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Volume 23, Number 3—March 2017
Dispatch

Rhodococcus Infection in Solid Organ and Hematopoietic Stem Cell Transplant Recipients1

Pascalis Vergidis2Comments to Author , Ella J. Ariza-Heredia, Anoma Nellore, Camille N. Kotton, Daniel R. Kaul, Michele I. Morris, Theodoros Kelesidis, Harshal Shah, Seo Young Park, M. Hong Nguyen, and Raymund R. Razonable
Author affiliations: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA (P. Vergidis, S.Y. Park, M.H. Nguyen); University of Texas MD Anderson Cancer Center, Houston, Texas, USA (E.J. Ariza-Heredia); University of Alabama, Birmingham, Alabama, USA (A. Nellore); Massachusetts General Hospital, Boston, Massachusetts, USA (C.N. Kotton); University of Michigan Medical School, Ann Arbor, Michigan, USA (D.R. Kaul); University of Miami Miller School of Medicine, Miami, Florida, USA (M.I. Morris); University of California David Geffen School of Medicine, Los Angeles, California, USA (T. Kelesidis); Mayo Clinic, Jacksonville, Florida, USA (H. Shah); Mayo Clinic, Rochester, Minnesota, USA (R.R. Razonable)

Main Article

Table 1

Clinical characteristics, treatment, and outcome for 18 patients infected with Rhodococcus spp, United States*

Patient age, y/sex Residence Transplant, underlying disease Time from transplant to infection Clinical feature Lung pathology Immunosuppression at infection Antimicrobial drug treatment Treatment duration Outcome at 90 d†
76/M Wisconsin Kidney, obstructive uropathy 4 y Pneumonia (productive cough, chest pain) Chronic inflammation and reactive changes Tacrolimus, prednisone Ertapenem, levofloxacin → moxifloxacin 12 mo Partial response
57/F Iowa Heart, ischemic cardiomyopathy 5 mo Catheter-associated bacteremia NT Sirolimus, MMF, prednisone Vancomycin, levofloxacin → levofloxacin 7 mo Complete response
76/M Minnesota Heart, ischemic cardiomyopathy 20 y Pacemaker pocket wound infection NT Cyclosporine, MMF, prednisone TMP/SMX 2 mo Complete response
59/F Massachusetts Double lung, usual interstitial pneumonia 8 mo Bacteremia NT Cyclosporine, prednisone Vancomycin → azithromycin 60 mo Complete response
45/M Massachusetts Double lung, lymphangiolyomatosis 5 y Pneumonia (fever, dyspnea), bacteremia NT Tacrolimus, MMF, prednisone Vancomycin, meropenem → azithromycin, rifampin 8 mo Unknown response
78/F Massachusetts Kidney, diabetic nephropathy 7 y Pneumonia (productive cough) Small chronic granulomas admixed with reactive bronchial cells Tacrolimus, MMF, prednisone Moxifloxacin → doxycycline 14 mo Stable disease
53/M Michigan Heart, ischemic cardiomyopathy 10 mo Pneumonia (cough), bacteremia NT Tacrolimus, MMF, prednisone Vancomycin → levofloxacin, azithromycin 5 mo Partial response
54/M Michigan Kidney, glomerulopathy 4 mo Pneumonia (cough) NT Tacrolimus, MMF, prednisone Meropenem, azithromycin, meropenem 3 mo Partial response
68/M Florida Heart, ischemic cardiomyopathy 3 mo Pneumonia (fever) NT Tacrolimus, MMF Vancomycin, imipenem, TMP/SMX → imipenem, ciprofloxacin 11 mo Partial response
53/M Florida Liver, alcoholic cirrhosis 34 mo Catheter-associated bacteremia NT Sirolimus, MMF Vancomycin, ceftriaxone 3 mo Complete response
67/F Pennsylvania Left lung, idiopathic pulmonary fibrosis 5 y Pneumonia (cough, dyspnea) NT Tacrolimus, MMF, prednisone Vancomycin, azithromycin 2 mo Complete response
51/M Nebraska Double lung, scleroderma with pulmonary fibrosis 22 mo Pneumonia (fever, cough, dyspnea, chest pain) NT Tacrolimus, MMF, prednisone Minocycline, azithromycin → azithromycin, linezolid 6 mo Partial response
14/M California Allogeneic HSCT, acute myeloid leukemia 6 mo Catheter-associated bacteremia NT Tacrolimus, prednisone Linezolid 2 wk Complete response
61/M Mississippi Allogeneic HSCT, chronic lymphocytic leukemia 54 mo Pneumonia (fever, dyspnea), bacteremia Acute pulmonary inflammation Prednisone Meropenem, tigecycline → ertapenem, TMP/SMX, tigecycline 6 mo Stable response, disease relapse at 9 mo
65/F Texas Allogeneic HSCT, follicular lymphoma 8 mo Pneumonia Focal tissue, eosinophilia, and Masson bodies; organizing pneumonia None Gatifloxacin, azithromycin 2 mo Complete response
3/M Texas Autologous HSCT, neuroblastoma 2 mo Bacteremia NT None Vancomycin, gatifloxacin 1 mo Complete response
63/M Texas Allogeneic HSCT, acute myeloid leukemia 4 mo Catheter-associated bacteremia NT Tacrolimus, prednisone for GVHD Vancomycin 1 mo Complete response
53/F Texas Allogeneic HSCT, chronic myelogenous leukemia 4 mo Pneumonia (fever, dyspnea, productive cough, chest pain), bacteremia NT Sirolimus for GVHD Tigecycline, TMP/SMX, piperacillin/tazobactam → levofloxacin, TMP/SMX, piperacillin/tazobactam 2 wk Died of respiratory failure/ARDS at day 13

*ARDS, acute respiratory distress syndrome; GVHD, graft-versus-host disease; MMF, mycophenolate mofetil; NT, not tested; TMP/SMX, trimethoprim/sulfamethoxazole; →, change in treatment regimen.
†Outcome (response to treatment) was categorized as complete (resolution of all attributable signs, symptoms, and radiographic abnormalities); partial (clinical improvement and >50% improvement in radiographic abnormalities); stable (no improvement in clinical manifestations and <50% improvement in radiographic findings); or failure (deterioration of condition or death).

Main Article

1Results from this study were presented in part at IDWeek 2012, October 17–21, 2012, San Diego, California, USA.

2Current affiliation: University of Manchester, Manchester, UK.

Page created: February 17, 2017
Page updated: February 17, 2017
Page reviewed: February 17, 2017
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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