Open Access

Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital

  • Authors:
    • Meifang Yang
    • Min Xu
    • Wei Wei
    • Hainv Gao
    • Xuan Zhang
    • Hong Zhao
    • Jianhua Hu
    • Huihui Dong
    • Lichen Xu
    • Lanjuan Li
  • View Affiliations

  • Published online on: May 14, 2014     https://doi.org/10.3892/etm.2014.1715
  • Pages: 25-30
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Abstract

To the best of our knowledge, no Chinese case studies concerning Nocardia infection have been published to date. Therefore, the present study aimed to retrospectively evaluate the risk factors, clinical features, imaging results, laboratory abnormalities, treatments and outcomes of nocardiosis in a Chinese tertiary hospital. Data collected from patients with laboratory‑confirmed nocardiosis were retrospectively analyzed. A total of 40 patients who had a positive culture of Nocardia were included. The median time between the onset of symptoms and diagnosis was 42 days. Underlying diseases were identified in 72.5% of the patients of which diabetes was the most common (32.5%). The most important risk factor was corticosteroid administration. Fever and cough were common clinical symptoms. The pleuropulmonary (85%) were the most frequently involved sites and the disseminated disease rate was 30.0%. Frequent chest computed tomography scans revealed the presence of airspace opacities, nodules and masses, in addition to cavitary lesions that were particularly common among the study group. Brain images revealed lesions associated with abscesses. The majority of the patients (71.1%) were treated with trimethoprim sulfamethoxazole alone or in combination with other drugs. The in‑hospital mortality rate was 15.0%. Disseminated disease, immunocompromised patients, an older age, brain involvement and concomitant infections were associated with a poor prognosis. Nocardiosis is an uncommon but emerging disease. The present study reports the first case series on nocardiosis from China and provides important information on the clinical features and risk factors of nocardiosis. Early recognition of the disease and the initiation of appropriate treatment are essential for a good prognosis.

References

1 

Wilson JW: Nocardiosis: updates and clinical overview. Mayo Clin Proc. 87:403–407. 2012. View Article : Google Scholar : PubMed/NCBI

2 

Rosman Y, Grossman E, Keller N, Thaler M, Eviatar T, Hoffman C and Apter S: Nocardiosis: A 15-year experience in a tertiary medical center in Israel. Eur J Intern Med. 24:552–557. 2013.PubMed/NCBI

3 

Cattaneo C, Antoniazzi F, Caira M, Castagnola C, Delia M, Tumbarello M, et al: Nocardia spp infections among hematological patients: results of a retrospective multicenter study. Int J Infect Dis. 17:e610–614. 2013. View Article : Google Scholar : PubMed/NCBI

4 

Garcia-Bellmunt L, Sibila O, Solanes I, Sanchez-Reus F and Plaza V: Pulmonary nocardiosis in patients with COPD: characteristics and prognostic factors. Arch Bronconeumol. 48:280–285. 2012. View Article : Google Scholar : PubMed/NCBI

5 

Ambrosioni J, Lew D and Garbino J: Nocardiosis: updated clinical review and experience at a tertiary center. Infection. 38:89–97. 2010. View Article : Google Scholar : PubMed/NCBI

6 

Mootsikapun P, Intarapoka B and Liawnoraset W: Nocardiosis in Srinagarind Hospital, Thailand: review of 70 cases from 1996–2001. Int J Infect Dis. 9:154–158. 2005.

7 

Saubolle MA and Sussland D: Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol. 41:4497–4501. 2003. View Article : Google Scholar : PubMed/NCBI

8 

Castro JG and Espinoza L: Nocardia species infections in a large county hospital in Miami: 6 years experience. J Infec. 54:358–361. 2007.PubMed/NCBI

9 

Tuo MH, Tsai YH, Tseng HK, Wang WS, Liu CP and Lee CM: Clinical experiences of pulmonary and bloodstream nocardiosis in two tertiary care hospitals in northern Taiwan, 2000–2004. J Microbiol Immunol Infect. 41:130–136. 2008.PubMed/NCBI

10 

Zhao K, Dong MJ, Sheng ZK, Liu KF, Yang SY, Liu ZF and Sheng JF: Elevated uptake of 18F-FDG in PET/CT imaging of a nocardial pleural nodule. Clin Imaging. 36:383–385. 2012.

11 

Hannaman MJ and Ertl MJ: Patients with immunodeficiency. Med Clin North Am. 97:1139–1159. 2013. View Article : Google Scholar

12 

Matulionyte R, Rohner P, Uckay I, Lew D and Garbino J: Secular trends of nocardia infection over 15 years in a tertiary care hospital. J Clin Pathol. 57:807–812. 2004.PubMed/NCBI

13 

Martínez Tomás R, Menéndez Villanueva R, Reyes Calzada S, Santos Durantez M, Vallés Tarazona JM, Modesto Alapont M and Gobernado Serrano M: Pulmonary nocardiosis: risk factors and outcomes. Respirology. 12:394–400. 2007.

14 

Uhde KB, Pathak S, McCullum I Jr, Jannat-Khah DP, Shadomy SV, Dykewicz CA, et al: Antimicrobial-resistant Nocardia isolates, United States, 1995–2004. Clin Infect Dis. 51:1445–1448. 2010.PubMed/NCBI

15 

Tremblay J, Thibert L, Alarie I, Valiquette L and Pépin J: Nocardiosis in Quebec, Canada, 1988–2008. Clin Microbiol Infect. 17:690–696. 2011.

16 

Brown-Elliott BA, Biehle J, Conville PS, Cohen S, Saubolle M, Sussland D, et al: Sulfonamide resistance in isolates of Nocardia spp. from a US multicenter survey. J Clin Microbiol. 50:670–672. 2012.

17 

Lai CC, Liu WL, Ko WC, Chen YH, Tan HR, Huang YT and Hsueh PR: Multicenter study in Taiwan of the in vitro activities of nemonoxacin, tigecycline, doripenem, and other antimicrobial agents against clinical isolates of various Nocardia species. Antimicrob Agents Chemother. 55:2084–2091. 2011. View Article : Google Scholar

18 

Garcia del Palacio JI and Martín Pérez I: Response of pulmonary nocardiosis to ceftriaxone in a patient with AIDS. Chest. 103:1925–1926. 1993.PubMed/NCBI

19 

Lo W and Rolston KV: Use of imipenem in the treatment of pulmonary nocardiosis. Chest. 103:951–952. 1993. View Article : Google Scholar : PubMed/NCBI

20 

Fihman V, Berçot B, Mateo J, Losser MR, Raskine L, Riahi J, et al: First successful treatment of Nocardia farcinica brain abscess with moxifloxacin. J Infect. 52:e99–e102. 2006.

21 

Tanioka K, Nagao M, Yamamoto M, Matsumura Y, Tabu H, Matsushima A, et al: Disseminated Nocardia farcinica infection in a patient with myasthenia gravis successfully treated by linezolid: a case report and literature review. J Infect Chemother. 18:390–394. 2012.

22 

Ogawa T, Kasahara K, Yonekawa S, Nakagawa C, Maeda K, Konishi M, et al: Nocardia beijingensis pulmonary infection successfully treated with intravenous β-lactam antibiotics and oral minocycline. J Infect Chemother. 17:706–709. 2011. View Article : Google Scholar

23 

Lewis KE, Ebden P, Wooster SL, Rees J and Harrison GA: Multi-system infection with Nocardia farcinica-therapy with linezolid and minocycline. J Infect. 46:199–202. 2003. View Article : Google Scholar : PubMed/NCBI

24 

Shen Q, Zhou H, Li H and Zhou J: Linezolid combined with trimethoprim-sulfamethoxazole therapy for the treatment of disseminated nocardiosis. J Med Microbiol. 60:1043–1045. 2011. View Article : Google Scholar : PubMed/NCBI

25 

Yu X, Han F, Wu J, He Q, Peng W, Wang Y, et al: Nocardia infection in kidney transplant recipients: case report and analysis of 66 published cases. Transpl Infect Dis. 13:385–391. 2011. View Article : Google Scholar

26 

Shen T, Wu L, Geng L, Wei Z and Zheng S: Successful treatment of pulmonary Nocardia farcinica infection with linezolid: case report and literature review. Braz J Infect Dis. 15:486–489. 2011.

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July 2014
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Copy and paste a formatted citation
APA
Yang, M., Xu, M., Wei, W., Gao, H., Zhang, X., Zhao, H. ... Li, L. (2014). Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital. Experimental and Therapeutic Medicine, 8, 25-30. https://doi.org/10.3892/etm.2014.1715
MLA
Yang, M., Xu, M., Wei, W., Gao, H., Zhang, X., Zhao, H., Hu, J., Dong, H., Xu, L., Li, L."Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital". Experimental and Therapeutic Medicine 8.1 (2014): 25-30.
Chicago
Yang, M., Xu, M., Wei, W., Gao, H., Zhang, X., Zhao, H., Hu, J., Dong, H., Xu, L., Li, L."Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital". Experimental and Therapeutic Medicine 8, no. 1 (2014): 25-30. https://doi.org/10.3892/etm.2014.1715