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Disseminated Nocardia otitidiscaviarum in a patient with AIDS

R M Sandre1, R C Summerbell

  • 1Haven (HIV) Clinic, Laurentian Hospital, Sudbury, Ontario; Ontario Ministry of Health, Laboratory Services Branch, Etobicoke, Ontario; University of Toronto, Department of Clinical Biochemistry, Toronto, Ontario.

The Canadian Journal of Infectious Diseases = Journal Canadien Des Maladies Infectieuses
|February 21, 2012
PubMed

Insights

Disseminated Nocardia otitidiscaviarum infection occurred in an HIV-positive man. Prompt treatment with surgery and antibiotics led to recovery, but long-term therapy prevented recurrence of this rare bacterial infection.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Immunology

Background:

  • Nocardia otitidiscaviarum is an opportunistic pathogen that can cause disseminated infections, particularly in immunocompromised individuals.
  • Human immunodeficiency virus (HIV) infection can lead to a weakened immune system, increasing susceptibility to opportunistic infections like nocardiosis.
  • Disseminated nocardiosis can present with diverse clinical manifestations, often mimicking other infectious or inflammatory conditions.

Observation:

  • A case of disseminated Nocardia otitidiscaviarum infection is presented in a Caucasian male with human immunodeficiency virus (HIV).
  • The patient had a CD4 lymphocyte count of 206 cells/mm(3) and presented with intra-abdominal and chest wall abscesses and bilateral pulmonary infiltrates.
  • No prior AIDS-defining conditions were noted at the time of presentation.

Findings:

  • Aggressive surgical debridement combined with antimicrobial therapy, specifically trimethoprim/sulfamethoxazole and amikacin, achieved clinical cure.
  • The treatment regimen was effective in resolving the disseminated Nocardia otitidiscaviarum infection.
  • Long-term suppressive antimicrobial therapy was crucial for preventing relapse of the infection.

Implications:

  • This case highlights the importance of considering Nocardia infections in immunocompromised patients, even those without advanced HIV disease.
  • Effective management involves a combination of surgical intervention and appropriate antimicrobial agents.
  • Long-term suppressive therapy is essential for preventing recurrence in patients with disseminated nocardiosis and underlying immunosuppression.

Keywords:
AIDSHuman immunodeficiency virusNocardia otitidiscaviarum

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