Disseminated Nocardia farcinica: literature review and fatal outcome in an immunocompetent patient.

Academic Article

Abstract

  • BACKGROUND: Nocardia farcinica is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete. Nocardia spp. are opportunistic pathogens, and N. farcinica is the least common species of clinical importance. METHODS: Review of the recent literature and description of a immunocompetent patient with no known risk factors who contracted fatal N. farcinica sepsis. RESULTS: Positive pre-mortem and post-mortem cultures from the lung and synovium correlated with acute bronchopneumonia and synovitis at autopsy. Colonies of filamentous bacteria, which were not apparent in conventional hematoxylin and eosin-stained sections, were observed with gram and methenamine silver stains, but acid-fast stains were negative. A literature review revealed that disseminated N. farcinica often is associated with an underlying malignant tumor or autoimmune disease (88% of patients). Chemotherapy or corticosteroid treatments are additional risk factors. CONCLUSIONS: Trimethoprim-sulfamethoxazole typically is the first-line therapy for N. farcinica; treatment with amikacin and imipenem-cilastatin is used less often (7% of patients). Despite aggressive therapy, we observed that the death rate (39%) associated with N. farcinica in recent publications was eight percentage points higher than reported in a review from 2000.
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    Keywords

  • Aged, Anti-Infective Agents, Fatal Outcome, Humans, Immunocompetence, Male, Nocardia Infections, Pneumonia, Bacterial, Synovitis, Trimethoprim, Sulfamethoxazole Drug Combination
  • Digital Object Identifier (doi)

    Author List

  • Budzik JM; Hosseini M; Mackinnon AC; Taxy JB
  • Start Page

  • 163
  • End Page

  • 170
  • Volume

  • 13
  • Issue

  • 3