Nocardia arthritidis Infection in an Immunocompetent Human in the United States

Osamuyimen Igbinosa^1, , Owen Igbinosa², Krishna Dass¹ and Glenn Wortmann¹

¹Section of Infectious Diseases, MedStar Washington Hospital Center, Washington DC USA

²Department of medicine, Obafemi Awolowo University Teachings Hospitals Complex, Ile-Ife, Nigeria

Cite this paper

Osamuyimen Igbinosa, Owen Igbinosa, Krishna Dass and Glenn Wortmann. Nocardia arthritidis Infection in an Immunocompetent Human in the United States. American Journal of Medical Case Reports. 2016; 4(7):251-254. doi: 10.12691/AJMCR-4-7-10

Abstract

Patients with T-cell defects are at the highest risk for nocardiosis, a potentially life-threatening infection caused by several species of the genus, Nocardia. We report a case of disseminated Nocardia arthritidis in a patient who had no recognizable risk factors for immunodeficiency. A 43-year-old woman was noted to have a left upper lobe cavitary lesion on an outpatient computerized tomography (CT) scan that was performed for evaluation of pelvic congestion syndrome. She subsequently had an image-guided biopsy of the lesion, but the results were still pending when she presented at the emergency department with a transient episode of aphasia. A CT scan of the patient’s head revealed hypodensities in the right frontoparietal and left frontal lobes. A modified acid-fast stain on the lung biopsy specimen demonstrated variable, branching, filamentous bacteria with morphology consistent with Nocardia species. Matrix-Assisted Laser Desorption / Ionization – Time-of-Flight (MALDI-TOF) Mass Spectrometry at a reference laboratory later identified the bacteria as Nocardia arthritidis. This case highlights that disseminated nocardiosis can occur in an apparently healthy population. A more detailed immunologic evaluation that include screening for chronic granulomatous disease, anticytokine autoantibody deficiency and interleukin-12-gamma interferon pathway deficiency may further assist in the diagnosis of patients’ underlying diseases.

Keywords

Norcadiosis, Norcadia arthritidis Immunocompromised

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Beaman, B. L., Burnside, J., Edwards, B. & Causey, W. (1976). Nocardial infections in the United States, 1972-1974, J Infect Dis 134: (3) 286-289.
[2]	Wilson, J. W. (2012). Nocardiosis: updates and clinical overview. Mayo Clin Proc.87: 403-407.
[3]	Hwang, J. H., Koh, W. J., Suh, G. Y., et al. (2004). Pulmonary nocardiosis with multiple cavitary nodules in a HIV-negative immunocompromised patient Intern Med 43(9): 852-854.
[4]	Conville, P. S., Brown, J. M., Steigerwalt, A. G., et al. (2008). Nocardia wallacei sp. nov. and Nocardia blacklockiae sp. nov., human pathogens and members of the “Nocardia transvalensis Complex”. J Clin Microbiol 2008; 46: 1178.
[5]	Kageyama, A., Torikoe, K., Iwamoto, M., et al. (2004). Nocardia arthritidis sp. nov., a New Pathogen Isolated from a Patient with Rheumatoid Arthritis in Japan J Clin Microbiol. 2004 Jun; 42(6): 2366-2371.
[6]	Aragaki-Nakahodo, A., Benzaquen, S. & Kirschner, M. (2014). Coinfection by Nocardia beijingensis and Nocardia arthritidis in an immunocompromised patient diagnosed by endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) Respir Med Case Rep 12: 22e23.
[7]	Brown-Elliott, B. A., Brown, J. M., Conville, P. S., Wallace, R. J. (2006). Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev. 19: 259-282.
[8]	Uhde, K. B., Pathak, S., McCullum, I. Jr., et al. (2010). Antimicrobial-resistant nocardia isolates, United States, 1995-2004. Clin Infect Dis 51: 1445-1448.
[9]	Beaman, B.L. & Beaman, L. (1994) Nocardia species: host-parasite relationships. Clin Microbiol Rev. 7: 213-264.
[10]	Yu, X., Han, F., Wu, J., et al. (2011). Nocardia infection in kidney transplant recipients: Case report and analysis of 66 published cases. Transpl Infect Dis. 13: 385-391.
[11]	Kundranda, M. N., Spiro, T. P., Muslimani, A., et al. (2007). Cerebral nocardiosis in a patient with NHL treated with rituximab. Am J Hematol. 82: 1033-1034.
[12]	Punatar, A. D., Kusne, S., Blair, J. E., Seville, M. T. & Vikram, H. R. (2012). Opportunistic infections in patients with pulmonary alveolar proteinosis. J Infect. 65(2): 173-9.
[13]	Bergstrom, R., Edebo, L., Fors, B. & Tegner, K. B. (1966). Systemic Nocardia infection. Scand J Respir Dis. 47: 75-84.
[14]	Debieuvre, D., Dalphin, J. C., Jacoulet, P., et al. (1993). Disseminated infection due to an unusual strain of Nocardia farcinica (Fre). Rev Mal Respir. 10: 356-358.
[15]	Torres, O. H., Domingo, P., Pericas, R. et al. (2000). Infection caused by Nocardia farcinica: Case report and review. Eur J Clin Microbiol Infect Dis. 19: 205-212.
[16]	Rosen, L. B., Rocha, P. N., Figueiredo, C., et al. (2015). Nocardia-induced granulocyte macrophage colony-stimulating factor is neutralized by autoantibodies in disseminated/ extrapulmonary nocardiosis. Clin Infect Dis. 1; 60(7): 1017-25.
[17]	Lederman, E. R. & Crum, N. F. (2004). A case series and focused review of nocardiosis: clinical and microbiologic aspects. Medicine (Baltimore) 83: 300-313.
[18]	Martinez, R., Reyes, S. & Menendez, R. (2008). Pulmonary nocardiosis: risk factors, clinical features, diagnosis and prognosis. Curr. Opin. Pulm. Med. 14: 219-227.
[19]	Wayne, L. G., Brenner, D. J., Colwell, R. R., et al. (1987). International Committee on Systematic Bacteriology. Report of the Ad Hoc Committee on reconciliation of approaches to bacterial systematics. Int J Syst Bacteriol. 37: 463-464.
[20]	Kageyama, A., Poonwan, N., Yazawa, K., Mikami, Y. & Nishimura, K. (2004). Nocardia beijingensis is a pathogenic bacterium to humans: the first infectious cases in Thailand and Japan. Mycopathology 157: 155-161.
[21]	Crozier, J. A., Andhavarapu, S., Brumble, L. M. & Sher, T., (2014). First Report of Nocardia beijingensis Infection in an Immunocompetent Host in the United States. J Clin Microbiol. 52(7): 2730-2732.