Search

Nocardiosis is known to be an opportunistic infection most commonly affecting immunocompromised patients that can lead to life-threatening conditions. Primary cutaneous disease remains a rare manifestation and unlike pulmonary or disseminated nocardiosis, it usually affects immunocompetent individuals. We present a case of a primary cutaneous nocardiosis of the head and neck after an insect bite in a healthy 50-year-old woman who had recently travelled from Greece. She presented with a painful right-sided swelling of her face and neck and an ulcerated plaque over the right temple. Biopsy of the plaque revealed inflammation with abscess formation indicating underlying infection. Culture from the biopsy showed growth of Nocardia spp and 16S rRNA gene sequence analysis identified Nocardia brasiliensis The patient was treated with trimethoprim/sulfamethoxazole and subsequently switched to amoxicillin/clavulanic acid due to a drug eruption. Antibiotic therapy was continued for a total of 3 months with complete resolution of the skin lesions., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

During a 5-y period (2003 - 2007), nocardial infections were diagnosed in 15 patients admitted to the University Hospital of Heraklion, Crete, Greece. Nine patients (60%) had 1 or more underlying conditions predisposing to nocardiosis. The skin was involved in 10 cases, followed by the lung in 4. One patient had disseminated disease. Five different species were identified: N. brasiliensis (n =7), N. otitidiscaviarum (n=4), N. abscessus (n=2), N. transvalensis (n=1), and N. farcinica (n=1). The most common species was N. brasiliensis. All isolates were sensitive to linezolid, moxifloxacin, and tigecycline, and 80% of them to trimethoprim-sulfamethoxazole. Antibiotics were given to all 15 patients. A clinical response was observed in 14 of them, while 1 died of nocardiosis. Nocardiosis is a rare but sometimes life-threatening infection, complicating immunosuppression. Early diagnosis and timely administration of appropriate treatment result in a favourable outcome.

Nocardia farcinica is an emerging pathogen in immunocompromised patients, accounting for approximately 20% of Nocardia clinical isolates in various countries. A case of fatal N. farcinica bacteremia in a 52-year-old man with lung cancer is described. He was admitted with severe respiratory distress, and despite the early onset of empirical antibiotic treatment, he failed to respond and died of septic shock 24 hours later. N. farcinica was isolated from blood cultures obtained at hospital admission and was identified by conventional methods. Strain identification was confirmed by nucleotide sequencing of the 16S rRNA gene. N. farcinica bacteremia is a life-threatening infection. Because of the actinomycete's highly-resistant antibiotic profile, early identification and antibiotic susceptibility testing are necessary to improve the chances of survival.

Nocardia species are Gram-positive bacteria responsible for systemic or cutaneous infections in humans. Nocardia brasiliensis is the most common infective agent in the cutaneous form of nocardiosis. We describe a case of a previously healthy man, who presented with lymphocutaneous Nocardia brasiliensis infection, and was successfully treated with trimethoprim-sulfamethoxazole. The identification of the isolate was confirmed by nucleotide sequence analysis of the 16S rRNA gene.