CASE SERIES OF ISOLATED PULMONARY NOCARDIOSIS AMONG POST-COVID-19 INDIVIDUALS
Keywords:Pulmonary nocardiosis, Post-covid-19, Nocardia asteroides, Trimethoprim-sulfamethoxazole
Nocardia infections are rare in an immunocompetent and healthy individual. It is frequently diagnosed and reported very late during the disease. Here we present an interesting case series of isolated pulmonary nocardiosis among post COVID-19 patients. A 45-year-old male presented to general medicine OPD with breathlessness and cough with expectoration. The patient was a known case of diabetes. A Sputum sample was sent for culture, gram, and acid-fast stain, and the nasopharyngeal swab was sent for RT-PCR and turned out to be COVID-19 negative. Gram stain showed numerous pus cells with filamentous hyphae-like structures. Nocardiosis was strongly considered based on imaging morphology. A 65-year-old female presented to OPD with fever, respiratory distress, and expectorating cough for one month. The patient was a not known case of diabetes and hypertension. The patient was diagnosed with pneumonia and had a history of COVID-19. The microscopic examination of the sputum sample revealed no fungal elements. The Gram and Ziehl-Neelsen stain showed pus cells with filamentous bacilli and no acid-fast bacilli. A 50-year-old male presented to general medicine OPD with breathlessness and expectorating cough for four weeks. The patient was a not known case of diabetes and hypertension. The sputum sample was negative for ZN stain; the Gram stain showed numerous pus cells with filamentous hyphae-like structures. The modified acid-fast staining was done for sputum and BAL samples in all cases showed filamentous weak acid-fast bacilli resembling Nocardia species. The patient did well with cotrimoxazole and was discharged later. The differential diagnosis of nocardia should always be in mind in case of lung infections. All respiratory samples must also be screened for Nocardia. The early diagnosis and management of pulmonary nocardiosis decide the patient’s prognosis.
Saubolle MA, Sussland D. Nocardiosis: review of clinical and laboratory experience. J Clin Microbiol. 2003;41(10):4497-501. doi: 10.1128/JCM.41.10.4497-4501.2003, PMID 14532173.
Hett EC, Rubin EJ. Bacterial growth and cell division: a mycobacterial perspective. Microbiol Mol Biol Rev. 2008;72(1):126-56. doi: 10.1128/MMBR.00028-07, PMID 18322037.
Donovan C, Bramkamp M. Cell division in corynebacterineae. Front Microbiol. 2014;5:132. doi: 10.3389/fmicb.2014.00132, PMID 24782835.
Herrero Martinez JA, Gomez Gomez J, Garcia Vazquez E, Hernandez Torres A. Nocardiosis. (Article in Spanish). Med Programa Form Med Continuada Acreditado. 2014;11(58):3412-8. doi: 10.1016/S0304-5412(14)70793-0.
Fatahi Bafghi M. Nocardiosis from 1888 to 2017. Microb Pathog. 2018;114:369-84. doi: 10.1016/j.micpath.2017.11.012, PMID 29146497.
Beaman BL, Beaman L. Nocardia species: host-parasite relationships. Clin Microbiol Rev. 1994;7(2):213-64. doi: 10.1128/CMR.7.2.213, PMID 8055469.
Fujita T, Ikari J, Watanabe A, Tatsumi K. Clinical characteristics of pulmonary nocardiosis in immunocompetent patients. J Infect Chemother. 2016;22(11):738-43. doi: 10.1016/j.jiac.2016.08.004, PMID 27615155.
Das AK, Nandy S, Dudeja M, Tiwari R, Alam S. The incidence of nocardiosis at pulmonary and extrapulmonary sites. J Clin Diagn Res. 2013;7(7):1427-9. doi: 10.7860/JCDR/2013/5177.3152, PMID 23998082.
Wilson JW. Nocardiosis: updates and clinical overview. Mayo Clin Proc. 2012;87(4). doi: 10.1016/j.mayocp.2011.11.016, PMID 22469352.
Martinez Tomas R, Menendez Villanueva R, Reyes Calzada S, Santos Durantez M, Valles Tarazona JM, Modesto Alapont M. Pulmonary nocardiosis: risk factors and outcomes. Respirology. 2007;12(3):394-400. doi: 10.1111/j.1440-1843.2007.01078.x, PMID 17539844.
Menendez R, Cordero PJ, Santos M, Gobernado M, Marco V. Pulmonary infection with Nocardia species: a report of 10 cases and review. Eur Respir J. 1997;10(7):1542-6. doi: 10.1183/09031936.97.10071542, PMID 9230244.
Beaman BL, Burnside J, Edwards B, Causey W. Nocardial infections in the United States, 1972-1974. J Infect Dis. 1976;134(3):286-9. doi: 10.1093/infdis/134.3.286, PMID 789786.
Pourmand G, Jazaeri SA, Mehrsai A, Kalhori S, Afshar K. Nocardiosis: report of four cases in renal transplant recipients. Transplant Proc. 1995;27(5):2731-3. PMID 7482893.
Gutierrez H, Salgado O, Garcia R, Henriquez C, Herrera J, Rodriguez Iturbe B. Nocardiosis in renal transplant patients. Transplant Proc. 1994;26(1):341-2. PMID 8109008.
Farina C, Andrini L, Bruno G, Sarti M, Tripodi MF, Utili R. Nocardia brasiliensis in Italy: a nine-year experience. Scand J Infect Dis. 2007;39(11-12):969-74. doi: 10.1080/00365540701466124, PMID 18027278.
Safdar N, Kaul DR, Saint S. Clinical problem-solving. Into the woods. N Engl J Med. 2007;356(9):943-7. doi: 10.1056/NEJMcps054496, PMID 17329702.
Mijares MC, Mendoza MT. Pulmonary nocardiosis in renal transplant recipients. Philol J Microbiol Infect Dis. 2001:144-52.
Yildiz O, Doganay M. Actinomycoses and Nocardia pulmonary infections. Curr Opin Pulm Med. 2006;12(3):228-34. doi: 10.1097/01.mcp.0000219273.57933.48, PMID 16582679.
Tsujimoto N, Saraya T, Kikuchi K, Takata S, Kurihara Y, Hiraoka S. High-resolution CT findings of patients with pulmonary nocardiosis. J Thorac Dis. 2012;4(6):577-82. doi: 10.3978/j.issn.2072-1439.2012.11.07. PMID 23205281.
Rao NK, Patil DNA, Agarwal N, Hande HM, Joseph A, Varghese G. A fibrous cavity in an immunocompromised lung: nocardiosis masquerading as tuberculosis. Asian J Pharm Clin Res. 2016;9(6, Nov):5-6. doi: 10.22159/ajpcr.2016.v9i6.13855.
Brown Elliott BA, Brown JM, Conville PS, Wallace RJ. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev. 2006;19(2):259-82. doi: 10.1128/CMR.19.2.259-282.2006, PMID 16614249.
Vera Cabrera L, Salinas Carmona MC. Current treatment for Nocardia infections expert opin. Pharmacother. 2013;14:2387-98.
Kumari CUA, PA Kumar. Effect of actinomycetes on growth of ocimum sanctum. Int J Curr Pharm Res. 2019;11(3 May):45-7.
How to Cite
Copyright (c) 2023 PRASANNA S., MAYURI MAHAJAN, NIKUNJA KUMAR DAS, NIKHIL MAHAJAN, CHANDANA S.
This work is licensed under a Creative Commons Attribution 4.0 International License.