Disseminated nocardiosis caused by Nocardia otitidiscaviarum in an immunocompetent host: A case report and literature review

Jiang,Yanwen; Huang,Aiben; Fang,Qiuhong

doi:10.3892/etm.2016.3755

Disseminated nocardiosis caused by Nocardia otitidiscaviarum in an immunocompetent host: A case report and literature review

Authors:
- Yanwen Jiang
- Aiben Huang
- Qiuhong Fang
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Affiliations: Department of Respiratory and Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, P.R. China
Published online on: September 28, 2016 https://doi.org/10.3892/etm.2016.3755
Pages: 3339-3346

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Abstract

The aim of the present study was to summarize the clinical characteristics of nocardiosis caused by Nocardia otitidiscaviarum in order to improve the knowledge of nocardiosis. A case of dissemination nocardiosis caused by N. otitidiscaviarum in an immunocompetent host is reported and the associated literature reviewed. Informed consent for publication of this case report was provided by the patient. The present patient was a young immunocompetent man suffering from disseminated nocardiosis induced by infection with N. otitidiscaviarum. Following a poor response to β‑lactam antibiotic, a combination of sulfonamide with minocycline was administered, which successfully ameliorated the symptoms. Previous studies published in English were retrieved from PubMed with ̔Nocardia otitidiscaviarum̓ used as the search keyword. A total of 23 articles were retrieved from the PubMed database, supporting the assertion that N. otitidiscaviarum is a rare Nocardia species. Among these 23 cases, there were 11 cases of lymphocutaneous (48%), 5 of pulmonary (22%), 2 of brain (9%) and 1 of pyothorax (4%) infection, and 4 cases of disseminated infections (17%). Analysis of the immune state of these patients demonstrated that 9 were immunocompetent (39%), 7 of whom had cutaneous infections (30%) with a predominant history of trauma (6/7), and 14 were immunosuppressed, 9 of whom were treated with prednisolone. Microbiology and histopathology were necessary in all cases for definite diagnosis. Among the 13 cases who underwent drug susceptibility testing, 10 cases were sensitive to trimethoprim-sulfamethoxazole (TMP‑SMX) and 12 cases were sensitive to aminoglycoside. In conclusion, although N. otitidiscaviarum is one of the less commonly isolated species of Nocardia, it is capable of inducing localized or disseminated infection, even in an immunocompetent host. The majority of cases respond well to TMP‑SMX and aminoglycoside, but the therapeutic action of cephalosporin is weak. Identification of bacteria and drug sensitivity tests for Nocardia is critical for guiding clinical treatment.

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1	Faghri J, Bourbour S, Moghim S, Meidani M, Safaei HG, Hosseini N, Esfahani BN, Fazeli H and Sedighi M: Comparison of three phenotypic and deoxyribonucleic acid extraction methods for isolation and identification of Nocardia spp. Adv Biomed Res. 3:151–154. 2014. View Article : Google Scholar : PubMed/NCBI
2	Yaşar Z, Acat M, Onaran H, Ozgü MA, Fener N, Talay F and Cetinkaya E: An unusual case of pulmonary nocardiosis in immunocompetent patient. Case Rep Pulmonol. 2014:9634822014.PubMed/NCBI
3	Shahapur PR, Peerapur BV, Shahapur RP, Honnutagi RM and Biradar MS: Lymphocutaneous nocardiosis caused by Nocardia otitidiscaviarum. A case report and review of literature. J Nat Sci Biol Med. 5:197–201. 2014. View Article : Google Scholar : PubMed/NCBI
4	Ramamoorthi K, Pruthvi BC, Rao NR, Belle J and Chawla K: Pulmonary nocardiosis due to Nocardia otitidiscaviarum in an immunocompetent host - a rare case report. Asian Pac J Trop Med. 4:414–416. 2011. View Article : Google Scholar : PubMed/NCBI
5	Chen B, Zhu LY, Xuan X, Wu LJ, Zhou TL, Zhang XQ and Li BX: Isolation of both Pseudozyma aphidis and Nocardia otitidiscaviarum from a mycetoma on the leg. Int J Dermatol. 50:714–719. 2011. View Article : Google Scholar : PubMed/NCBI
6	Betrán A, Villuendas MC, Rezusta A, Moles B, Rubio MC, Revillo MJ, Boiron P, Bello S and Rodríguez-Nava V: Cavitary pneumonia caused by Nocardia otitidiscaviarum. Braz J Microbiol. 41:329–332. 2010. View Article : Google Scholar : PubMed/NCBI
7	Pelaez AI, Garcia-Suarez MM, Manteca A, Melon O, Aranaz C, Cimadevilla R, Mendez FJ and Vazquez F: A fatal case of Nocardia otitidiscaviarum pulmonary infection and brain abscess: Taxonomic characterization by molecular techniques. Ann Clin Microbiol Antimicrob. 8:11–16. 2009. View Article : Google Scholar : PubMed/NCBI
8	Thoms KM, Zimmermann O, Schupp P, Thoms S and Emmert S: Nocardia otitidiscaviarum: Cause of long-term cutaneous abscesses on the leg of an immunocompetent man. Arch Dermatol. 143:1086–1087. 2007. View Article : Google Scholar : PubMed/NCBI
9	Sharma M, Gilbert BC, Benz RL and Santoro J: Disseminated Nocardia otitidiscaviarum infection in a woman with sickle cell anemia and end-stage renal disease. Am J Med Sci. 333:372–375. 2007. View Article : Google Scholar : PubMed/NCBI
10	Fabre S, Gibert C, Lechiche C, Jorgensen C and Sany J: Primary cutaneous Nocardia otitidiscaviarum infection in a patient with rheumatoid arthritis treated with infliximab. J Rheumatol. 32:2432–2433. 2005.PubMed/NCBI
11	Yoshida K, Bandoh S, Fujita J, Tokuda M, Negayama K and Ishida T: Pyothorax caused by Nocardia otitidiscaviarum in a patient with rheumatoid vasculitis. Intern Med. 43:615–619. 2004. View Article : Google Scholar : PubMed/NCBI
12	Hemmersbach-Miller M, Martel AC, Benítez AB and Sosa AO: Brain abscess due to Nocardia otitidiscaviarum: Report of a case and review. Scand J Infect Dis. 36:381–384. 2004. View Article : Google Scholar : PubMed/NCBI
13	Dikensoy O, Filiz A, Bayram N, Balci I, Zer Y, Celik G and Ekinci E: First report of pulmonary Nocardia otitidiscaviarum infection in an immunocompetent patient from Turkey. Int J Clin Pract. 58:210–213. 2004. View Article : Google Scholar : PubMed/NCBI
14	Alberts JH and Boyd AS: Nocardia otitidiscaviarum: An unusual Nocardia species causing a primary lymphocutaneous infectious process in a mildly immunosuppressed patient. Skinmed. 1:62–64. 2002. View Article : Google Scholar : PubMed/NCBI
15	Wada A, Matsuda S, Kubota H, Miura H and Iwamoto Y: Primary lymphocutaneous nocardiosis caused by Nocardia otitidiscaviarum. Hand Surg. 7:285–287. 2002. View Article : Google Scholar : PubMed/NCBI
16	Durán E, López L, Martínez A, Comuñas F, Boiron P and Rubio MC: Primary brain abscess with Nocardia otitidiscaviarum in an intravenous drug abuser. J Med Microbiol. 50:101–103. 2001.PubMed/NCBI
17	Hartmann A, Halvorsen CE, Jenssen T, Bjørneklett A, Brekke IB, Bakke SJ, Hirschberg H, Tønjum T and Gaustad P: Intracerebral abscess caused by Nocardia otitidiscaviarum in a renal transplant patient cured by evacuation plus antibiotic therapy. Nephron. 86:79–83. 2000. View Article : Google Scholar : PubMed/NCBI
18	Taniguchi H, Mukae H, Ashitani J, Ihi T, Sakamoto A, Kohno S and Matsukura S: Pulmonary Nocardia otitidiscaviarum infection in a patient with chronic respiratory infection. Intern Med. 37:872–876. 1998. View Article : Google Scholar : PubMed/NCBI
19	Sandre RM and Summerbell RC: Disseminated Nocardia otitidiscaviarum in a patient with AIDS. Can J Infect Dis. 8:347–350. 1997. View Article : Google Scholar : PubMed/NCBI
20	Mereghetti L, van der Mee-Marquet N, Dubost AF and Boiron P: Nocardia otitidiscaviarum infection of a traumatic skin wound. Eur J Clin Microbiol Infect Dis. 16:383–384. 1997. View Article : Google Scholar : PubMed/NCBI
21	Suzuki Y, Toyama K, Utsugi K, Yazawa K, Mikami Y, Fujita M and Shinkai H: Primary lymphocutaneous nocardiosis due to Nocardia otitidiscaviarum: The first case report from Japan. J Dermatol. 22:344–347. 1995. View Article : Google Scholar : PubMed/NCBI
22	Clark NM, Braun DK, Pasternak A and Chenoweth CE: Primary cutaneous Nocardia otitidiscaviarum infection: case report and review. Clin Infect Dis. 20:1266–1270. 1995. View Article : Google Scholar : PubMed/NCBI
23	Castelli L, Zlotnik H, Ponti R and Vidotto V: First reported Nocardia otitidiscaviarum infection in an AIDS patient in Italy. Mycopathologia. 126:131–136. 1994. View Article : Google Scholar : PubMed/NCBI
24	Yang LJ, Chan HL, Chen WJ and Kuo TT: Lymphocutaneous nocardiosis caused by Nocardia caviae: The first case report from Asia. J Am Acad Dermatol. 29:639–41. 1993. View Article : Google Scholar : PubMed/NCBI
25	Simmons BP, Gelfand MS and Roberts GD: Nocardia otitidiscaviarum (caviae) infection in a heart transplant patient presented as having a thigh abscess (Madura thigh). J Heart Lung Transplant. 11:824–826. 1992.PubMed/NCBI
26	Snijders EP: Verslag van het wetenschappenllijk gdeelte der vergaderingen van der afdelling Sumatras oostkurst. Geneesk Tijdschr Ned Indie. 64:75–77. 1924.(In Dutch).
27	Ferreira NP and Tracey RP: Numerical taxonomy of cholesterol-degrading soil bacteria. J Appl Microbiol. 57:429–446. 2008.
28	Goodfellow M, Kämpfer P, Busse HJ, Trujillo ME, Suzuki KI, Ludwig W and Whitman WB: The ActinobacteriaBergeys Manual of Systematic Bacteriology. 5. 2nd. Springer; New York, NY: 2012, View Article : Google Scholar
29	Gomez-Flores A, Welsh O, Said-Fernández S, Lozano-Garza G, Tavar-Alejandro RE and Vera-Cabrera L: In Vitro and In Vivo Activities of Antimicrobials against Nocardia brasiliensis. Antimicrob Agents Chemother. 48:832–837. 2004. View Article : Google Scholar : PubMed/NCBI
30	Brown-Elliott BA, Brown JM, Conville PS and Wallace RJ Jr: Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev. 19:259–282. 2006. View Article : Google Scholar : PubMed/NCBI
31	Schaal KP and Lee HJ: Actinomycete infections in humans: A review. Gene. 115:201–211. 1992. View Article : Google Scholar : PubMed/NCBI
32	Duran E, Lopez L, Martinez A, Comuñas F, Boiron P and Rubio MC: Primary brain abscess with Nocardia otitidiscaviarum in an intravenous drug abuser. J Med Microbiol. 50:101–103. 2001.PubMed/NCBI
33	Tan CK, Lai CC and Lin SH: Clinical and microbiological characteristics of Nocardiosis including those caused by emerging Nocardia species in Taiwan, 1998–2008. Clin Microbiol Infect. 16:966–972. 2010. View Article : Google Scholar : PubMed/NCBI
34	Mari B, Montón C and Mariscal D: Pulmonary nocardiosis: Clinical experience in ten cases. Respiration. 68:382–388. 2001. View Article : Google Scholar : PubMed/NCBI
35	Miralles GD: Disseminated Nocardia farcinica infection in an AIDS patient. Eur J Clin Microbiol Infect Dis. 13:497–500. 1994. View Article : Google Scholar : PubMed/NCBI
36	McNeil MM and Brown JM: The medically important aerobic actinomycetes: Epidemiology and microbiology. Clin Micmbiol Rev. 7:357–417. 1994. View Article : Google Scholar
37	Zhang W, Peng GJ, Liu J, Hu H and Liang H: Identification of rare Nocardia otitidiscaviarum and its drug sensitivity analysis. Int J Lab Med. 35:1320–1325. 2014.