Volume 30, Number 2—February 2024
Dispatch
Critically Ill Patients with Visceral Nocardia Infection, France and Belgium, 2004–2023
Lucas Khellaf
, Virginie Lemiale, Maxens Decavèle, Marc Pineton de Chambrun, Alexandra Beurton, Toufik Kamel, Anabelle Stoclin, Djamel Mokart, Fabrice Bruneel, Clara Vigneron, Achille Kouatchet, Benoît Henry, Jean-Pierre Quenot, Grégoire Jolly, Nahema Issa, Matthieu Bellal, Julien Poissy, Claire Pichereau, Julien Schmidt, Nathalie Layios, Maxime Gaillet, Elie Azoulay, and Adrien Joseph
, Virginie Lemiale, Maxens Decavèle, Marc Pineton de Chambrun, Alexandra Beurton, Toufik Kamel, Anabelle Stoclin, Djamel Mokart, Fabrice Bruneel, Clara Vigneron, Achille Kouatchet, Benoît Henry, Jean-Pierre Quenot, Grégoire Jolly, Nahema Issa, Matthieu Bellal, Julien Poissy, Claire Pichereau, Julien Schmidt, Nathalie Layios, Maxime Gaillet, Elie Azoulay, and Adrien Joseph
Table 2
Patient clinical and radiologic findings from the intensive care unit in study of critically ill patients with visceral Nocardia infection, France and Belgium, 2004–2023*
| Findings | Nocardiosis cases, n = 50 |
|---|---|
| Clinical features | |
| Chronic cough† | 36 (72) |
| No. previous antibacterial therapy lines | 2 (0–3) |
| Fever | 29 (58) |
| Co-infection | 22 (44) |
| Fungal‡ | 11 (22) |
| Bacterial§ | 8 (16) |
| Viral¶ | 5 (10) |
| Lung involvement | 49 (98) |
| Oxygen therapy at admission | 32 (64) |
| Oxygen flow, L/min, median (IQR) | 8 (4–15) |
| Respiratory rate, L/min, median (IQR) | 30 (25–36) |
| Hemoptysis | 8 (16) |
| Neurologic involvement | 24 (48) |
| Confusion | 21 (42) |
| Coma | 16 (32) |
| Motor deficit | 13 (26) |
| Cranial nerve lesions | 10 (20) |
| Meningitis | 8 (16) |
| Epilepsy | 6 (12) |
| Glasgow score, median (IQR) | 13 (12–14) |
| Skin/muscle abscess | 10 (20) |
| Disseminated infection | 24 (48) |
| Organ failures | 45 (90) |
| Multiorgan | 25 (50) |
| Respiratory | 33 (66) |
| Including acute respiratory distress syndrome | 3 (8) |
| Acute kidney injury | 11 (22) |
| Hemodynamic | 17 (34) |
| Neurologic | 19 (38) |
| Hepatic | 4 (8) |
| Sequential organ failure assessment score, median (IQR) |
5 (3–7) |
| Imaging findings | |
| Computed tomography scan | |
| Lung consolidation | 43 (86) |
| Lung nodules with cavitation | 26 (52) |
| Pleural effusion | 15 (30) |
| Interstitial syndrome | 8 (16) |
| Alveolar hemorrhage | 6 (12) |
| Lung lobes involved | |
| 1 lobe | 16 (32) |
| Multilobe | 16 (32) |
| Bilateral | 18 (36) |
| Brain magnetic resonance imaging, n = 23 | |
| Single lesion | 9 (39) |
| Multiple lesions | 14 (61) |
| >10 mm | 17 (74) |
| <10 mm | 6 (26) |
| Brain herniation | 6 (26) |
| Ventriculitis |
2 (9) |
| Diagnostics methods | |
| Bronchoalveolar lavage analysis | 42 (84) |
| Diagnostic yield, n = 42 | 25 (60) |
| Computed tomography–scan targeted biopsy | 18 (36) |
| Blood culture positivity | 7 (14) |
| Nocardia PCR-based assay positivity | 26 (52) |
| Nocardia culture positivity | 24 (48) |
| Diagnosis made in intensive care unit | 23 (46) |
*Values are no. (%) except as indicated. IQR, interquartile range. †Chronic cough is defined as a cough persisting for >8 weeks. ‡Fungal infections (n = 11) comprised 8 invasive Aspergillus sp. infections, 2 Pneumocystis jirovecii infections, and 1 case of cutaneous candidosis. §Comprised 7 gram-negative bacillus co-infections and 1 methicillin-resistant Staphylococcus aureus co-infection. ¶Virus infections (n = 5) comprised 3 influenza infections (including 1 H1N1 co-infection) and 2 respiratory syncytial virus infections.
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