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Case report
peer-reviewed

Rare Multidrug-Resistant Pulmonary Nocardiosis in AIDS



Abstract

Nocardiosis is an opportunistic infection in patients with depressed cell-mediated immunity. Inhalation is the primary route for exposure via dust particles. Patients with acquired immune deficiency syndrome (AIDS) are at increased risk of disseminated disease. A challenge in the diagnosis of pulmonary nocardiosis is that it can mimic other pulmonary diseases. Nocardia farcinica tends to be a more virulent, multidrug-resistant strain with an increased tendency to disseminate. This report describes a 64-year-old man with AIDS found to have pulmonary nocardiosis that did not respond to standard antibiotic therapy. Further evaluation revealed the virulent, multidrug-resistant Nocardia farcinica species. Targeted antibiotic therapy was initiated, after which the patient had an improvement in pulmonary symptoms. It is important to suspect pulmonary nocardiosis in immunocompromised patients who fail to respond to standard antimicrobial therapy. Susceptibilities should be obtained so that appropriate therapy can be promptly initiated as Nocardia farcinica is highly resistant to multiple antimicrobials.



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Case report
peer-reviewed

Rare Multidrug-Resistant Pulmonary Nocardiosis in AIDS


Author Information

Cherry O. Onaiwu Corresponding Author

Department of Internal Medicine, Creighton University Medical Center

Manasa Velagapudi

Department of Infectious Diseases, Creighton University Medical Center

Luay Sarsam

Department of Internal Medicine, Creighton University Medical Center

Lindsay Utley

Department of Internal Medicine, Creighton University Medical Center

Lauren Bricker

Department of Pharmacology, Creighton University Medical Center

Venkata Sunil Bendi

Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center

Renuga Vivekanandan

Department of Infectious Diseases, Creighton University Medical Center


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

Rare Multidrug-Resistant Pulmonary Nocardiosis in AIDS


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Case report
peer-reviewed

Rare Multidrug-Resistant Pulmonary Nocardiosis in AIDS

Cherry O. Onaiwu">Cherry O. Onaiwu , Manasa Velagapudi">Manasa Velagapudi, Luay Sarsam">Luay Sarsam, Lindsay Utley">Lindsay Utley, Lauren Bricker">Lauren Bricker, Venkata Sunil Bendi">Venkata Sunil Bendi, Renuga Vivekanandan">Renuga Vivekanandan

  • Author Information
    Cherry O. Onaiwu Corresponding Author

    Department of Internal Medicine, Creighton University Medical Center

    Manasa Velagapudi

    Department of Infectious Diseases, Creighton University Medical Center

    Luay Sarsam

    Department of Internal Medicine, Creighton University Medical Center

    Lindsay Utley

    Department of Internal Medicine, Creighton University Medical Center

    Lauren Bricker

    Department of Pharmacology, Creighton University Medical Center

    Venkata Sunil Bendi

    Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center

    Renuga Vivekanandan

    Department of Infectious Diseases, Creighton University Medical Center


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: November 11, 2017

    DOI

    10.7759/cureus.1839

    Cite this article as:

    Onaiwu C O, Velagapudi M, Sarsam L, et al. (November 11, 2017) Rare Multidrug-Resistant Pulmonary Nocardiosis in AIDS. Cureus 9(11): e1839. doi:10.7759/cureus.1839

    Publication history

    Received by Cureus: September 30, 2017
    Peer review began: October 24, 2017
    Peer review concluded: November 08, 2017
    Published: November 11, 2017

    Copyright

    © Copyright 2017
    Onaiwu et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Nocardiosis is an opportunistic infection in patients with depressed cell-mediated immunity. Inhalation is the primary route for exposure via dust particles. Patients with acquired immune deficiency syndrome (AIDS) are at increased risk of disseminated disease. A challenge in the diagnosis of pulmonary nocardiosis is that it can mimic other pulmonary diseases. Nocardia farcinica tends to be a more virulent, multidrug-resistant strain with an increased tendency to disseminate. This report describes a 64-year-old man with AIDS found to have pulmonary nocardiosis that did not respond to standard antibiotic therapy. Further evaluation revealed the virulent, multidrug-resistant Nocardia farcinica species. Targeted antibiotic therapy was initiated, after which the patient had an improvement in pulmonary symptoms. It is important to suspect pulmonary nocardiosis in immunocompromised patients who fail to respond to standard antimicrobial therapy. Susceptibilities should be obtained so that appropriate therapy can be promptly initiated as Nocardia farcinica is highly resistant to multiple antimicrobials.



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Cherry O. Onaiwu, M.D., M.Sc.

Department of Internal Medicine, Creighton University Medical Center

For correspondence:
cherryonaiwu@creighton.edu

Manasa Velagapudi, M.D., Assistant Professor

Department of Infectious Diseases, Creighton University Medical Center

Luay Sarsam, M.D.

Department of Internal Medicine, Creighton University Medical Center

Lindsay Utley

Department of Internal Medicine, Creighton University Medical Center

Lauren Bricker

Department of Pharmacology, Creighton University Medical Center

Venkata Sunil Bendi

Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center

Renuga Vivekanandan

Department of Infectious Diseases, Creighton University Medical Center

Cherry O. Onaiwu, M.D., M.Sc.

Department of Internal Medicine, Creighton University Medical Center

For correspondence:
cherryonaiwu@creighton.edu

Manasa Velagapudi, M.D., Assistant Professor

Department of Infectious Diseases, Creighton University Medical Center

Luay Sarsam, M.D.

Department of Internal Medicine, Creighton University Medical Center

Lindsay Utley

Department of Internal Medicine, Creighton University Medical Center

Lauren Bricker

Department of Pharmacology, Creighton University Medical Center

Venkata Sunil Bendi

Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center

Renuga Vivekanandan

Department of Infectious Diseases, Creighton University Medical Center