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Trimethoprim and Trimethoprim–Sulfamethoxazole (Cotrimoxazole)
Published in M. Lindsay Grayson, Sara E. Cosgrove, Suzanne M. Crowe, M. Lindsay Grayson, William Hope, James S. McCarthy, John Mills, Johan W. Mouton, David L. Paterson, Kucers’ The Use of Antibiotics, 2017
Jason A. Trubiano, M. Lindsay Grayson
Nocardia species that are potential human pathogens include N. asteroides, N. farcinica, N. brasiliensis, N. caviae, N. transvalensis, N. otitidiscaviarum, and N. nova, although the first three are the most frequent pathogens (Arduino et al., 1993; Schiff et al., 1993; Farina et al., 1995; Brown-Elliott et al., 2006). Nocardiosis can be an acute, subacute, or chronic suppurative infection that ranges from mild cutaneous or pulmonary disease to aggressive and often fatal dissemination, with the clinical presentation and course depending on the degree of host immune suppression. Pulmonary disease and bloodborne spread to other organs, particularly the CNS, are the major clinical manifestations of N. asteroides infection. Nocardia farcinica is notable for its propensity to cause serious systemic infection in both normal and immunocompromised patients and its greater resistance to many antibacterial agents (Schiff et al., 1993). Nocardia brasiliensis more frequently causes infections of the skin and soft tissues, such as mycetoma. Mycetomas are chronic lesions, often on the lower extremities, with draining sinuses exuding sulfur granules (Smego and Gallis, 1984; Georghiou and Blacklock, 1992). Nocardia transvalensis, a rare Nocardia species, causes primary pulmonary and disseminated disease mainly in immunosuppressed patients and generally displays greater antimicrobial resistance than other Nocardia species, but successful therapy with CoT has been reported (McNeil et al., 1992; Weinberger et al., 1995).
Bacterial infections after lung transplantation
Published in Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell, LUNG Transplantation, 2016
Jennifer Delacruz, Jennifer L. Steinbeck, Kenneth Pursell, David Pitrak
Nocardia, although encountered less frequently, is associated with an increase in mortality in LTRs. Husain and coworkers retrospectively reviewed the clinical histories and outcomes of 473 LTRs over a 9-year span. In their study Nocardia infection was diagnosed in 0.6% to 2.1% of LTRs, the overall mortality rate was 40%, and rate of Nocardiarelated mortality was 75%, which is much higher than that in previous studies. The researchers attributed this disparity to the fact that the study patient population had lung transplants exclusively, as well as an increased frequency of infection with Nocardia farcinica, which is a more virulent strain.63 LTRs with Nocardia pneumonia typically had nonspecific findings on imaging, and recipients of single-lung transplants frequently had native lung involvement, which the researchers presumed to be secondary to native structural and functional lung abnormalities rather than to reactivation of preexisting infection.63 The LTRs who were receiving Bactrim (TMP-SMX) prophylaxis were among the recipients in whom Nocardia developed, which illustrates that Bactrim-resistant strains exist.1,63 Bactrim prophylaxis should not preclude Nocardia as a potential pathogen in LTRs. Cutaneous lesions are the most common form of extrapulmonary disease.63 Cutaneous lesions have been reported in liver and renal transplant recipients; however, cutaneous lesions were not reported in the LTRs in this study or in other reviewed cases outside their institution. Hussain and coworkers concluded that unlike other transplant recipients, LTRs exhibit nonspecific symptoms.63 Like many other atypical pathogens, Nocardia is a great mimicker of other infection; therefore, Nocardia should be considered as a potential pathogen, especially in LTRs with progressive disease who are not responding to broad-spectrum antibiotics.1
Disseminated Nocardia farcinica infection associated with bacteraemia and osteomyelitis pubis in an elderly patient
Published in Infectious Diseases, 2023
Domingo Fernández Vecilla, Mary Paz Roche Matheus, Mikel Joseba Urrutikoetxea Gutiérrez, Felicitas Elena Calvo Muro, Cristina Aspichueta Vivanco, Iñigo López Azkarreta, Mikel Grau García, José Luis Díaz de Tuesta del Arco
N. farcinica is an aerobic actinomycete, Gram-positive branched bacillus, partially acid-alcohol-resistant with facultative intracellular growth and is present in soil, plants and water and has a global distribution. Inhalation is considered the predominant transmission route of Nocardia sp. infections [2], which is supported by the observation that most infections involve the lung [3]. Nocardia farcinica can be transmitted through other routes as well. Gastrointestinal transmission can occur through the ingestion of contaminated food, while cutaneous transmission can happen through direct inoculation. Cutaneous involvement can manifest in various clinical forms, including primary cutaneous, lymphocutaneous, actinomycetoma [4], and cutaneous involvement resulting from disseminated nocardiosis. These routes of transmission highlight the potential for Nocardia farcinica to cause infections through different modes of exposure [5].