in the prevention of disease. The Subspecies identification and modification of the plan of management according to antibiotic sensitivity results in improved outcomes.

Nocardia Liver Abscess – An Uncommon Infection Post Liver Transplant

Background: Nocardiosis is a rare, localised or disseminated, bacterial infection caused by aerobic actinomyces. It commonly affects immunocompromised hosts. With increasing load of post transplant patients the world over, this infection has been reported with increasing frequency.Case Report: A 59-year-old gentleman underwent living donor liver transplant for ethanol related ESLD in our hospital. Immediate post OP period was uneventful. After 6 weeks post transplant he presented with abdominal pain and low grade fever. General examination was unremarkable except for minimal tenderness over right hypochondrium. His baseline laboratory evaluation revealed hemoglobin 8.7 gm%, leukocyte count 7170/cumm, platelets 176,000/cmm. Liver function revealed total bilirubin 0.46 mg/dL, AST 14 μ/L, ALT 25 μ/L, albumin 2.6 g/L, alkaline phosphatase 74 μ/L, GGT 78 μ/L and INR 1.2. Tacrolimus level 6 mg/dL. Ultrasound abdomen revealed well-defined thin walled hypoechoic lesion in segment VII measuring 53 mm × 58 mm liver abscess. CT scan of abdomen showed a 6.2 cm × 6 cm × 5.9 cm size multiloculated hypodense collection in segment VII of right lobe with perilesional edema. He underwent percutaneous drainage of collection, which revealed purulent aspirate. Microbiological examination of aspirates showed pus cells and occasional gram-positive branching filaments. Modified acid-fast stain was positive. Culture revealed Nocardai spp. MALDI-TOF test was positive for Nocardia farcinica. He was treated with trimethoprime-sulfamethoxazole, amikacin and imipenem for 2 weeks. He was kept on low immunosuppression. His fever subsided over next few days. Repeat ultrasound scan revealed collapsed abscess cavity with small remnant collection. He was discharged on oral antimicrobials and is under regular follow up.Conclusion: Nocardiosis should be suspected as a likely cause of liver abscess in the setting of immunocompromised patients. Long-term treatment with trimethoprime-sulfamethoxazole for up to 6 months improves survival.Conflicts of InterestThe authors have none to declare. Background: Nocardiosis is a rare, localised or disseminated, bacterial infection caused by aerobic actinomyces. It commonly affects immunocompromised hosts. With increasing load of post transplant patients the world over, this infection has been reported with increasing frequency. Case Report: A 59-year-old gentleman underwent living donor liver transplant for ethanol related ESLD in our hospital. Immediate post OP period was uneventful. After 6 weeks post transplant he presented with abdominal pain and low grade fever. General examination was unremarkable except for minimal tenderness over right hypochondrium. His baseline laboratory evaluation revealed hemoglobin 8.7 gm%, leukocyte count 7170/cumm, platelets 176,000/cmm. Liver function revealed total bilirubin 0.46 mg/dL, AST 14 μ/L, ALT 25 μ/L, albumin 2.6 g/L, alkaline phosphatase 74 μ/L, GGT 78 μ/L and INR 1.2. Tacrolimus level 6 mg/dL. Ultrasound abdomen revealed well-defined thin walled hypoechoic lesion in segment VII measuring 53 mm × 58 mm liver abscess. CT scan of abdomen showed a 6.2 cm × 6 cm × 5.9 cm size multiloculated hypodense collection in segment VII of right lobe with perilesional edema. He underwent percutaneous drainage of collection, which revealed purulent aspirate. Microbiological examination of aspirates showed pus cells and occasional gram-positive branching filaments. Modified acid-fast stain was positive. Culture revealed Nocardai spp. MALDI-TOF test was positive for Nocardia farcinica. He was treated with trimethoprime-sulfamethoxazole, amikacin and imipenem for 2 weeks. He was kept on low immunosuppression. His fever subsided over next few days. Repeat ultrasound scan revealed collapsed abscess cavity with small remnant collection. He was discharged on oral antimicrobials and is under regular follow up. Conclusion: Nocardiosis should be suspected as a likely cause of liver abscess in the setting of immunocompromised patients. Long-term treatment with trimethoprime-sulfamethoxazole for up to 6 months improves survival. Conflicts of InterestThe authors have none to declare. The authors have none to declare.

Vascular Nosocomial Nocardia farcinica Infection After Arterial Stenting in an Immunocompetent Patient

Vascular Nosocomial <i>Nocardia farcinica</i> Infection After Arterial Stenting in an Immunocompetent Patient

Bacteria That Masquerade as Fungi: Actinomycosis/Nocardia

The order Actinomycetales includes phylogenetically diverse but morphologically similar aerobic and anaerobic bacteria that exhibit filamentous branching structures which fragment into bacillary or coccoid forms. The aerobic actinomyces are a large, diverse group of gram-positive bacteria including Nocardia, Gordona, Tsukamurella, Streptomyces, Rhodococcus, Streptomycetes, Mycobacteria, and Corynebacteria. The anaerobic genera of medical importance include Actinomyces, Arachnia, Rothia, and Bifidobacterium. Both Actinomyces and Nocardia cause similar clinical syndromes involving the lung, bone and joint, soft tissue, and the central nervous system. The medically important Actinomyces organisms cause infections characterized by chronic progression, abscess formation with fistulous tracts and draining sinuses. Called "great masqueraders," diagnosis of actinomycosis and nocardiosis is often delayed. Once recognized, treatment of these infections requires long courses of parenteral and oral therapy. This review will compare and contrast infections due to Actinomyces and Nocardia.

Nocardiosis following solid organ transplantation: a single-centre experience

Nocardiosis is a localized or disseminated bacterial infection caused by aerobic Actinomyces that commonly affects immunocompromised hosts. The aim of this study was to retrospectively review clinical course and outcome of nocardiosis in solid organ recipients at our centre. Five cases of nocardiosis were identified in a series of more than 4000 consecutive solid organ transplants performed at Innsbruck university hospital during a 25-year period. Of the five patients with nocardiosis, two had undergone multivisceral, one liver, one kidney and one lung transplantation. Three patients with Nocardia asteroides infection were treated successfully and recovered from their infectious disease, however, one lost his renal graft following withdrawal of immunosuppression. The lung recipient recovered from nocardiosis but died later on from Pseudomonas pneumonia. One multivisceral recipient died from Nocardia farcinica-disseminated infection. Nocardiosis is a rare, difficult-to-diagnose-and-treat complication following solid organ transplantation. Intestinal recipients might be at increased risk to develop this infection.

Pulmonary nocardiosis treated with chloramphenicol.

Human infections with aerobic Actinomyces which were formerly considered a rarity are being recognized with increasing frequency.1-3Over 57 cases have been reported from various regions of the world. Nine of the forty-two known strains of Nocardia have been isolated from human cases.6 The disease involves most frequently the lungs in the form of an acute bronchopneumonia, which may become chronic, with areas of consolidation and often involvement of the pleura. Healing of pulmonary lesions may occur by complete resolution, or fibrosis may follow. Metastatic lesions, apparently blood borne, may involve any organ but are especially frequent in the brain.3,7Cerebral symptomatology may be the initial or sole manifestation of the disease.8 Although the disease was almost always fatal in the past and still carries a high mortality rate (about 60%), since the introduction of effective chemotherapeutic and antibiotic agents a considerable proportion of the cases

Nocardiosis of the central nervous system.

R ECENT reviews of Nocardia infections in man 8,8,~6 have devoted only scanty attention to the neurological aspects of this disease; yet in 56 cases of proven human nocardiosis collected to date, involvement of the central nervous system was demonstrable in 18 patients, and often appeared directly responsible for the fatal outcome. The first pathogenic aerobic Actinomyces was isolated from cattle by Nocard 21 in 1888, and called Nocardia farcinica by Trevisan 25 in 1889. In 1890, Eppinger TM isolated pathogenic aerobic Actinomyces from a brain abscess of a 5~-year-old glassworker suffering from a pseudo-tuberculous infection and described the organism as Cladothrix asteroides. In 1896, Blanchard 5 renamed the organism Nocardia asteroides. For many decades these organisms, which in their early stages of growth on culture media show structure similar to that of Actinomyces, were considered intimately related to the latter. Unlike Actinomyces, Nocardia is aerobic and primarily saprophytic, occurring on grasses, grains, and in the soil. In staining reactions it may or may not be acid-fast. Occasionally it gains access to the human body by airborne contamination or by introduction into previously traumatized tissues; and it may then disseminate widely by hematogenous routes. While rather sensitive to sulfonamides, it is relatively resistant to penicillin. Pulmonary involvement in nocardiosis constitutes the most common clinical manifestation, thus, like actinomycosis proper, often simulating tuberculosis. While neurological complications are relatively rare in actinomycosis, involvement of the central nervous system, most often in the form of brain abscesses, has been reported in approximately 30 per cent of the cases of nocardiosis, thus rendering the prognosis of the latter more serious. Since all known cases of nocardiosis of the central nervous system published to date, except 1 case of meningitis, were diagnosed either preterminally or post mortem, the following case report of a 4~-year-old Negro, at present alive and well 15 months following excision of a Nocardia brain abscess, appears worthy of recording.

ACTINOMYCOSIS OF THE KNEE

ACTINOMYCOSIS has been known as a clinical disease in animals since Bollinger, 1 of Munich, first described it as lumpy jaw in cattle in 1877. Israel 2 reported the disease in human beings in 1878. Some four years later Ponfick 3 established the unity of human and bovine infections. Langenbeck, 4 Lebert, 5 Davaine, 6 Robin, 7 Revolta, 8 and Perroncito 9 had all described a syndrome resembling actinomycosis prior to Bollinger but did not definitely identify it as such. It remained for Harz 10 and for Wolff and Israel 11 to work out the bacteriology. In 1905 Wright 12 established the pathogenicity of Actinomyces bovis in this country. However, it was not until 1931 that Naeslund 13 described both anaerobic and aerobic actinomyces as being capable of causing the disease. The first clinical case in this country was reported by John B. Murphy. 14 The first complete study was

Aerobic Actinomyces in Urine: Preliminary Report

Aerobic Actinomyces in Urine: Preliminary Report