Nocardiosis in transplant recipients

Nocardiosis is a rare opportunistic infection caused by Nocardia spp., an aerobic actinomycete, that mainly affects patients with cell-mediated immunity defects, such as transplant recipients. Despite recent progress regarding Nocardia identification and changes in taxonomic assignment, many challen...

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Bibliographic Details
Published in:European journal of clinical microbiology & infectious diseases 2014-05, Vol.33 (5), p.689-702
Main Authors: Lebeaux, D., Morelon, E., Suarez, F., Lanternier, F., Scemla, A., Frange, P., Mainardi, J.-L., Lecuit, M., Lortholary, O.
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Antibiotics
Antiinfectives and antibacterials
Bacterial diseases
Biological and medical sciences
Biomedical and Life Sciences
Biomedicine
Calcineurin
Calcineurin inhibitors
Cell-mediated immunity
Corticoids
Corticosteroids
Cytomegalovirus
Diagnosis
Differential diagnosis
Hematopoietic stem cells
Hemopoiesis
Human bacterial diseases
Humans
Immunocompromised Host
Immunosuppressive agents
Infections
Infectious diseases
Internal Medicine
Medical Microbiology
Medical sciences
Microbiology
Miscellaneous
Neuroimaging
Nocardia
Nocardia - isolation & purification
Nocardia Infections - diagnosis
Nocardia Infections - drug therapy
Nocardia Infections - epidemiology
Nocardiosis
Opportunist infection
Patients
Review
Species
Stem cell transplantation
Stem cells
Toxicity
Transplant Recipients
Transplantation
Transplantation - adverse effects
Transplants & implants
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Summary:Nocardiosis is a rare opportunistic infection caused by Nocardia spp., an aerobic actinomycete, that mainly affects patients with cell-mediated immunity defects, such as transplant recipients. Despite recent progress regarding Nocardia identification and changes in taxonomic assignment, many challenges remain for the diagnosis or management of nocardiosis. This opportunistic infection affects 0.04 to 3.5 % of patients with solid organ or hematopoietic stem cell transplantation, depending on the organ transplanted, cytomegalovirus (CMV) infection, corticosteroids dose and calcineurin inhibitors level. Nocardiosis diagnosis relies on appropriate clinical, radiological and microbiological workup that includes the sampling of an accessible involved site and molecular microbiology tools. In parallel, extensive clinical and radiological evaluations are mandatory, including brain imaging, even in the absence of neurological signs. In transplanted patients, differential diagnosis is challenging, with co-infections reported in 20 to 64 % of cases. As the antibiotic susceptibility pattern varies among species, the antimicrobial regimen before species identification should rely on the association of antibiotics active on all species of Nocardia . Bactericidal antibiotics are required in cases of severe or disseminated disease. Furthermore, in transplant recipients, combination therapy is difficult to manage because of cumulative toxicity and interactions with immunosuppressive agents. Because of a high recurrence rate, antibiotic therapy should be prescribed for 6 to 12 months.
ISSN:0934-9723
1435-4373
DOI:10.1007/s10096-013-2015-5