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Volume 29, Number 4—April 2023
CME ACTIVITY - Synopsis

Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients

Daniel Beau Stamos, Aldo Barajas-Ochoa, and Jillian E. RaybouldComments to Author 
Author affiliation: Virginia Commonwealth University Health System, Richmond, Virginia, USA

Main Article

Table 2

Nocardiosis infections reported during or shortly after COVID-19 infection, 2021*

Study Age, y/sex Nocardia species; positive culture site(s) Days from SARS-CoV-2 diagnosis to Nocardia diagnosis Site(s) of Nocardia infection Predisposing factor On MV? Steroids before Nocardia diagnosis Susceptibilities Final therapy Outcome
Colaneri et al. (5)
45/F
N. cryarcigeorgica; subcutaneous lumps, lower respiratory tract sputum smear and culture
5 d
Lung, skin, kidney
AIDS
No
Hydrocortisone for persistent fever
Susceptible: TMP/SMX, amikacin, linezolid; resistant: AMO/CLA, third-generation cephalosporins, quinolones
Tedizolid for 1 wk followed by 1 y TMP/SMX
Survived
Arif et al. (6)
61/F
N. farcinica; Gram stain of pulmonary nodule biopsy
10 d
Lung
Type 2 diabetes mellitus
No
Dexamethasone for COVID-19
NA
TMP/SMX and linezolid
Survived
Atemnkeng et al. (7)
63/M
N. asteroids; bronchial lavage culture
50 d
Lung, brain
Type 2 diabetes mellitus
No
Dexamethasone for COVID-19
Resistant: carbapenem
TMP/SMX and linezolid for 1 y
Survived
Kaur and Bhatti (8)
80/F
N. farcinica; Gram stain and culture of brain abscess biopsy
>10 d, exact date unspecified
Brain
Advanced age
No
Dexamethasone for COVID-19
NA
TMP/SMX, ceftriaxone, doxycycline
Not reported
Driscoll et al. 2022 (9)
16/M
N. farcinica; lower airway samples
9 d
Lung
Cystic fibrosis, bronchiectasis
Yes
Dexamethasone for COVID-19
NA
Linezolid
Died
Cicero et. al. 2022 (10)
79/M
N. otitidiscaviarum: sputum culture
17 d
Lung
COPD, previous pulmonary tuberculosis, cirrhosis
No
Methylpredisolone for COVID-19
Susceptible: ceftriaxone, amikacin, ciprofloxacin, meropenem, TMP/SMX
Not given
Died
Velickovic et al. 2022 (11)
30/F
N. cyriacigeorgica; brain abscess
200 d
Brain
Systemic lupus erythematosus, glucocorticoid therapy, CD4 count <100
No
Prednisone for systemic lupus erythematosus
Susceptible: TMP/SMX, ceftriaxone, cefotaxime, imipenem, linezolid; resistant: ampicillin, AMO/CLA, fluoroquinolones
TMP/SMX
Survived
DiMeglio et al. 2022 (12)
70/M
N. farcinica: spinal cord abscess
48 d
Brain and spinal cord
Diabetes mellitus, advanced age, glucocorticoid therapy
No
Dexamethasone for COVID-19
NR
TMP/SMX, linezolid
Died
Laplace et al. 2022 (13)
83/M
N. cyriacigeorgica: sputum culture
4 d
Lung
Advanced age
No
Dexamethasone for COVID-19
NR
Imipenem, cotrimoxazole
Died
This study 52/M N. pseudobrasiliensis: sputum gram stain 7 d Lung Bronchiectasis, sarcoidosis, immunosuppressive therapy, type 2 diabetes mellitus No Dexamethasone for COVID-19 Susceptible: amikacin, ciprofloxacin, clarithromycin, linezolid, moxifloxacin, tobramycin, TMP/SMX; resistant: AMO/CLA, doxycycline, imipenem, minocycline Linezolid, ciprofloxacin Survived

*AMO/CLA, amoxicillin/clavulanic acid; COPD, chronic obstructive pulmonary disease; MV, mechanical ventilation; NA, not available; NR, not reported; TMP/SMX, trimethoprim/sulfamethoxazole.

Main Article

References
  1. Wallace  RJ Jr, Brown  BA, Blacklock  Z, Ulrich  R, Jost  K, Brown  JM, et al. New Nocardia taxon among isolates of Nocardia brasiliensis associated with invasive disease. J Clin Microbiol. 1995;33:152833. DOIPubMedGoogle Scholar
  2. Veerappan Kandasamy  V, Nagabandi  A, Horowitz  EA, Vivekanandan  R. Multidrug-resistant Nocardia pseudobrasiliensis presenting as multiple muscle abscesses. BMJ Case Rep. 2015;2015:bcr2014205262. DOIPubMedGoogle Scholar
  3. Wilson  JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc. 2012;87:4037. DOIPubMedGoogle Scholar
  4. Saubolle  MA, Sussland  D. Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol. 2003;41:4497501. DOIPubMedGoogle Scholar
  5. Colaneri  M, Lupi  M, Sachs  M, Ludovisi  S, Di Matteo  A, Pagnucco  L, et al. A challenging case of SARS-CoV-2- AIDS and nocardiosis coinfection from the SMatteo COvid19 REgistry (SMACORE). New Microbiol. 2021;44:12934.PubMedGoogle Scholar
  6. Arif  M, Talon  A, Sarma  H, Munoz  J, Charley  E. Nocardia after COVID-19 infection. Chest. 2021;160(Supplement):A429. DOIGoogle Scholar
  7. Atemnkeng  F, Ducey  J, Khalil  A, Elemam  A, Diaz  K. Diagnosing disseminated nocardiosis in a patient with COVID-19 pneumonia. J Med Cases. 2021;12:31924. DOIPubMedGoogle Scholar
  8. Kaur  T, Bhatti  W. Complications of high-dose steroids in COVID-19. Chest. 2021;160(Supplement):A490. DOIGoogle Scholar
  9. Driscoll  S, Carroll  WD, Nichani  S, Fishwick  R, Bakewell  K, Gilchrist  FJ. COVID-19 infection and nocardiosis causing the death of an adolescent with cystic fibrosis. Pediatr Pulmonol. 2022;57:18235. DOIPubMedGoogle Scholar
  10. Cicero  MN, Memmo  AI, Piccionello  IR, Seminara  G, Benfante  A, Scichilone  NA. 79-year-old-man with SARS-CoV-2 pneumonia and unusual pulmonary coinfection. Minerva Respir Med. 2022;61:8691. DOIGoogle Scholar
  11. Veličković  J, Vukičević  TA, Spurnić  AR, Lazić  I, Popović  B, Bogdanović  I, et al. Case report: Nocardial brain abscess in a persistently SARS-CoV-2 PCR positive patient with systemic lupus erythematosus. Front Med (Lausanne). 2022;9:973817. DOIPubMedGoogle Scholar
  12. DiMeglio  M, Shaikh  H, Newman  J, Vazsquez-Rubio  G. Nocardiosis of the Central Nervous System: A rare complication of COVID management? IDCases. 2022;29:e01599. DOIPubMedGoogle Scholar
  13. Laplace  M, Flamand  T, Ion  C, Gravier  S, Zadeh  MM, Debriel  D, et al. Pulmonary nocardiosis as an opportunistic infection in COVID-19. Eur J Case Rep Intern Med. 2022;9:003477. DOIPubMedGoogle Scholar
  14. Toyokawa  M, Ohana  N, Ueda  A, Imai  M, Tanno  D, Honda  M, et al. Identification and antimicrobial susceptibility profiles of Nocardia species clinically isolated in Japan. Sci Rep. 2021;11:16742. DOIPubMedGoogle Scholar
  15. Garcia-Vidal  C, Sanjuan  G, Moreno-García  E, Puerta-Alcalde  P, Garcia-Pouton  N, Chumbita  M, et al.; COVID-19 Researchers Group. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: a retrospective cohort study. Clin Microbiol Infect. 2021;27:838. DOIPubMedGoogle Scholar
  16. Søvik  S, Barrat-Due  A, Kåsine  T, Olasveengen  T, Strand  MW, Tveita  AA, et al. Corticosteroids and superinfections in COVID-19 patients on invasive mechanical ventilation. J Infect. 2022;85:5763. DOIPubMedGoogle Scholar
  17. Paget  C, Trottein  F. Mechanisms of bacterial superinfection post-influenza: a role for unconventional T cells. Front Immunol. 2019;10:336. DOIPubMedGoogle Scholar
  18. Chong  WH, Saha  BK, Ananthakrishnan Ramani , Chopra  A. State-of-the-art review of secondary pulmonary infections in patients with COVID-19 pneumonia. Infection. 2021;49:591605. DOIPubMedGoogle Scholar
  19. Russell  CD, Fairfield  CJ, Drake  TM, Turtle  L, Seaton  RA, Wootton  DG, et al.; ISARIC4C investigators. Co-infections, secondary infections, and antimicrobial use in patients hospitalised with COVID-19 during the first pandemic wave from the ISARIC WHO CCP-UK study: a multicentre, prospective cohort study. Lancet Microbe. 2021;2:e35465. DOIPubMedGoogle Scholar

Main Article

Page created: February 01, 2023
Page updated: March 22, 2023
Page reviewed: March 22, 2023
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