Varying presentations of pulmonary nocardiosis in kidney transplant recipients - Case series
Infections continue to be a significant cause of morbidity and mortality after solid organ transplantation. Early identification of the pathogenic organism is extremely important as the disease process might progress rapidly resulting in fatality. In this case series, we describe varying presentatio...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2021-01-01
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| Series: | Indian Journal of Transplantation |
| Subjects: | |
| Online Access: | http://www.ijtonline.in/article.asp?issn=2212-0017;year=2021;volume=15;issue=3;spage=275;epage=278;aulast=Shabeen |
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| author | Kumar Shabeen Sandeep Sreedharan Zachariah Paul Polachirakkal Nandita Shashindran Anil Mathew V Anil Kumar George Kurian Rajesh R Nair |
| author_facet | Kumar Shabeen Sandeep Sreedharan Zachariah Paul Polachirakkal Nandita Shashindran Anil Mathew V Anil Kumar George Kurian Rajesh R Nair |
| author_sort | Kumar Shabeen |
| collection | DOAJ |
| description | Infections continue to be a significant cause of morbidity and mortality after solid organ transplantation. Early identification of the pathogenic organism is extremely important as the disease process might progress rapidly resulting in fatality. In this case series, we describe varying presentations of pulmonary nocardiosis, an uncommon opportunistic bacterial infection that often complicates the diagnosis of pneumonia, especially in immunocompromised patients. Although cough, fever, expectoration and breathlessness are the most common symptoms of pulmonary nocardiosis, they can also manifest as night sweats, weight loss and malaise. Some are incidentally diagnosed while being evaluated for other causes. Radiological features are also non-specific, usual findings being irregular nodules, cavitation, reticulo nodular diffuse pneumonia and pleural effusions. Bronchoalveolar lavage has the best diagnostic yield, but may have to be repeated several times to confirm a diagnosis, if the index of suspicion is high. Initial therapy with high dose trimethoprim- sulfamethoxazole is found to be effective in most of the cases. Duration of treatment should be a minimum of 6 months, and at least 12 months if central nervous system is affected. Other agents used for treatment include imipenem, minocycline, third generation cephalosporins, linezolid and amikacin. A high index of suspicion, with aggressive evaluation in an immunosuppressed individual will enable an early diagnosis, leading to prompt treatment and limit dissemination of disease thus preventing fatality. |
| first_indexed | 2024-12-19T18:06:29Z |
| format | Article |
| id | doaj.art-2da07a65724644f7b1c69993540c1962 |
| institution | Directory Open Access Journal |
| issn | 2212-0017 2212-0025 |
| language | English |
| last_indexed | 2024-12-19T18:06:29Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Transplantation |
| spelling | doaj.art-2da07a65724644f7b1c69993540c19622022-12-21T20:11:26ZengWolters Kluwer Medknow PublicationsIndian Journal of Transplantation2212-00172212-00252021-01-0115327527810.4103/ijot.ijot_146_20Varying presentations of pulmonary nocardiosis in kidney transplant recipients - Case seriesKumar ShabeenSandeep SreedharanZachariah Paul PolachirakkalNandita ShashindranAnil MathewV Anil KumarGeorge KurianRajesh R NairInfections continue to be a significant cause of morbidity and mortality after solid organ transplantation. Early identification of the pathogenic organism is extremely important as the disease process might progress rapidly resulting in fatality. In this case series, we describe varying presentations of pulmonary nocardiosis, an uncommon opportunistic bacterial infection that often complicates the diagnosis of pneumonia, especially in immunocompromised patients. Although cough, fever, expectoration and breathlessness are the most common symptoms of pulmonary nocardiosis, they can also manifest as night sweats, weight loss and malaise. Some are incidentally diagnosed while being evaluated for other causes. Radiological features are also non-specific, usual findings being irregular nodules, cavitation, reticulo nodular diffuse pneumonia and pleural effusions. Bronchoalveolar lavage has the best diagnostic yield, but may have to be repeated several times to confirm a diagnosis, if the index of suspicion is high. Initial therapy with high dose trimethoprim- sulfamethoxazole is found to be effective in most of the cases. Duration of treatment should be a minimum of 6 months, and at least 12 months if central nervous system is affected. Other agents used for treatment include imipenem, minocycline, third generation cephalosporins, linezolid and amikacin. A high index of suspicion, with aggressive evaluation in an immunosuppressed individual will enable an early diagnosis, leading to prompt treatment and limit dissemination of disease thus preventing fatality.http://www.ijtonline.in/article.asp?issn=2212-0017;year=2021;volume=15;issue=3;spage=275;epage=278;aulast=Shabeenatypical pneumonianocardianocardiosisopportunistic infectionsrenal transplant |
| spellingShingle | Kumar Shabeen Sandeep Sreedharan Zachariah Paul Polachirakkal Nandita Shashindran Anil Mathew V Anil Kumar George Kurian Rajesh R Nair Varying presentations of pulmonary nocardiosis in kidney transplant recipients - Case series Indian Journal of Transplantation atypical pneumonia nocardia nocardiosis opportunistic infections renal transplant |
| title | Varying presentations of pulmonary nocardiosis in kidney transplant recipients - Case series |
| title_full | Varying presentations of pulmonary nocardiosis in kidney transplant recipients - Case series |
| title_fullStr | Varying presentations of pulmonary nocardiosis in kidney transplant recipients - Case series |
| title_full_unstemmed | Varying presentations of pulmonary nocardiosis in kidney transplant recipients - Case series |
| title_short | Varying presentations of pulmonary nocardiosis in kidney transplant recipients - Case series |
| title_sort | varying presentations of pulmonary nocardiosis in kidney transplant recipients case series |
| topic | atypical pneumonia nocardia nocardiosis opportunistic infections renal transplant |
| url | http://www.ijtonline.in/article.asp?issn=2212-0017;year=2021;volume=15;issue=3;spage=275;epage=278;aulast=Shabeen |
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