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Infectious Disorders - Drug Targets

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ISSN (Print): 1871-5265
ISSN (Online): 2212-3989

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Research Article

Nocardia Infections: Ten Years Experience from a Tertiary Health Care Center in North India (2007-2016)

Author(s): Yashik Bansal, Nidhi Singla*, Hena Butta, Deepak Aggarwal, Neelam Gulati and Jagdish Chander

Volume 21, Issue 3, 2021

Published on: 16 May, 2020

Page: [445 - 451] Pages: 7

DOI: 10.2174/1871526520666200516161940

Price: $65

Abstract

Background: Nocardia species are important cause of infections in humans but are underreported due to missed diagnosis as well as misdiagnosis. Majority of the literature on these infections consists of case reports or series with few articles describing high number of cases.

Objective: To study the epidemiology of Nocardia infections in a tertiary care center.

Materials and Methods: This retrospective observational study was done in a tertiary care centre of North India over a period of 10 years (2007-2016). The detection of Nocardia spp. from clinical specimens was done by conventional methods viz. direct microscopy (Gram’s stain, modified Ziehl -Neelsen stain [1%], KOH examination) and culture.

Results: A total of 25 cases of nocardiosis were diagnosed during the study period. The mean age of the patients was 50.9 years (range 30-72 years) with a male:female ratio of 3:2. The site of disease in these patients included pulmonary (n=18), cutaneous (n=4), perinephric abscess (n=1), ocular (n=1) and bone (n=1). Risk factors associated were underlying lung disease (n=11), smoking (n=7), diabetes (n=5) and steroid therapy (n=4) in pulmonary nocardiosis, iatrogenic (n=1) and leprosy (n=1) in cutaneous nocardiosis, diabetes in perinephric abscess and cataract surgery in ocular nocardiosis. Culture was positive in 12/25 (48%) patients for Nocardia spp. Direct microscopy was positive in 22 patients. We wish to highlight that meticulous observation of KOH wet mount examination helped in clinching the diagnosis of Nocardiosis in 3 cases which were earlier missed by other methods.

Conclusion: Good communication with the clinician alongside a meticulous effort in the laboratory is essential for appropriate diagnosis and management of these cases.

Keywords: Nocardia, actinomycetes, pulmonary nocardiosis, mycetoma, sputum, KOH.

Graphical Abstract

[1]
Steinbrink, J.; Leavens, J.; Kauffman, C.A.; Miceli, M.H. Manifestations and outcomes of nocardia infections: Comparison of immunocompromised and nonimmunocompromised adult patients. Medicine (Baltimore), 2018, 97(40), e12436.
[http://dx.doi.org/10.1097/MD.0000000000012436] [PMID: 30290600]
[2]
Conville, P.S.; Brown-Elliott, B.A.; Smith, T.; Zelazny, A.M. The Complexities of Nocardia Taxonomy and Identification. J. Clin. Microbiol., 2017, 56(1), e01419-e17.
[http://dx.doi.org/10.1128/JCM.01419-17] [PMID: 29118169]
[3]
Hall, G.S. Color Atlas and Textbook of Diagnostic Microbiology; Procop, G.W.; Church, D.L.; Hall, G.S.; Janda, W.M.; Koneman, E.W.; Schreckenberger, P.C.; Woods, G.L., Eds.; Wolters Kluwer: Philadelphia, 2017, pp. 960-982.
[4]
Senard, O.; Blanot, S.; Jouvion, G.; Rodriguez-Nava, V.; Lortholary, O.; Join-Lambert, O.; Toubiana, J. Fulminant Nocardiosis Due to a Multidrug-Resistant Isolate in a 12-Year-Old Immunocompetent Child. Pediatrics, 2018, 141(2), e20163131.
[5]
Woodworth, M.H.; Saullo, J.L.; Lantos, P.M.; Cox, G.M.; Stout, J.E. Increasing nocardia incidence associated with bronchiectasis at a tertiary care center. Ann. Am. Thorac. Soc., 2017, 14(3), 347-354.
[http://dx.doi.org/10.1513/AnnalsATS.201611-907OC] [PMID: 28231023]
[6]
Kageyama, A.; Yazawa, K.; Ishikawa, J.; Hotta, K.; Nishimura, K.; Mikami, Y. Nocardial infections in Japan from 1992 to 2001, including the first report of infection by Nocardia transvalensis. Eur. J. Epidemiol., 2004, 19(4), 383-389.
[http://dx.doi.org/10.1023/B:EJEP.0000024706.02325.c0] [PMID: 15180109]
[7]
Arjun, R.; Padmanabhan, A.; Reddy Attunuru, B.P.; Gupta, P. Disseminated nocardiosis masquerading as metastatic malignancy. Lung India, 2016, 33(4), 434-438.
[http://dx.doi.org/10.4103/0970-2113.184920] [PMID: 27578940]
[8]
Vijay Kumar, G.S.; Mahale, R.P.; Rajeshwari, K.G.; Rajani, R.; Shankaregowda, R. Primary facial cutaneous nocardiosis in a HIV patient and review of cutaneous nocardiosis in India. Indian J Sex Transm Dis AIDS, 2011, 32(1), 40-43.
[http://dx.doi.org/10.4103/0253-7184.81254] [PMID: 21799576]
[9]
Dhingra, M.; Kaistha, N.; Bansal, N.; Solanki, L.S.; Chander, J.; Thami, G.P.; van de Sande, W.W. Nocardia nova mycetoma over forehead in a lepromatous leprosy patient. Dermatol. Online J., 2012, 18(7), 3.
[PMID: 22863625]
[10]
Aggarwal, D.; Garg, K.; Chander, J.; Saini, V.; Janmeja, A.K. Pulmonary nocardiosis revisited: A case series. Lung India, 2015, 32(2), 165-168.
[http://dx.doi.org/10.4103/0970-2113.152638] [PMID: 25814804]
[11]
Ott, S.R.; Meier, N.; Kolditz, M.; Bauer, T.T.; Rohde, G.; Presterl, E.; Schürmann, D.; Lepper, P.M.; Ringshausen, F.C.; Flick, H.; Leib, S.L.; Pletz, M.W. OPINION Study Group. Pulmonary nocardiosis in Western Europe-Clinical evaluation of 43 patients and population-based estimates of hospitalization rates. Int. J. Infect. Dis., 2019, 81, 140-148.
[http://dx.doi.org/10.1016/j.ijid.2018.12.010] [PMID: 30658169]
[12]
Kurahara, Y.; Tachibana, K.; Tsuyuguchi, K.; Akira, M.; Suzuki, K.; Hayashi, S. Pulmonary nocardiosis: a clinical analysis of 59 cases. Respir. Investig., 2014, 52(3), 160-166.
[http://dx.doi.org/10.1016/j.resinv.2013.09.004] [PMID: 24853015]
[13]
Fujita, T.; Ikari, J.; Watanabe, A.; Tatsumi, K. Clinical characteristics of pulmonary nocardiosis in immunocompetent patients. J. Infect. Chemother., 2016, 22(11), 738-743.
[http://dx.doi.org/10.1016/j.jiac.2016.08.004] [PMID: 27615155]
[14]
Hemmersbach-Miller, M.; Stout, J.E.; Woodworth, M.H.; Cox, G.M.; Saullo, J.L. Nocardia infections in the transplanted host. Transpl. Infect. Dis., 2018, 20(4), e12902.
[http://dx.doi.org/10.1111/tid.12902] [PMID: 29668123]
[15]
Majeed, A.; Beatty, N.; Iftikhar, A.; Mushtaq, A.; Fisher, J.; Gaynor, P.; Kim, J.C.; Marquez, J.L.; Mora, F.E.; Georgescu, A.; Zangeneh, T. A 20-year experience with nocardiosis in solid organ transplant (SOT) recipients in the Southwestern United States: A single-center study. Transpl. Infect. Dis., 2018, 20(4), e12904.
[http://dx.doi.org/10.1111/tid.12904] [PMID: 29668074]
[16]
Singh, A.; Chhina, D.; Soni, R.K.; Kakkar, C.; Sidhu, U.S. Clinical spectrum and outcome of pulmonary nocardiosis: 5-year experience. Lung India, 2016, 33(4), 398-403.
[http://dx.doi.org/10.4103/0970-2113.184873] [PMID: 27578932]
[17]
Wadhwa, T.; Baveja, U.; Kumar, N.; Govil, D.; Sengupta, S. Clinical manifestations of nocardiosis: Study of risk factors and outcomes in a tertiary care hospital. J. Lab. Physicians, 2017, 9(4), 288-295.
[http://dx.doi.org/10.4103/JLP.JLP_111_16] [PMID: 28966493]
[18]
Kiska, D.L.; Hicks, K.; Pettit, D.J. Identification of medically relevant Nocardia species with an abbreviated battery of tests. J. Clin. Microbiol., 2002, 40(4), 1346-1351.
[http://dx.doi.org/10.1128/JCM.40.4.1346-1351.2002] [PMID: 11923355]
[19]
Brown-Elliott, B.A.; Brown, J.M.; Conville, P.S.; Wallace, R.J., Jr Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin. Microbiol. Rev., 2006, 19(2), 259-282.
[http://dx.doi.org/10.1128/CMR.19.2.259-282.2006] [PMID: 16614249]
[20]
Wong, L.K.; Barry, A.L.; Horgan, S.M. Comparison of six different criteria for judging the acceptability of sputum specimens. J. Clin. Microbiol., 1982, 16(4), 627-631.
[http://dx.doi.org/10.1128/JCM.16.4.627-631.1982] [PMID: 7153311]
[21]
Wilson, K.H.; Blitchington, R.B.; Greene, R.C. Amplification of bacterial 16S ribosomal DNA with polymerase chain reaction. J. Clin. Microbiol., 1990, 28(9), 1942-1946.
[http://dx.doi.org/10.1128/JCM.28.9.1942-1946.1990] [PMID: 2095137]
[22]
Wilson, J.W. Nocardiosis: updates and clinical overview. Mayo Clin. Proc., 2012, 87(4), 403-407.
[http://dx.doi.org/10.1016/j.mayocp.2011.11.016] [PMID: 22469352]
[23]
Maggiorelli, C.; Di Pierro, I.; Manta, C.; Maccari, U.; Galanti, I.; Scala, R. Nocardia and Lungs in COPD: Beyond Immuno-deficiencies. COPD, 2015, 12(3), 315-319.
[http://dx.doi.org/10.3109/15412555.2014.933951] [PMID: 25093624]
[24]
Sharma, N.L.; Mahajan, V.K.; Agarwal, S.; Katoch, V.M.; Das, R.; Kashyap, M.; Gupta, P.; Verma, G.K. Nocardial mycetoma: diverse clinical presentations. Indian J. Dermatol. Venereol. Leprol., 2008, 74(6), 635-640.
[http://dx.doi.org/10.4103/0378-6323.45110] [PMID: 19171991]
[25]
Welsh, O.; Vera-Cabrera, L.; Salinas-Carmona, M.C. Current treatment for nocardia infections. Expert Opin. Pharmacother., 2013, 14(17), 2387-2398.
[http://dx.doi.org/10.1517/14656566.2013.842553] [PMID: 24093436]
[26]
Jiang, Y.; Huang, A.; Fang, Q. Disseminated nocardiosis caused by Nocardia otitidiscaviarum in an immunocompetent host: A case report and literature review. Exp. Ther. Med., 2016, 12(5), 3339-3346.
[http://dx.doi.org/10.3892/etm.2016.3755] [PMID: 27882160]
[27]
Zheng, S.W. Disseminated nocardiosis due to Nocardia otitidiscaviarum: A case report and literature review. Asian Pac. J. Trop. Med., 2019, 12(4), 185-194.
[http://dx.doi.org/10.4103/1995-7645.257120]
[28]
Zhao, P.; Zhang, X.; Du, P.; Li, G.; Li, L.; Li, Z. Susceptibility profiles of Nocardia spp. to antimicrobial and antituberculotic agents detected by a microplate Alamar Blue assay. Sci. Rep., 2017, 7, 43660.
[http://dx.doi.org/10.1038/srep43660] [PMID: 28252662]

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