Cases Of Pulmonary Nocardiosis Research Articles

Rapid detection of pulmonary nocardiosis by metagenomic next generation sequencing

We retrospectively analyzed 3 cases of pulmonary nocardiosis. Patients were identified by metagenomic next generation sequencing (mNGS) in the First Affiliated Hospital of Soochow University, from January 2019 to April 2022. All patients had underlying diseases, and were in immunocompromised state, with membranous nephropathy, acute lymphoblastic leukemia (ALL), and systemic lupus erythematosus (SLE), respectively. Symptoms common to all cases included fever, cough and expectoration. Chest computed tomography (CT) presented patchy shadows or nodules, with or without cavitation lesions, or pleural effusion. mNGS detected Nocardia spp. via bronchoalveolar lavage fluid (BALF) or blood samples from patients. All the patients were discharged with recovery after using the trimethoprim-sulfamethoxazole (TMP-SMX) and remained without evidence of disease during regular follow-ups. mNGS may be a tool for rapid and accurate detection and identification of pulmonary nocardiosis, but interpreting the mNGS results should be more cautious because the mNGS assay can also detect colonization.

Clinical characteristics and treatment strategy of nocardiosis in lung transplant recipients: A single-center experience

Nocardia are infrequent pathogens that disproportionately afflict organ transplant recipients. The present study aimed to summarize the clinical manifestations, diagnostic approaches, and treatment strategies of nocardiosis in lung transplant recipients. This retrospective study reviewed the clinical data of adult lung transplant recipients who were complicated with nocardiosis between January 2018 and December 2021 at the largest lung transplant center in South China. The incidence of nocardiosis was 4.2% (13/316), including 9 cases of pulmonary nocardiosis and 4 disseminated nocardiosis (blood, pulmonary and intracranial). The accuracy in diagnosing nocardiosis was 77.8% by culture and 100% by metagenomic next-generation sequencing (mNGS). Nocardia farcinica was the most common causative pathogen. Trimethoprim-sulfamethoxazole-based combination therapy was administered initially, followed by a single antibiotic as the maintained therapy, lasting for 4-8 months. mNGS is more accurate than culture in diagnosing nocardiosis. Most patients responded well to the antibiotic therapy with combined antibiotics at the initial stage followed by a single antibiotic treatment.

Clinical Features, Radiological Findings, and Treatment Outcomes in Patients with Pulmonary Nocardiosis: A Retrospective Analysis.

IntroductionLack of specific clinical features makes the diagnosis of pulmonary nocardiosis difficult. A high index of suspicion is required for diagnosis especially in cohorts with pre-existing risk factors. This study aimed to study the clinical and radiological characteristics and outcomes in patients with pulmonary nocardiosis.MethodsThis was a retrospective observational study. Data of confirmed cases with pulmonary nocardiosis were collected from a digital patient management system.ResultsA total of eight cases of pulmonary nocardiosis were included. The mean age of patients was 50 ± 14.3 years with a female preponderance (62.5%). The most common co-morbidity was chronic lung disease (37.5%). The common clinical feature of pulmonary nocardiosis was cough with expectoration (50%) and the mean duration of symptoms was 18 days. The common radiological (CT thorax) findings were consolidation, bronchiectasis, mediastinal lymphadenopathy, and nodularity (50% each). One patient had an extension of pulmonary disease in the chest wall. Microbiological detection of Nocardia spp. was done in sputum samples (50%) and in bronchoalveolar lavage (BAL) samples (50%). Culture was positive in two BAL samples. Intravenous empirical antibiotics in combination with oral trimethoprim-sulfamethoxazole double standard (15 mg/kg trimethoprim) were started at the time of diagnosis. Ceftriaxone and amikacin were commonly used antimicrobials.ConclusionNocardia spp. commonly causes disease in patients with pre-existing chronic disease. A high index of suspicion is required in patients with subacute to chronic respiratory symptoms, raised inflammatory markers, and the absence of common respiratory pathogens in evaluation.

In Response to the Article "Computed Tomography Features of Pulmonary Nocardiosis in Immunocompromised and Immunocompetent Patients"; Pol J Radiol, 2015; 80: 13-17.

Dear Editor, The article by Mehrian P. et al. [1] on CT features of pulmonary nocardiosis in immunocompromised and immunocompetent patients was quite informative and made an interesting reading. Nocardiosis is an uncommon infection that occurs primarily in the immunocompromised patients, especially in patients with defective cell-mediated immunity [2]. Less commonly it may also be encountered in immunocompetent hosts. However, its incidence is rising probably due to the advent of improved and advanced laboratory detection methods and also due to the growing number of immunosuppressed patients. The incidence of nocardiosis ranges from 0.7% to 3.5% in solid organ transplant recipients [3]; whereas its incidence in patients infected with human immunodeficiency virus (HIV) is decreasing probably due to effective medical therapy. CT features of nocardiosis are highly variable, with the most common findings on chest CT being consolidation, nodules which are often cavitating, pleural involvement in the form of thickening and effusions, and extension to the chest wall resulting in formation of an abscess or phlegmon [1,2,4]. Other less common features which have also been described include bronchiectasis, ground glass haze with superimposed septal thickening [2]. Herein are present two cases of pulmonary nocardiosis, one in an immunocompromised and one in an immunocompetent patient, highlighting the variable and non-specific nature of CT findings in this condition. A 24-year-old male who was a kidney transplant recipient, presented with complaints of cough with expectoration and fever. Based on the clinical suspicion of an opportunistic infection, a CT scan of the thorax (Figure 1A–1C) was carried out, which revealed cavitatory nodules with multiple small satellite nodules in the upper lobes of both lungs. Pulmonary nocardiosis was diagnosed with a CT-guided biopsy. Figure 1 A 24-year-old male, kidney transplant recipient, with pulmonary nocardiosis. Axial (A), coronal (B) and sagittal (C) CT images showing cavitatory nodules with multiple satellite nodules in the upper lobes of both lungs. (Sagittal image is of the right ... Figure 2 shows a CT picture of a 50-year-old man with COPD (chronic obstructive pulmonary disease) with no history of corticosteroid intake. He presented with increased cough for the past several months with fever for the last few weeks. There was no history of weight loss. Intradermal tuberculin test was negative and the sputum was sterile. Chest radiograph showed multiple nodular opacities in the bilateral upper zones along with the presence of a cavity in the upper zone of the right lung. These findings were confirmed on CT which also revealed a patch of ground glass haziness in the middle lobe of the right lung and bilateral irregular pleural thickening. Pulmonary nocardiosis was diagnosed with a CT-guided biopsy. Figure 2 A 50-year-old man with COPD presenting with gradually increasing chronic cough and fever. Axial CT chest image depicting multiple nodular opacities in bilateral upper lobes along with the presence of a cavity in the right upper lobe. To conclude, although the CT features of pulmonary nocardiosis are nonspecific and can mimic other infections and tumors, familiarity with nocardiosis and its CT findings may help the radiologist/physician in suggesting the diagnosis when it is not suspected clinically.

Pulmonary nocardiosis from a tertiary care hospital in Southern India

The present study highlights eight cases of pulmonary nocardiosis diagnosed during the time period of January 2006-March 2008. Nocardia otitidiscaviarum, N. asteroides and N. brasiliensis were isolated from these cases. Whereas six patients were treated successfully, one showed partial response and one case expired before the institution of treatment. Early and correct microbiological diagnosis can help to decrease the disease-related morbidity and mortality.

Pulmonary Nocardiosis

Six cases of pulmonary nocardiosis are reported. All patients were compromised hosts treated with corticosteroids and/or immunosuppressive agents. The clinical presentations ranged from malaise to respiratory failure. The radiological manifestations varied from a solitary nodule to extensive cavitary bronchopneumonia with distant dissemination. The diagnosis was made by sputum culture in one, open lung biopsy in 3, and at autopsy in 2 others. In 3 patients, in whom early diagnosis was made, the infection was controlled by sulfonamide therapy.