Disseminated Nocardia farcinica: literature review and fatal outcome in an immunocompetent patient. Surg Infect (Larchmt) 2012 Jun;13(3):163-70
Date
05/23/2012Pubmed ID
22612440Pubmed Central ID
PMC3375863DOI
10.1089/sur.2011.012Scopus ID
2-s2.0-84862859437 (requires institutional sign-in at Scopus site) 57 CitationsAbstract
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.
Author List
Budzik JM, Hosseini M, Mackinnon AC Jr, Taxy JBMESH terms used to index this publication - Major topics in bold
AgedAnti-Infective Agents
Fatal Outcome
Humans
Immunocompetence
Male
Nocardia Infections
Pneumonia, Bacterial
Synovitis
Trimethoprim, Sulfamethoxazole Drug Combination
