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Musculoskeletal infections associated with Nocardia species: a case series

Ryan B Khodadadi1, Jack W McHugh1, Supavit Chesdachai1

  • 1Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.

Journal of Bone and Joint Infection
|November 14, 2024
PubMed

Insights

Musculoskeletal Nocardia infections are rare but can be serious. Localized infections often resolve well with treatment, but disseminated Nocardia infections, especially in transplant recipients, carry a high mortality risk.

Area of Science:

  • Infectious Diseases
  • Musculoskeletal Infections
  • Medical Microbiology

Background:

  • Nocardia species are infrequent causes of musculoskeletal infections.
  • Existing literature primarily consists of case reports, limiting understanding of management and outcomes.
  • Further research is needed to elucidate effective treatment strategies and prognosis.

Purpose of the Study:

  • To investigate the clinical characteristics, management, and outcomes of musculoskeletal Nocardia infections.
  • To identify risk factors and prognostic indicators for these infections.
  • To provide insights into the effective treatment of Nocardia musculoskeletal infections.

Main Methods:

  • A multicenter retrospective cohort study was conducted.
  • Adult patients with culture-confirmed musculoskeletal Nocardia infections were included.
  • Data were collected from November 2011 to April 2022 across three Mayo Clinic centers.

Main Results:

  • Nine cases of musculoskeletal Nocardia infection were identified, predominantly in men (78%).
  • Infections varied, including septic arthritis, osteomyelitis, and pyomyositis. Disseminated disease occurred in 33% of cases, notably in solid organ transplant recipients.
  • Mortality was 22% at 1 year, exclusively in patients with disseminated Nocardia infections.

Conclusions:

  • Localized musculoskeletal Nocardia infections generally have favorable outcomes.
  • Disseminated Nocardia infections are associated with significantly higher mortality.
  • Surgical intervention is frequently required for management, and recurrence is possible.

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