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Primary cutaneous Nocardia otitidiscaviarum infection: case report and review
N M Clark1, D K Braun, A Pasternak
1Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor, USA.
Abstract:
Organisms of the genus Nocardia cause a variety of illnesses in humans and other mammals. Nocardiae normally enter the body via the respiratory tract, but they may also be directly inoculated into the skin, causing primary cutaneous disease. Nocardia otitidiscaviarum is one of the less commonly isolated species of Nocardia, but it can produce localized or disseminated infection. We report a case of primary cutaneous N. otitidiscaviarum infection and review the clinical and microbiological features of other reported cases. Cutaneous N. otitidiscaviarum infection usually occurs in the setting of trauma, most often in otherwise healthy hosts. The manifestations of N. otitidiscaviarum skin infection range from cellulitis and abscess formation to the development of mycetomas. Cutaneous infection by N. otitidiscaviarum can mimic disease caused by more common pyogenic organisms, often leading to delay in diagnosis and treatment. Appropriate antibiotic therapy, usually with a sulfa drug-containing regimen, is generally successful.
Insights
Nocardia otitidiscaviarum can cause primary skin infections, often after trauma in healthy individuals. Prompt diagnosis and sulfa drug treatment are key to successful outcomes for this rare Nocardia species.
Area of Science:
- Medical Microbiology
- Dermatology
- Infectious Diseases
Background:
- Nocardia species are Gram-positive bacteria known to cause opportunistic infections in mammals.
- Nocardiae typically enter the host via the respiratory tract or direct inoculation, leading to cutaneous or systemic disease.
- Nocardia otitidiscaviarum is a less common Nocardia species implicated in human infections.
Observation:
- This report details a case of primary cutaneous Nocardia otitidiscaviarum infection.
- Cutaneous infections by N. otitidiscaviarum frequently follow skin trauma in immunocompetent hosts.
- Clinical presentations vary, including cellulitis, abscesses, and mycetomas.
Findings:
- Nocardia otitidiscaviarum skin infections can mimic other pyogenic bacterial infections, potentially delaying diagnosis.
- Microbiological identification is crucial for differentiating N. otitidiscaviarum from more common pathogens.
- Treatment typically involves antibiotic regimens containing sulfonamides.
Implications:
- Increased awareness of Nocardia otitidiscaviarum as a cause of cutaneous infections is necessary for timely diagnosis.
- Understanding the clinical spectrum aids in distinguishing these infections from more common skin conditions.
- Effective antibiotic strategies, particularly sulfa drugs, offer a favorable prognosis.