Disseminated Nocardia farcinica: Literature Review and Fatal Outcome in an Immunocompetent Patient

Department of Pathology, Pritzker School of Medicine, Chicago, Illinois, USA.
Surgical Infections (Impact Factor: 1.45). 05/2012; 13(3):163-70. DOI: 10.1089/sur.2011.012
Source: PubMed


Nocardia farcinica is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete. Nocardia spp. are opportunistic pathogens, and N. farcinica is the least common species of clinical importance.
Review of the recent literature and description of a immunocompetent patient with no known risk factors who contracted fatal N. farcinica sepsis.
Positive pre-mortem and post-mortem cultures from the lung and synovium correlated with acute bronchopneumonia and synovitis at autopsy. Colonies of filamentous bacteria, which were not apparent in conventional hematoxylin and eosin-stained sections, were observed with gram and methenamine silver stains, but acid-fast stains were negative. A literature review revealed that disseminated N. farcinica often is associated with an underlying malignant tumor or autoimmune disease (88% of patients). Chemotherapy or corticosteroid treatments are additional risk factors.
Trimethoprim-sulfamethoxazole typically is the first-line therapy for N. farcinica; treatment with amikacin and imipenem-cilastatin is used less often (7% of patients). Despite aggressive therapy, we observed that the death rate (39%) associated with N. farcinica in recent publications was eight percentage points higher than reported in a review from 2000.

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    • "As intrinsic infection, N. farcinica caused community-acquired pneumonia associated with influenza A virus infection this time. Nocardia infections are rare but potentially fatal, typically more problematic in patients with cell-mediated immunosuppressive conditions [21], but occasionally inimmunocompetent patients as well [22]. N. farcinica is a ubiquitous, Gram-positive actinomycete saprophyte that lives in soil, organic matter and water. "
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    • "Gram staining is the most sensitive method for visualizing and recognizing nocardia. Nocardia is partially acid-fast by conventional Ziehl-Nielsen staining and is reactive with Gomori methenamine silver.16 It is important to obtain cultures from tissue biopsies when disseminated infection is considered to allow for prompt organism identification and perhaps better patient care.17 "
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