Rushika Saksena1, Dabet Rynga2, Santosh Rajan3, Rajni Gaind4, Reetika Dawar5, Raman Sardana6, Manas Kamal Sen7, Jagdish Chandra Suri8. 1. Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India. rushi.saksena@gmail.com. 2. Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India. dabetrynga@gmail.com. 3. Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India. drsanthosh_ysmu@yahoo.co.in. 4. Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India. rgaind5@hotmail.com. 5. Department of Microbiology, Indraprastha Apollo Hospitals, Delhi, India. reetika_d@apollohospitalsdelhi.com. 6. Department of Microbiology, Indraprastha Apollo Hospitals, Delhi, India. ramansardana@apollohospitals.com. 7. Department of Pulmonary Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India. drmksen@yahoo.com. 8. Department of Pulmonary Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India. docjcsuri@gmail.com.
Abstract
INTRODUCTION: Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients. METHODOLOGY: Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France). CONCLUSION: Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically ill patients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis. Copyright (c) 2020 Rushika Saksena, Dabet Rynga, Santosh Rajan, Rajni Gaind, Reetika Dawar, Raman Sardana, Manas Kamal Sen, Jagdish Chandra Suri.
INTRODUCTION:Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients. METHODOLOGY: Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France). CONCLUSION: Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically illpatients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis. Copyright (c) 2020 Rushika Saksena, Dabet Rynga, Santosh Rajan, Rajni Gaind, Reetika Dawar, Raman Sardana, Manas Kamal Sen, Jagdish Chandra Suri.
Authors: Mazin Barry; Shahad AlShehri; Ahlam Alguhani; Mohammad Barry; Ali Alhijji; Khalifa Binkhamis; Fahad Al-Majid; Fatimah S Al-Shahrani; Taim Muayqil Journal: Ann Clin Microbiol Antimicrob Date: 2022-05-16 Impact factor: 6.781