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Volume 23, Number 3—March 2017

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
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