Disseminated Nocardia farcinica: literature review and fatal outcome in an immunocompetent patient.

Abstract:

BACKGROUND:Nocardia farcinica is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete. Nocardia spp. are opportunistic pathogens, and N. farcinica is the least common species of clinical importance. METHODS:Review of the recent literature and description of a immunocompetent patient with no known risk factors who contracted fatal N. farcinica sepsis. RESULTS:Positive pre-mortem and post-mortem cultures from the lung and synovium correlated with acute bronchopneumonia and synovitis at autopsy. Colonies of filamentous bacteria, which were not apparent in conventional hematoxylin and eosin-stained sections, were observed with gram and methenamine silver stains, but acid-fast stains were negative. A literature review revealed that disseminated N. farcinica often is associated with an underlying malignant tumor or autoimmune disease (88% of patients). Chemotherapy or corticosteroid treatments are additional risk factors. CONCLUSIONS:Trimethoprim-sulfamethoxazole typically is the first-line therapy for N. farcinica; treatment with amikacin and imipenem-cilastatin is used less often (7% of patients). Despite aggressive therapy, we observed that the death rate (39%) associated with N. farcinica in recent publications was eight percentage points higher than reported in a review from 2000.

journal_name

Surg Infect (Larchmt)

journal_title

Surgical infections

authors

Budzik JM,Hosseini M,Mackinnon AC Jr,Taxy JB

doi

10.1089/sur.2011.012

subject

Has Abstract

pub_date

2012-06-01 00:00:00

pages

163-70

issue

3

eissn

1096-2964

issn

1557-8674

journal_volume

13

pub_type

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