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Fulminant Nocardiosis Due to a Multidrug-Resistant Isolate in a 12-Year-Old Immunocompetent Child

Olivia Senard1,2, Stéphane Blanot3, Gregory Jouvion4

  • 1Department of General Pediatrics and Infectious Diseases, AP-HP, Necker-Enfants malades University Hospital, Sorbonne Paris Cité, Paris, France.

Pediatrics
|February 2, 2018
PubMed

Insights

Nocardiosis, a rare infection, can be fatal in children, even those not immunocompromised. Early diagnosis and appropriate treatment are crucial due to multidrug-resistant Nocardia strains.

Area of Science:

  • Medical Microbiology
  • Pediatric Infectious Diseases
  • Clinical Case Reports

Background:

  • Nocardiosis is an opportunistic infection typically seen in immunocompromised adults.
  • It is infrequently recognized in pediatric populations, especially in immunocompetent children.
  • Prompt diagnosis and treatment are vital due to potential severity and antimicrobial resistance.

Observation:

  • A previously healthy child presented with abdominal pain and altered general status, initially suspected as a renal malignancy.
  • Clinical findings included lymphocytic meningitis, disseminated brain abscesses, and kidney cystic lesions.
  • Despite broad-spectrum antibiotics and supportive care, the patient experienced a fatal outcome.

Findings:

  • Cultures from renal biopsy and cerebrospinal fluid identified Nocardia species.
  • Species identification revealed a multidrug-resistant strain within the Nocardia elegans/aobensis/africana complex.
  • The case highlights diagnostic challenges in pediatric nocardiosis.

Implications:

  • This case underscores the importance of considering Nocardia infection in children with unexplained disseminated disease.
  • It emphasizes the need for awareness among pediatricians regarding Nocardia's varied presentations.
  • The findings highlight challenges in treating Nocardia due to intrinsic antimicrobial resistance patterns.

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