Related Experiment Videos
Nocardiosis in liver transplantation: variation in presentation, diagnosis and therapy
G M Forbes1, F A Harvey, J N Philpott-Howard
1Liver Unit, King's College Hospital, London, U.K.
Abstract:
Nocardiosis arose in seven of 191 liver transplant patients (3.7%) over a period of 3.5 years. Four patients had only pulmonary lesions while three had disseminated disease. Nocardia asteroides was isolated from three patients following bronchoscopy, percutaneous aspirate of a pulmonary lesion in one patients, and from the skin from the aspirates in three patients. Delay in diagnosis in two cases was due to negative microscopy; in one, the diagnosis was made only after repeated bronchoscopy. Of the seven patients, three (43%) died. In two of these, nocardiosis was considered to have directly contributed to death. Co-existent bacterial and viral infections were present in all patients who died. In vitro susceptibility of the organism to co-trimoxazole was variable and did not necessarily reflect clinical efficacy. In one patient, a good clinical response was achieved with co-trimoxazole despite apparently reduced in vitro susceptibility.
Insights
Nocardiosis is a rare but serious infection in liver transplant recipients. Early diagnosis and treatment are crucial, as this opportunistic infection can be fatal, even with variable antibiotic susceptibility.
Area of Science:
- Infectious Diseases
- Transplant Surgery
- Microbiology
Background:
- Nocardiosis is an opportunistic infection caused by Nocardia species.
- Liver transplant recipients are immunocompromised and at risk for opportunistic infections.
- The incidence and clinical presentation of nocardiosis in liver transplant patients are not well-defined.
Purpose of the Study:
- To determine the incidence of nocardiosis in liver transplant recipients.
- To describe the clinical manifestations, diagnostic challenges, and outcomes of nocardiosis in this patient population.
- To evaluate the in vitro susceptibility of Nocardia asteroides to co-trimoxazole and its correlation with clinical efficacy.
Main Methods:
- Retrospective review of liver transplant recipients over a 3.5-year period.
- Identification of Nocardia asteroides through microbiological cultures (bronchoscopy, aspirates).
- Analysis of clinical data, including lesion sites, diagnostic delays, treatment, and patient outcomes.
Main Results:
- Seven out of 191 liver transplant patients (3.7%) developed nocardiosis.
- Pulmonary lesions were observed in four patients; disseminated disease occurred in three.
- Diagnosis was delayed in some cases due to negative microscopy or the need for repeated procedures. Three patients (43%) died, with nocardiosis contributing to death in two.
- In vitro susceptibility to co-trimoxazole was variable, and clinical response did not always correlate with susceptibility.
Conclusions:
- Nocardiosis is a significant opportunistic infection in liver transplant recipients, associated with high mortality.
- Diagnostic delays can occur, highlighting the importance of high clinical suspicion.
- Treatment with co-trimoxazole may be effective despite variable in vitro susceptibility, warranting careful clinical monitoring.