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Failure of trimethoprim/sulfamethoxazole in invasive Nocardia asteroides infection
Abstract:
A case of pulmonary nocardiosis occurred with progressive involvement of the pleura, pericardium, mediastinum, and sternum. Surgical resection and drainage procedures followed by administration of the drug combination, trimethoprim/sulfamethoxazole, over a six-month period led to clinical recovery. Discontinuation of drug therapy, however, was followed by relapse and further invasion by the same organism. A literature survey of Nocardia asteroides infections treated with trimethoprim/sulfamethoxazole disclosed that posttreatment follow-up is often too brief or unknown, making the ultimate success of therapy uncertain.
Insights
Pulmonary nocardiosis can spread to surrounding structures. Prolonged trimethoprim/sulfamethoxazole treatment and extended follow-up are crucial for successful Nocardia asteroides infection management.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Background:
- Nocardiosis is an opportunistic infection caused by Nocardia species.
- Pulmonary involvement is common, with potential for extrapulmonary dissemination.
Observation:
- A case of severe pulmonary nocardiosis with extensive pleural, pericardial, mediastinal, and sternal involvement is presented.
- Initial treatment involved surgical resection, drainage, and a six-month course of trimethoprim/sulfamethoxazole, leading to clinical recovery.
Findings:
- Discontinuation of antibiotic therapy resulted in disease relapse and further progression.
- A literature review indicated that many Nocardia asteroides infections treated with trimethoprim/sulfamethoxazole have uncertain outcomes due to insufficient post-treatment follow-up.
Implications:
- This case highlights the importance of extended treatment durations for invasive nocardiosis.
- The findings underscore the necessity for prolonged patient monitoring to ensure sustained remission and prevent relapse.
- Optimizing treatment strategies for Nocardia infections requires careful consideration of patient follow-up duration.