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Systemic Nocardiosis as Unusual Clinical Onset of Late Advanced HIV Infection: A Case Report

Received: 3 August 2018     Accepted: 12 September 2018     Published: 25 October 2018
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Abstract

The genus Nocardia includes aerobic actinomycetes causing disease in both humans and animals. Nocardiosis is a rare bacterial infection, but the incidence of human disease has increased in the recent years in association with an increasing population of immune-compromised hosts and the improved methods for detection and identification of Nocardia spp. in the clinical laboratory. All those situations of immune-system compromise are conditions associated with increased risk, especially when cell-mediated immunity is involved. The prognosis depends both upon the immediacy of therapy initiation, concomitant disorders and the immune status of the patient. Recently cases of multi-drug resistance nocardiosis and the epidemiology and drug susceptibility of less common Nocardia species have been described. In HIV positive patients pulmonary nocardiosis, the most common clinical presentation, has a low reported prevalence of 0.3%, and it is not considered an AIDS-defining disease. The difficulties in isolation, the non-specific clinical and radiologic presentation, and the widespread use of cotrimoxazole (TMP/SMX) prophylaxis could be responsible for this low prevalence. In this paper, it is described a rare and fatal case of systemic nocardiosis arising with chest pain in a patient with a severe immune deficiency, unaware of his HIV positivity. Systemic nocardiosis is generally caused by N. asteroids and the prognosis is good, but in patients with AIDS, mortality in disseminated forms with central nervous system involvement is more than 50%.

Published in International Journal of Infectious Diseases and Therapy (Volume 3, Issue 3)
DOI 10.11648/j.ijidt.20180303.13
Page(s) 62-65
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2018. Published by Science Publishing Group

Keywords

Disseminated Nocardiosis, AIDS, Late Advanced Naive

References
[1] Fatahi-Bafghi M. Nocardiosis from 1888 to 2017. Microb Pathog. 114:369-384, 2018.
[2] Conville P.S., Brown-Elliott B.A., Smith T., Zelazny A.M. The Complexities of Nocardia Taxonomy and Identification. J Clin Microbiol. 56(1), 2017.
[3] Brown-Elliott B.A., Brown J.M., Conville P.S. and Wallace R.J. Jr. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev 19: 259-282, 2006.
[4] Corti M.E., Villafafie Fioti M.F. Nocardiosis: a review. Int J Infect Dis 7: 243-250, 2003.
[5] Wilson J.W. Nocardiosis: Updates and Clinical Overview. Mayo Clin Proc. 87(4):403-407, 2012.
[6] Yu S., Wang J., Fang Q., Zhang J., Yan F. Specific clinical manifestations of Nocardia: A case report and literature review. Exp Ther Med. 12(4): 2021–2026, 2016.
[7] Peleg A.Y., Husain S., Qureshi Z.A. et al. Risk factors, clinical characteristics, and outcome of Nocardia infection in organ transplant recipients: a matched case-control study. Clin Infect Dis. 44:1307–1314, 2007.
[8] Kim Y.K., Sung H., Jung J. et al. Impact of immune status on the clinical characteristics and treatment outcomes of nocardiosis. Diagn Microbiol Infect Di. 85(4):482-7, 2016.
[9] Senard O. Blanot S. Jouvion G. et al. Fulminant Nocardiosis Due to a Multidrug-Resistant Isolate in a 12-Year-Old Immunocompetent Child. Pediatrics. 141(2). pii: e20163131. doi: 10.1542/peds.2016-3131, 2018.
[10] Cooper C.J., Said S., Popp M. et al. A complicated case of an immunocompetent patient with disseminated nocardiosis. Infect Dis Rep. 6(1):5327, 2014.
[11] Valdezate S., Garrido N., Carrasco G. et al. Epidemiology and susceptibility to antimicrobial agents of the main Nocardia species in Spain. J Antimicrob Chemother. 72(3):754-761, 2017.
[12] Haussaire D., Fournier P.E., Djiguiba K. et al. Nocardiosis in the south of France over a 10-years period, 2004-2014. Int J Infect Dis. 57:13-20, 2017.
[13] King A.S., Castro J.G., Dow G.C. Nocardia farcinica lung abscess presenting in the context of advanced HIV infection: spontaneous resolution in response to highly active antiretroviral therapy alone. Can J Infect Dis Med Microbiol. 20:103–106, 2009.
[14] Palmer D.L., Harvey R.L., Wheeler J.K. Diagnostic and therapeutic considerations in Nocardia asteroids infection. Medicine (Baltimore). 53:391-401, 1974.
[15] Lucas S.B., Hounnou A., Peacock C., Beaumel A., Kadio A., De Cock K.M. Nocardiosis in HIV-positive patients: an autopsy study in West Africa. Tuber Lung Dis. 75:301-307, 1994.
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  • APA Style

    Santoro Carmen Rita, Brindicci Gaetano, Mazzola Michele, Giannelli Anna, Infante Giovanni, et al. (2018). Systemic Nocardiosis as Unusual Clinical Onset of Late Advanced HIV Infection: A Case Report. International Journal of Infectious Diseases and Therapy, 3(3), 62-65. https://doi.org/10.11648/j.ijidt.20180303.13

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    ACS Style

    Santoro Carmen Rita; Brindicci Gaetano; Mazzola Michele; Giannelli Anna; Infante Giovanni, et al. Systemic Nocardiosis as Unusual Clinical Onset of Late Advanced HIV Infection: A Case Report. Int. J. Infect. Dis. Ther. 2018, 3(3), 62-65. doi: 10.11648/j.ijidt.20180303.13

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    AMA Style

    Santoro Carmen Rita, Brindicci Gaetano, Mazzola Michele, Giannelli Anna, Infante Giovanni, et al. Systemic Nocardiosis as Unusual Clinical Onset of Late Advanced HIV Infection: A Case Report. Int J Infect Dis Ther. 2018;3(3):62-65. doi: 10.11648/j.ijidt.20180303.13

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  • @article{10.11648/j.ijidt.20180303.13,
      author = {Santoro Carmen Rita and Brindicci Gaetano and Mazzola Michele and Giannelli Anna and Infante Giovanni and Fiorella Carmen Silvia and Pappalettera Antonio and Capodivento Saverio and Cascarano Marina and Quinto Nicola and Losappio Ruggero and Laura Monno},
      title = {Systemic Nocardiosis as Unusual Clinical Onset of Late Advanced HIV Infection: A Case Report},
      journal = {International Journal of Infectious Diseases and Therapy},
      volume = {3},
      number = {3},
      pages = {62-65},
      doi = {10.11648/j.ijidt.20180303.13},
      url = {https://doi.org/10.11648/j.ijidt.20180303.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20180303.13},
      abstract = {The genus Nocardia includes aerobic actinomycetes causing disease in both humans and animals. Nocardiosis is a rare bacterial infection, but the incidence of human disease has increased in the recent years in association with an increasing population of immune-compromised hosts and the improved methods for detection and identification of Nocardia spp. in the clinical laboratory. All those situations of immune-system compromise are conditions associated with increased risk, especially when cell-mediated immunity is involved. The prognosis depends both upon the immediacy of therapy initiation, concomitant disorders and the immune status of the patient. Recently cases of multi-drug resistance nocardiosis and the epidemiology and drug susceptibility of less common Nocardia species have been described. In HIV positive patients pulmonary nocardiosis, the most common clinical presentation, has a low reported prevalence of 0.3%, and it is not considered an AIDS-defining disease. The difficulties in isolation, the non-specific clinical and radiologic presentation, and the widespread use of cotrimoxazole (TMP/SMX) prophylaxis could be responsible for this low prevalence. In this paper, it is described a rare and fatal case of systemic nocardiosis arising with chest pain in a patient with a severe immune deficiency, unaware of his HIV positivity. Systemic nocardiosis is generally caused by N. asteroids and the prognosis is good, but in patients with AIDS, mortality in disseminated forms with central nervous system involvement is more than 50%.},
     year = {2018}
    }
    

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    T1  - Systemic Nocardiosis as Unusual Clinical Onset of Late Advanced HIV Infection: A Case Report
    AU  - Santoro Carmen Rita
    AU  - Brindicci Gaetano
    AU  - Mazzola Michele
    AU  - Giannelli Anna
    AU  - Infante Giovanni
    AU  - Fiorella Carmen Silvia
    AU  - Pappalettera Antonio
    AU  - Capodivento Saverio
    AU  - Cascarano Marina
    AU  - Quinto Nicola
    AU  - Losappio Ruggero
    AU  - Laura Monno
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    T2  - International Journal of Infectious Diseases and Therapy
    JF  - International Journal of Infectious Diseases and Therapy
    JO  - International Journal of Infectious Diseases and Therapy
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    PB  - Science Publishing Group
    SN  - 2578-966X
    UR  - https://doi.org/10.11648/j.ijidt.20180303.13
    AB  - The genus Nocardia includes aerobic actinomycetes causing disease in both humans and animals. Nocardiosis is a rare bacterial infection, but the incidence of human disease has increased in the recent years in association with an increasing population of immune-compromised hosts and the improved methods for detection and identification of Nocardia spp. in the clinical laboratory. All those situations of immune-system compromise are conditions associated with increased risk, especially when cell-mediated immunity is involved. The prognosis depends both upon the immediacy of therapy initiation, concomitant disorders and the immune status of the patient. Recently cases of multi-drug resistance nocardiosis and the epidemiology and drug susceptibility of less common Nocardia species have been described. In HIV positive patients pulmonary nocardiosis, the most common clinical presentation, has a low reported prevalence of 0.3%, and it is not considered an AIDS-defining disease. The difficulties in isolation, the non-specific clinical and radiologic presentation, and the widespread use of cotrimoxazole (TMP/SMX) prophylaxis could be responsible for this low prevalence. In this paper, it is described a rare and fatal case of systemic nocardiosis arising with chest pain in a patient with a severe immune deficiency, unaware of his HIV positivity. Systemic nocardiosis is generally caused by N. asteroids and the prognosis is good, but in patients with AIDS, mortality in disseminated forms with central nervous system involvement is more than 50%.
    VL  - 3
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Author Information
  • Operative Unit of Infectious Diseases, Ospedale Civile Vittorio Emanuele II, Bisceglie, Italy

  • Operative Unit of Infectious Diseases, AOU Consorziale Policlinico, Bari, Italy

  • Operative Unit of Infectious Diseases, Ospedale Civile Vittorio Emanuele II, Bisceglie, Italy

  • Operative Unit of Infectious Diseases, Ospedale Civile Vittorio Emanuele II, Bisceglie, Italy

  • Operative Unit of Infectious Diseases, Ospedale Civile Vittorio Emanuele II, Bisceglie, Italy

  • Operative Unit of Infectious Diseases, Ospedale Civile Vittorio Emanuele II, Bisceglie, Italy

  • Operative Unit of Infectious Diseases, Ospedale Civile Vittorio Emanuele II, Bisceglie, Italy

  • Operative Unit of Radiodiagnostic, Ospedale Civile Vittorio Emanuele II, Bisceglie, Italy

  • Operative Unit of Radiodiagnostic, Ospedale Civile Vittorio Emanuele II, Bisceglie, Italy

  • Operative Unit of Radiodiagnostic, Ospedale Civile Vittorio Emanuele II, Bisceglie, Italy

  • Operative Unit of Infectious Diseases, Ospedale Civile Vittorio Emanuele II, Bisceglie, Italy

  • Operative Unit of Infectious Diseases, AOU Consorziale Policlinico, Bari, Italy

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