A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim–sulfamethoxazole: case report and literature review
Abstract Background Disseminated nocardiosis still causes significant morbidity and mortality and is often caused by Nocardia asteroides, N. basiliensis, and N. farcinica and are often treated with trimethoprim–sulfamethoxazole (TMP–SMX). Nocardia otitidiscaviarum (N. otitidiscaviarum) rarely causes...
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| Format: | Article |
| Language: | English |
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BMC
2022-05-01
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| Series: | Annals of Clinical Microbiology and Antimicrobials |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12941-022-00511-9 |
| _version_ | 1818548650703323136 |
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| author | Mazin Barry Shahad AlShehri Ahlam alguhani Mohammad Barry Ali Alhijji Khalifa Binkhamis Fahad Al-Majid Fatimah S. Al-Shahrani Taim Muayqil |
| author_facet | Mazin Barry Shahad AlShehri Ahlam alguhani Mohammad Barry Ali Alhijji Khalifa Binkhamis Fahad Al-Majid Fatimah S. Al-Shahrani Taim Muayqil |
| author_sort | Mazin Barry |
| collection | DOAJ |
| description | Abstract Background Disseminated nocardiosis still causes significant morbidity and mortality and is often caused by Nocardia asteroides, N. basiliensis, and N. farcinica and are often treated with trimethoprim–sulfamethoxazole (TMP–SMX). Nocardia otitidiscaviarum (N. otitidiscaviarum) rarely causes disseminated disease and resistance to TMP–SMX is even more rare. Case presentation A 37-year-old woman with metastatic breast cancer and right ear deafness with recent occupational gardening and manipulating soil, presented to the hospital with first time seizure and multiple skin nodules. Magnetic resonance imaging (MRI) showed ring enhancing lesions, biopsy of the skin and brain lesions grew N. otitidiscaviarum. She was empirically treated with TMP–SMX and Imipenem–Cilastatin, however, almost three weeks into therapy, susceptibility results revealed it to be resistant to both antimicrobials, she was subsequently changed to Amikacin, Linezolid, Moxifloxacin, and Doxycycline but ultimately died. Conclusions This case report highlights the importance of suspecting a rare Nocardia species in patients at risk with proper occupational exposure, moreover, TMP–SMX resistance should be suspected with lack of clinical response, this may have important implications on clinical practice when facing similar infections. |
| first_indexed | 2024-12-12T08:23:01Z |
| format | Article |
| id | doaj.art-5fd57bb20ab840aaa4615aed095e2780 |
| institution | Directory Open Access Journal |
| issn | 1476-0711 |
| language | English |
| last_indexed | 2024-12-12T08:23:01Z |
| publishDate | 2022-05-01 |
| publisher | BMC |
| record_format | Article |
| series | Annals of Clinical Microbiology and Antimicrobials |
| spelling | doaj.art-5fd57bb20ab840aaa4615aed095e27802022-12-22T00:31:20ZengBMCAnnals of Clinical Microbiology and Antimicrobials1476-07112022-05-012111810.1186/s12941-022-00511-9A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim–sulfamethoxazole: case report and literature reviewMazin Barry0Shahad AlShehri1Ahlam alguhani2Mohammad Barry3Ali Alhijji4Khalifa Binkhamis5Fahad Al-Majid6Fatimah S. Al-Shahrani7Taim Muayqil8Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud UniversityInfectious Diseases Unit, Internal Medicine Department, Prince Sultan Military Medical CityInfectious Diseases Unit, Internal Medicine Department, King Abdullah Medical City National GuardMedical Imaging Department, King Abdullah bin Abdulaziz University HospitalDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud UniversityDepartment of Pathology, College of Medicine, King Saud UniversityDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud UniversityDivision of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud UniversityKing Saud University Medical City, King Saud UniversityAbstract Background Disseminated nocardiosis still causes significant morbidity and mortality and is often caused by Nocardia asteroides, N. basiliensis, and N. farcinica and are often treated with trimethoprim–sulfamethoxazole (TMP–SMX). Nocardia otitidiscaviarum (N. otitidiscaviarum) rarely causes disseminated disease and resistance to TMP–SMX is even more rare. Case presentation A 37-year-old woman with metastatic breast cancer and right ear deafness with recent occupational gardening and manipulating soil, presented to the hospital with first time seizure and multiple skin nodules. Magnetic resonance imaging (MRI) showed ring enhancing lesions, biopsy of the skin and brain lesions grew N. otitidiscaviarum. She was empirically treated with TMP–SMX and Imipenem–Cilastatin, however, almost three weeks into therapy, susceptibility results revealed it to be resistant to both antimicrobials, she was subsequently changed to Amikacin, Linezolid, Moxifloxacin, and Doxycycline but ultimately died. Conclusions This case report highlights the importance of suspecting a rare Nocardia species in patients at risk with proper occupational exposure, moreover, TMP–SMX resistance should be suspected with lack of clinical response, this may have important implications on clinical practice when facing similar infections.https://doi.org/10.1186/s12941-022-00511-9NocardiosisNocardia otitidiscaviarumTrimethoprim–sulfamethoxazole (TMP–SMX) |
| spellingShingle | Mazin Barry Shahad AlShehri Ahlam alguhani Mohammad Barry Ali Alhijji Khalifa Binkhamis Fahad Al-Majid Fatimah S. Al-Shahrani Taim Muayqil A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim–sulfamethoxazole: case report and literature review Annals of Clinical Microbiology and Antimicrobials Nocardiosis Nocardia otitidiscaviarum Trimethoprim–sulfamethoxazole (TMP–SMX) |
| title | A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim–sulfamethoxazole: case report and literature review |
| title_full | A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim–sulfamethoxazole: case report and literature review |
| title_fullStr | A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim–sulfamethoxazole: case report and literature review |
| title_full_unstemmed | A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim–sulfamethoxazole: case report and literature review |
| title_short | A fatal case of disseminated nocardiosis due to Nocardia otitidiscaviarum resistant to trimethoprim–sulfamethoxazole: case report and literature review |
| title_sort | fatal case of disseminated nocardiosis due to nocardia otitidiscaviarum resistant to trimethoprim sulfamethoxazole case report and literature review |
| topic | Nocardiosis Nocardia otitidiscaviarum Trimethoprim–sulfamethoxazole (TMP–SMX) |
| url | https://doi.org/10.1186/s12941-022-00511-9 |
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