Volume : III, Issue : VIII, August - 2014

Nocardiabrasiliensis as an Emerging Cause of Opportunistic Infection in Surgical Wards

Drshivanand Reddy, Drvijayanand Reddy, Drmanjunathshenoy

Abstract :

A 34-year-old female was admitted to the Surgery ward of JSS Hospital with multiple inflammatory nodules, Single keloidal scar and discharging sinuses over the thoracic wall right sided. Physical examination revealed a discharging area that occupied the entire right sided thoracic wall, extending up to the left shoulder and scapular region. There were numerous large sinuses discharging viscous yellow pus and serosanguinous material, often plugged with protuberant masses of granulation tissue.The PCR products were sequenced by using an ABI Prism 377 automated sequencer (PE Applied Biosystems)1.The strain was definitively identified as N. asiliensis (ATCC 19296, accession number AY756544)2.The patient was medicated with imipenem-cilastatin (60 mg/kg/day i.v. q6h) for 8 weeks, with a good response (healing of most of the cutaneous lesions, improvement of general health, weight gain of 13 kg and Hb increased to 11.4 g/l) (Fig. 1B) and subsequently with trimethoprim and sulphamethoxazole (160 mg TMP/800 mg SMZ p.o. q12h) until complete eradication of the organism was documented2.Among the several species of Nocardia causing cutaneous infections, N. asiliensis is the commonest species isolated . Recently, new species including N. mexicana and N. veterana were reported as causative agents of human mycetoma3. Cutaneous involvement with N. asteroides is usually secondary to haematogenous dissemination from a pulmonary focus. The commonest predisposing event in all the reported cases of primary cutaneous nocardiosis is a local trauma caused by thorns or splinters or, less commonly, insect bites and cat scratches3-4. It is most commonly caused by N. asiliensis, typically affects immunocompetent individuals, and can be subdivided into 3 clinical entities, including: lymphocutaneous infection, mycetoma, and superficial skin infection, including ulceration, abscess, and cellulites 4. An intermediate form of the disease between mycetoma and superficial skin infection has been reported recently 5.We report here a case of an immunocompetent female patient with extensive and destructive primary cutaneous nocardiosisover the thoracic wall .

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Article: Download PDF   DOI : 10.36106/ijsr  

Cite This Article:

DrShivanand Reddy, DrVijayanand Reddy, DrManjunathShenoy Nocardiabrasiliensis as an Emerging Cause of Opportunistic Infection in Surgical Wards International Journal of Scientific Research, Vol : 3, Issue : 8 August 2014

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