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Cutaneous nocardiosis associated with insect bites
1Department of Emergency Medicine, Darnall Army Community Hospital, Fort Hood, Texas.
Cutis
|October 1, 1992
Summary
A rare case of skin infection, cutaneous nocardiosis, was linked to insect bites in an asplenic patient. Prompt treatment with specific antibiotics led to recovery, highlighting the importance of considering this diagnosis for non-responsive skin infections.
Area of Science:
- Medical Microbiology
- Dermatology
- Infectious Diseases
Background:
- Cutaneous nocardiosis is a bacterial infection typically caused by Nocardia species.
- Insect bites can serve as an inoculation route for various pathogens.
- Asplenic individuals are more susceptible to certain bacterial infections.
Observation:
- A healthy, asplenic 26-year-old male presented with fever, pustular insect bites on his leg, lymphangitis, and adenopathy.
- Initial treatment with intravenous nafcillin was ineffective.
- Wound and blood cultures identified Nocardia brasiliensis.
Findings:
- Nocardia brasiliensis infection was confirmed following insect bites.
- The patient responded well to a combination of intravenous amikacin and oral trimethoprim-sulfamethoxazole.
- Recovery was achieved with minimal scarring.
Implications:
- This case highlights insect bites as a potential, previously unreported, transmission route for cutaneous nocardiosis.
- Clinicians should consider Nocardia infection in cases of severe cutaneous infections unresponsive to standard antibiotic therapy, particularly in endemic areas like the southwestern United States.
- Early and appropriate antimicrobial treatment is crucial for favorable outcomes in Nocardia infections.