Fatal pulmonary infection by trimethoprim-sulfamethoxazole resistant Nocardia otitidiscaviarum: report of two cases and review

  • Rushika Saksena Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India http://orcid.org/0000-0002-0101-9569
  • Dabet Rynga Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
  • Santosh Rajan Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
  • Rajni Gaind Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
  • Reetika Dawar Department of Microbiology, Indraprastha Apollo Hospitals, Delhi, India
  • Raman Sardana Department of Microbiology, Indraprastha Apollo Hospitals, Delhi, India
  • Manas Kamal Sen Department of Pulmonary Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
  • Jagdish Chandra Suri Department of Pulmonary Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India
Keywords: Nocardia otitidiscaviarum, pulmonary infection, fatal

Abstract

Introduction: Nocardia otitidiscaviarum is a rare cause of human infections, mostly causing cutaneous and lymphocutaneous infections of mild severity. We report two cases of fatal pulmonary infection caused by Nocardia otitidiscaviarum in elderly patients.

Methodology: Case 1: A 70-year old woman presented with fever and cough with expectoration for a month. On physical examination, she had tachypnea and inspiratory crepitations in bilateral basal regions. Case 2: A 74-year old man presented with productive cough with foul smelling expectoration, fever and shortness of breath for one week. On examination, he had tachypnea, bilateral wheezing and inspiratory crepitations. In both cases, sputum was sent to microbiology laboratory. On direct microscopy Gram-positive, finely branching filaments were observed which were acid fast with 1% sulphuric acid. Chalky white opaque wrinkled colonies with musty basement type odour were seen on blood agar. Both patients were treated empirically with trimethoprim-sulfamethoxazole for Nocardia infection after notification of microscopy findings however both expired on Day 2 and Day 5 of admission, respectively. Both isolates were susceptible to amikacin, linezolid, ciprofloxacin and gentamicin. They were resistant to trimethoprim-sulfamethoxazole, ampicillin, amoxicillin-clavulanic acid, erythromycin, and imipenem. Based on biochemical identification and antimicrobial susceptibility pattern, the organism was identified as Nocardia otitidiscaviarum. The identification was confirmed using MALDI-TOF (Vitek MS, Biomerieux, France).

Conclusion: Our report highlights the importance of early identification of Nocardia to species level to improve treatment outcomes especially in critically ill patients. Mass spectrometry can become an integral part of diagnostic algorithms for nocardiosis.

Author Biographies

Rushika Saksena, Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India

Assistant Professor, Department of Microbiology

Dabet Rynga, Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India

Assistant Professor, Department of Microbiology

Santosh Rajan, Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India

MD Student, Department of Microbiology

Rajni Gaind, Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India

Consultant and Assoc Prof, Dept of Microbiology

Reetika Dawar, Department of Microbiology, Indraprastha Apollo Hospitals, Delhi, India

Consultant, Department of Microbiology

Raman Sardana, Department of Microbiology, Indraprastha Apollo Hospitals, Delhi, India

Consultant and Head, Department of Microbiology

Manas Kamal Sen, Department of Pulmonary Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India

Consultant, Department of Pulmonary Medicine

Jagdish Chandra Suri, Department of Pulmonary Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, Delhi, India

Consultant and Head, Department of Pulmonary Medicine

Published
2020-02-29
How to Cite
1.
Saksena R, Rynga D, Rajan S, Gaind R, Dawar R, Sardana R, Sen MK, Suri JC (2020) Fatal pulmonary infection by trimethoprim-sulfamethoxazole resistant Nocardia otitidiscaviarum: report of two cases and review. J Infect Dev Ctries 14:214-222. doi: 10.3855/jidc.10169
Section
Case Reports