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

• Published in: Surgical infections Vol. 13; no. 3; p. 163
• Main Authors: Budzik, Jonathan M, Hosseini, Mojgan, Mackinnon, Jr, Alexander C, Taxy, Jerome B
• Format: Journal Article
• Language: English
• Published: United States 01.06.2012
• Subjects: Aged; Anti-Infective Agents - therapeutic use; Fatal Outcome; Humans; Immunocompetence; Male; Nocardia Infections - drug therapy; Nocardia Infections - immunology; Nocardia Infections - microbiology; Pneumonia, Bacterial - drug therapy; Pneumonia, Bacterial - immunology; Pneumonia, Bacterial - microbiology; Synovitis - drug therapy; Synovitis - immunology; Synovitis - microbiology; Trimethoprim, Sulfamethoxazole Drug Combination - therapeutic use
• ISSN: 1557-8674
• DOI: 10.1089/sur.2011.012

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. Review of the recent literature and description of a immunocompetent patient with no known risk factors who contracted fatal N. farcinica sepsis. 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. 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.