Epidemiology of Nocardiosis -A six years study from Northern India

Öz

Objective: To isolate and speciate Nocardia species from clinical samples and to study their antimicrobial susceptibility pattern to different antimicrobials. Various risk factors associated with nocardiosis were also studied. Methods: 32 clinical specimens with clinical history of pneumonia, abscesses, or disseminated infections were collected over a period of 6 years (2009-2014) from Inpatient and Outpatient departments and processed for Nocardia cultures and sensitivity. Results: Twelve cases of nocardiosis were reported out of 32 clinically suspected cases. The mean age of presentation in our study was 57.9 years. Pneumonia was the most common clinical presentation followed by primary cutaneous disease and one case of disseminated disease. 8/ 10 patients with nocardiosis were immunocompromised with history of organ transplantation, use of immunosuppressive agents or steroids. Based on biochemical reactions 5 of the isolates were identified as N. asteroides, 3 N. brasiliensis, 2 N. farcinica and 1 each were N. transvalensis, & N. nova. All were sensitive to linezolid followed by cotrimoxazole (91.6%) Conclusions: With increasing number of immunocompromised patients and an increased incidence of nocardiosis, diagnosis of Nocardia infections should always be kept in mind as it can present with nonspecific symptoms and can mimic confused with other diseases. Linezolid, Cotrimoxazole, imipenem and minocycline were found to be very effective, in vitro, against most Nocardia species. J Microbiol Infect Dis 2016;6(2): 60-64    

Anahtar Kelimeler

• Nocardiosis,pulmonary,Incidence,India,resistance,immunocompromised,bacterial infections

Kaynakça

1. 1. Brown JM, McNeil MM. Nocardia, rhodococcus, gordonia, actinomadura, streptomyces, and other aerobic actinomycetes. In: Murray PR, Baron EJ, Pfaller MA, et al. editors. Manual of Clinical Microbiology, 8th edn. Washington, D.C: American Society for Microbiology; 2003:502-531.
2. 2. Rodríguez-Nava V, Couble A, Devulder G, Flandrois JP, Boiron P, Laurent F. Use of PCR-Restriction Enzyme Pattern Analysis and Sequencing Database for hsp65 GeneBased Identification of Nocardia Species. J Clın Microbiol 2006;44:536-546.
3. 3. Indamuthi V A, Shivakumar NS. Disseminated nocardiosis in an elderly patient presenting with prolonged pyrexia, diagnosis by thyroid abscess culture. Indian J Med Microbiol 2007; 25:294-296.
4. 4. Filice GA. Nocardiosis. In Longo DL, Fauci AS, Kasper LD, et al.editors. Harrison’s principles of Internal Medicine McGraw Hill Company 2012;1322-1326.
5. 5. Fiss E, Brooks G F.Use of siderophore detection medium,ethyleneglycol degradation, and beta –galactosidase activity in early presumptive differentiation of Nocardia, Rhodococcus, Streptomyces and rapidly growing Mycobacterium species. J Clin Microbiol 1991;29:1533-1535.
6. 6. Saubolle M A, Sussland D. Nocardiosis: Review of Clinical and Laboratory Experience. J Clin Microbiol 2003;41:4497- 4501.
7. 7. Barbara A. Brown-Elliott, Brown JM, Conville PS, Wallace RJ. Clinical and Laboratory Features of the Nocardia spp. Based on Current Molecular Taxonomy .Clin. Microbiol. Rev 2006;19 :259-282.
8. 8. Ambaye A, Kohner P C, Wollan P C, et al. Comparison of agar dilution, broth microdilution, disk diffusion, E-test, and BACTEC radiometric methods for antimicrobial susceptibility testing of clinical isolates of the Nocardia asteroides complex. Journal of Clinical Microbiology. 1997;35:847-852.

9. 9. Gail. L .W. Barbara A. B. E, Edward P. D et al. Susceptibility testing of Mycobacteria, Nocardiae and other aerobic Actinomycetes; approved standard-Second Edn. 2009.CLSI document M24-A2.
10. 10. Winn, Washington C.Koneman, Elmer W.,eds. Koneman’s Color Atlas And Textbook Of Diagnostic Microbiology. Philadelphia : Lippincott Williams & Wilkins, 2006;858-876:1478- 1479.
11. 11. Sharma NL, Mahajan VK, Agarwal S et al. Nocardial mycetoma: Diverse clinical presentations. Indian J Dermatol Venereol Leprol 2008;74:635-640.
12. 12. Shome S.K, Upreti H.B, Singh M.M, Pamra S.P. Mycoses associated with pulmonary tuberculosis. Ind J Tub 1976;23:64- 68.
13. 13. Shivaprakash MR, Rao P, Mandal J, et al. Nocardiosis in a tertiary care hospital in North India and review of patients reported from India. Mycopathologia 2007;163:267-274.
14. 14. A. Kageyama, K. Yazawa, J. Ishikawa A. et al. Nocardial infections in Japan from 1992 to 2001 including first report of infection Nocardia transvalensis. Eur J Epidemiol 2004;19:383-389.
15. 15. Mijares CC, Mendoza TM. Pulmonary nocardiois in renal transplant recipients. Phil J Microbiol Infect Dis 2001;144- 152.
16. 16. Mootsikapun P, Intarapoka B, Liawnoraset W. Nocardiosis in Srinagarind Hospital, Thailand: review of 70 cases from 1996-2001. International Journal of Infectious Diseases 2005;154-158.
17. 17. Yildiz, Orhan, Dogonay, Mehmet. Actinomycoses and Nocardia pulmonary infections. Current Opinion in Pulmonary Medicine 2006;12:228-234.
18. 18. Inamdar AC, Palit A. Primary cutaneous nocardiosis: A case study and review. Indian J Dermatol Venerol Leprol 2003;69:386-391.
19. 19. Glupczynski, C. Berhin, M. Janssens and G. Wauters. Determination of antimicrobial susceptibility patterns of Nocardia spp. from clinical specimens by E test. Clin Microbiol Infect 2006:12:905-912.
20. 20. Yildiz O, Alp E, Tokgoz B, et al. Nocardiosis in a teaching hospital in the Central Anatolia region of Turkey: treatment and outcome. Clin Microbiol Infect 2005; 11:495-499.
21. 21. Bibi S, Irfan S, Zafar A, Khan E. Isolation frequency and susceptibility patterns of Nocardia species at a tertiary hospital laboratory in Karachi, Pakistan. Journal of Infection in Developing Countries 2011;5:499-501.