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Table 1.  

Antimicrobial drug This study Case 1† Case 2† Case 3† Case 4† Case 5† Case 6† Case 7‡
Amikacin S R S II S S S VSR or II
Amoxi-clav R R II S R R R R
Ceftriaxone I R R II S S R VSR or II
Ciprofloxacin S S S S S S S II
Clarithromycin S S II S S S S S
Doxycycline R R II II II R R II
Imipenem R R R R II R R VSR or II
Linezolid S S S II II S S S
Minocycline R R II II M R R II
Moxifloxacin S S II II II S II II
Tobramycin S II II II II II II II
TMP/SMX S R R II R S S

Reported susceptibility of Nocardia pseudobrasiliensis bacteria to antimicrobial drugs*

*Amoxi-clav, amoxicilline/clavulanic acid; I, intermediate; II, insufficient information; M, moderate; R, resistant; S, susceptible; TMP/SMX, trimethoprim/sulfamethoxazole; VSR, variable susceptibility results.
†Veerappan Kandasamy et al. (2).
‡Wilson et al. (3).
§This specimen was susceptible to SMX only.

Table 2.  

Study Age, y/sex Nocardia species; positive culture site(s) Days from SARS-CoV-2 diagnosis to Nocardia diagnosis Site(s) of Nocardia infection Predisposing factor On MV? Steroids before Nocardia diagnosis Susceptibilities Final therapy Outcome
Colaneri et al. (5) 45/F N. cryarcigeorgica; subcutaneous lumps, lower respiratory tract sputum smear and culture 5 d Lung, skin, kidney AIDS No Hydrocortisone for persistent fever Susceptible: TMP/SMX, amikacin, linezolid; resistant: AMO/CLA, third-generation cephalosporins, quinolones Tedizolid for 1 wk followed by 1 y TMP/SMX Survived
Arif et al. (6) 61/F N. farcinica; Gram stain of pulmonary nodule biopsy 10 d Lung Type 2 diabetes mellitus No Dexamethasone for COVID-19 NA TMP/SMX and linezolid Survived
Atemnkeng et al. (7) 63/M N. asteroids; bronchial lavage culture 50 d Lung, brain Type 2 diabetes mellitus No Dexamethasone for COVID-19 Resistant: carbapenem TMP/SMX and linezolid for 1 y Survived
Kaur and Bhatti (8) 80/F N. farcinica; Gram stain and culture of brain abscess biopsy >10 d, exact date unspecified Brain Advanced age No Dexamethasone for COVID-19 NA TMP/SMX, ceftriaxone, doxycycline Not reported
Driscoll et al. 2022 (9) 16/M N. farcinica; lower airway samples 9 d Lung Cystic fibrosis, bronchiectasis Yes Dexamethasone for COVID-19 NA Linezolid Died
Cicero et. al. 2022 (10) 79/M N. otitidiscaviarum: sputum culture 17 d Lung COPD, previous pulmonary tuberculosis, cirrhosis No Methylpredisolone for COVID-19 Susceptible: ceftriaxone, amikacin, ciprofloxacin, meropenem, TMP/SMX Not given Died
Velickovic et al. 2022 (11) 30/F N. cyriacigeorgica; brain abscess 200 d Brain Systemic lupus erythematosus, glucocorticoid therapy, CD4 count <100 No Prednisone for systemic lupus erythematosus Susceptible: TMP/SMX, ceftriaxone, cefotaxime, imipenem, linezolid; resistant: ampicillin, AMO/CLA, fluoroquinolones TMP/SMX Survived
DiMeglio et al. 2022 (12) 70/M N. farcinica: spinal cord abscess 48 d Brain and spinal cord Diabetes mellitus, advanced age, glucocorticoid therapy No Dexamethasone for COVID-19 NR TMP/SMX, linezolid Died
Laplace et al. 2022 (13) 83/M N. cyriacigeorgica: sputum culture 4 d Lung Advanced age No Dexamethasone for COVID-19 NR Imipenem, cotrimoxazole Died
This study 52/M N. pseudobrasiliensis: sputum gram stain 7 d Lung Bronchiectasis, sarcoidosis, immunosuppressive therapy, type 2 diabetes mellitus No Dexamethasone for COVID-19 Susceptible: amikacin, ciprofloxacin, clarithromycin, linezolid, moxifloxacin, tobramycin, TMP/SMX; resistant: AMO/CLA, doxycycline, imipenem, minocycline Linezolid, ciprofloxacin Survived

Nocardiosis infections reported during or shortly after COVID-19 infection, 2021*

*AMO/CLA, amoxicillin/clavulanic acid; COPD, chronic obstructive pulmonary disease; MV, mechanical ventilation; NA, not available; NR, not reported; TMP/SMX, trimethoprim/sulfamethoxazole.

CME / ABIM MOC

Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients

  • Authors: Daniel Beau Stamos, BS; Aldo Barajas-Ochoa, MD; Jillian E. Raybould, MD
  • CME / ABIM MOC Released: 3/22/2023
  • Valid for credit through: 3/22/2024, 11:59 PM EST
Start Activity

  • Credits Available

    Physicians - maximum of 1.00 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 1.00 ABIM MOC points

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for infectious disease clinicians, pulmonologists, internists, intensivists, and other clinicians caring for patients with pneumonia who may have coinfection with SARS-CoV-2 and Nocardia.

The goal of this activity is for learners to be better able to describe clinical features, course, treatment, and predisposing factors for nocardiosis and COVID-19 coinfection, based on a case report of SARS-CoV-2 coinfection with pulmonary Nocardia pseudobrasiliensis and a literature review.

Upon completion of this activity, participants will:

  • Determine the clinical features and predisposing factors for nocardiosis and COVID-19 coinfection, based on a case report of SARS-CoV-2 coinfection with pulmonary Nocardia pseudobrasiliensis and a literature review
  • Assess the course and treatment of nocardiosis and COVID-19 coinfection, based on a case report of SARS-CoV-2 coinfection with pulmonary Nocardia pseudobrasiliensis and a literature review
  • Evaluate the clinical implications of the features, course, treatment, and predisposing factors for nocardiosis and COVID-19 coinfection, based on a case report of SARS-CoV-2 coinfection with pulmonary Nocardia pseudobrasiliensis and a literature review


Disclosures

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Faculty

  • Daniel Beau Stamos, BS

    Virginia Commonwealth University Health System
    Richmond, Virginia, USA

  • Aldo Barajas-Ochoa, MD

    Virginia Commonwealth University Health System
    Richmond, Virginia, USA

  • Jillian E. Raybould, MD

    Virginia Commonwealth University Health System
    Richmond, Virginia, USA

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has no relevant financial relationships.

Editor

  • Dana C. Dolan, BS

    Copyeditor
    Emerging Infectious Diseases

Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.


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CME / ABIM MOC

Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients

Authors: Daniel Beau Stamos, BS; Aldo Barajas-Ochoa, MD; Jillian E. Raybould, MDFaculty and Disclosures

CME / ABIM MOC Released: 3/22/2023

Valid for credit through: 3/22/2024, 11:59 PM EST

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Abstract and Introduction

Abstract

During the SARS-CoV-2 pandemic, few cases of Nocar­dia spp. co-infection have been reported during or after a COVID-19 infection. Nocardia spp. are gram-positive aerobic actinomycetes that stain partially acid-fast, can infect immunocompromised patients, and may cause dis­seminated disease. We report the case of a 52-year-old immunocompromised man who had Nocardia pseudobrasiliensis pneumonia develop after a SARS-CoV-2 in­fection. We also summarize the literature for no­cardiosis and SARS-CoV-2 co-infections. Nocardia spp. infection should remain a part of the differential diagnosis for pneumonia in immunocompromised hosts, regardless of other co-infections. Sulfonamide/carbapenem combina­tions are used as empiric therapy for nocardiosis; species identification and susceptibility testing are required to se­lect the optimal treatment for each patient.

Introduction

Nocardia pseudobrasiliensis are gram-positive aerobic actinomycetes; stains of N. pseudobrasiliensis are partially acid fast (1). As with other Nocardia species, N. pseudobrasiliensis can infect immunocompromised patients and may cause disseminated disease (2). Risk factors for nocardiosis include immunosuppression caused by solid organ or hematopoietic cell transplantation, glucocorticoid therapy, chronic lung disease, diabetes, AIDS, and malignancy (3,4). Infection by other pathogens during or after SARS-CoV-2 infection is a known but relatively uncommon occurrence. Nocardiosis co-infection with SARS-CoV-2 is rarely reported. We describe a case of SARS-CoV-2 co-infection with pulmonary Nocardia pseudobrasiliensis and summarize the literature on nocardiosis and COVID-19 co-infection.