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Published on: February 23, 2014
[Unusual gram positive rods, causing pneumonia]
W Bär1, J Wakili, G Márquez de Bär
1Carl-Thiem-Klinikum, Institut Medizinische Mikrobiologie, Cottbus. Mikrobiologie@ctk.de
Abstract:
In the last decade, a growing number of patients with pneumonia, caused by unusual gram positive rods have been observed. Mostly, the patients had been infected as a consequence of impaired immunity. In some cases, bioterrorist activities may also induce pneumonia by gram positive rods (B. anthracis). In order to bring these organisms to the attention of the medical community, we present three clinical cases and describe six species of gram positive rods, known to provoke this kind of pneumonias. Case 1 was a 84 years old patient with impaired lung function. He was suspicious of tuberculosis (Tbc). Nocardia spec. was isolated. Case 2 was an alcoholic of 46 years with pneumonia. Reactivation of Tbc was suspected. Actinomadura madurae has been isolated. Case 3 was a patient of 58 years with myelodysplastic syndrome (MDS) and pneumonia. N. asteroides was isolated. All patients shared impaired immunity (age, alcoholism, MDS) with impaired lung functions; Tbc had been suspected (Case 1 + 2). Infection by A. madurae was contained by Clindamycin. Therapy of Nocardia with Moxifloxacin (Case 1) or Bactrim (Case 3) was only partly effective. In the appendix, six species of gram positive rods which are known to cause pneumonia, are summarized (Nocardia, Actinomyceta, Actinomadura, Rhodococcus, Corynebacterium and Bacillus).
Insights
Unusual gram-positive rod pneumonias are increasing, particularly in immunocompromised patients. Early diagnosis and targeted antibiotic therapy are crucial for managing these infections.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Background:
- Gram-positive rods are increasingly recognized as causative agents of pneumonia, especially in individuals with compromised immune systems.
- Bioterrorism agents like Bacillus anthracis can also cause gram-positive rod pneumonia, necessitating heightened medical awareness.
Observation:
- Three clinical cases of pneumonia caused by gram-positive rods in elderly, alcoholic, and myelodysplastic syndrome patients are presented.
- Nocardia species and Actinomadura madurae were isolated from patients with suspected tuberculosis and impaired immunity.
- Patients presented with impaired immunity and lung function, complicating diagnosis and treatment.
Findings:
- Actinomadura madurae infection was successfully treated with Clindamycin.
- Therapy for Nocardia infections with Moxifloxacin or Bactrim showed only partial effectiveness.
- Six species of gram-positive rods (Nocardia, Actinomyceta, Actinomadura, Rhodococcus, Corynebacterium, and Bacillus) are known to cause pneumonia.
Implications:
- This study highlights the importance of considering unusual gram-positive rods in the differential diagnosis of pneumonia, particularly in at-risk populations.
- Effective treatment strategies require accurate identification of the causative organism and tailored antibiotic regimens.
- Further research is needed to optimize therapeutic approaches for these challenging infections.
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