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Rare Multidrug-Resistant Pulmonary Nocardiosis in AIDS

Cherry O Onaiwu1, Manasa Velagapudi2, Luay Sarsam1

  • 1Department of Internal Medicine, Creighton University Medical Center.

Cureus
|January 19, 2018
PubMed

Insights

Pulmonary nocardiosis, an opportunistic infection, can mimic other lung diseases, especially in immunocompromised patients. Early diagnosis and targeted therapy are crucial, particularly for multidrug-resistant Nocardia farcinica.

Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Pulmonology

Background:

  • Nocardiosis is an opportunistic infection primarily affecting individuals with compromised cell-mediated immunity.
  • Inhalation of contaminated dust particles is the main exposure route, with patients with acquired immune deficiency syndrome (AIDS) facing a higher risk of disseminated disease.
  • Pulmonary nocardiosis diagnosis is challenging due to its resemblance to other pulmonary conditions.

Observation:

  • A 64-year-old male patient diagnosed with AIDS presented with pulmonary nocardiosis.
  • The patient's condition did not improve with standard antibiotic treatments.
  • Further investigations identified the presence of the virulent and multidrug-resistant Nocardia farcinica species.

Findings:

  • Nocardia farcinica is a particularly virulent strain known for its multidrug resistance and propensity for dissemination.
  • Targeted antibiotic therapy, guided by susceptibility testing, led to the improvement of the patient's pulmonary symptoms.
  • The case highlights the importance of considering Nocardia farcinica in immunocompromised patients with refractory pulmonary infections.

Implications:

  • Clinicians should maintain a high index of suspicion for pulmonary nocardiosis in immunocompromised patients unresponsive to standard antimicrobial regimens.
  • Prompt susceptibility testing is essential for guiding effective treatment against Nocardia species, especially Nocardia farcinica.
  • Effective management of Nocardia farcinica infections requires tailored antibiotic strategies due to its significant antimicrobial resistance.
Keywords:
aidsnocardia farcinicapulmonary nocardia

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