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Intracranial Nocardia dissemination during minocycline therapy
1Department of Nephrology/Infectious Disease, Erlanger Medical Center, University of Tennessee-Chattanooga Unit, 979 East Third Street, Chattanooga, TN 37403, USA.
Abstract:
Nocardia species is a well-known pathogen in immunocompromised hosts, including renal transplant recipients. Primary pulmonary infection can disseminate to other organs and recommended first-line therapy is high-dose trimethoprim/sulfamethoxazole (TMP/SMX). We report two cases of primary pulmonary Nocardia sp. in immunosuppressed patients who were treated with minocycline, a second-line drug. During treatment with minocycline, both patients developed central nervous system (CNS) lesions of Nocardia sp. and were then treated with TMP/SMX with resolution of disease. The literature on Nocardia and treatment with minocycline is reviewed. Treatment of pulmonary Nocardia sp. with 200 mg minocycline daily is not adequate to prevent disseminated CNS disease.
Insights
Minocycline is not adequate for treating pulmonary Nocardia infections in immunocompromised patients. Patients treated with minocycline developed central nervous system disease, requiring trimethoprim/sulfamethoxazole for resolution.
Area of Science:
- Infectious Diseases
- Microbiology
- Immunology
Background:
- Nocardia species are opportunistic pathogens, particularly affecting immunocompromised individuals like renal transplant recipients.
- Primary pulmonary Nocardia infections can lead to disseminated disease in other organs.
- High-dose trimethoprim/sulfamethoxazole (TMP/SMX) is the recommended first-line therapy.
Observation:
- Two cases of primary pulmonary Nocardia sp. in immunosuppressed patients treated with minocycline are presented.
- Both patients developed central nervous system (CNS) lesions despite minocycline treatment.
- Subsequent treatment with TMP/SMX resulted in disease resolution.
Findings:
- Daily minocycline (200 mg) was insufficient to prevent disseminated CNS Nocardia sp. in these patients.
- Minocycline may not be an adequate monotherapy for pulmonary Nocardia in immunocompromised hosts.
- TMP/SMX was effective in treating disseminated CNS Nocardia sp. after minocycline failure.
Implications:
- This study highlights the potential inadequacy of minocycline for pulmonary Nocardia in immunocompromised patients.
- Clinicians should be vigilant for CNS dissemination when using minocycline for Nocardia infections.
- TMP/SMX remains a crucial treatment option for Nocardia infections, especially when CNS involvement is suspected or confirmed.