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Published on: November 7, 2020
[Nocardial pulmonary infection]
S Couraud1, R Houot, M Coudurier
1Service de pneumologie, Centre Hospitalier Lyon Sud, CHU Lyon, Pierre Bénite, France. scouraud@yahoo.fr
Introduction:
Nocardial pneumonias are due to a genus of aerobic, filamentous, partly acid-alcohol fast, mainly Gram positive, actinomycetes.
Case Report:
We report here two cases of nocardial pneumonia. The first was a 62 year old man with a history of fludaribine treatment and bone marrow transplant for lymphocytic leukaemia. During the investigation of pyrexia evidence of N. farcinica infection was found in the bronchial secretions. The second case was a man of 61 receiving long term corticosteroids and cytotoxic chemotherapy. Investigation of a pneumonia with pleural effusion found evidence, on culture of blood and pleural fluid, of disseminated infection with N. nova (cerebral, pleural, pulmonary and splenic).
Conclusion:
Nocardiosis is a rare cause of pneumonia mainly occurring in immuno-compromised adults (corticosteroid therapy, HIV infection, transplantation, cancer or leukaemia). It should be suspected in the presence of pleuro-pulmonary symptoms associated with neurological and cutaneous signs, general deterioration and weight loss. The microbiology laboratory should be advised of this eventuality as soon as possible in order to optimise the search for the organism.
Insights
Nocardial pneumonia, a rare infection caused by actinomycetes, primarily affects immunocompromised adults. Early suspicion and laboratory consultation are crucial for diagnosing this serious condition.
Area of Science:
- Medical Microbiology
- Infectious Diseases
Background:
- Nocardial pneumonias are caused by Nocardia, a genus of aerobic, filamentous, Gram-positive actinomycetes.
- These infections are rare but significant in immunocompromised individuals.
Observation:
- Two cases of nocardial pneumonia are presented in immunocompromised patients.
- Case 1: A 62-year-old man post-bone marrow transplant for lymphocytic leukemia developed N. farcinica infection.
- Case 2: A 61-year-old man on corticosteroids and chemotherapy presented with disseminated N. nova infection.
Findings:
- Nocardia species can cause severe pulmonary infections, particularly in immunocompromised hosts.
- Disseminated Nocardia infections can affect multiple organs, including the brain, pleura, lungs, and spleen.
- Diagnosis requires microbiological identification of the organism from clinical specimens.
Implications:
- Nocardiosis should be suspected in immunocompromised patients with pleuro-pulmonary symptoms, especially when accompanied by neurological or cutaneous signs.
- Prompt communication with the microbiology laboratory is essential for timely diagnosis and management.
- Early detection and appropriate antimicrobial therapy are critical for favorable outcomes in nocardiosis.
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