Nocardiosis in liver transplantation: variation in presentation, diagnosis and therapy.
Nocardiosis arose in seven of 191 liver transplant patients (3.7%) over a period of 3.5 years. Four patients had only pulmonary lesions while three had disseminated disease. Nocardia asteroides was isolated from three patients following bronchoscopy, percutaneous aspirate of a pulmonary lesion in one patients, and from the skin from the aspirates in three patients. Delay in diagnosis in two cases was due to negative microscopy; in one, the diagnosis was made only after repeated bronchoscopy. Of the seven patients, three (43%) died. In two of these, nocardiosis was considered to have directly contributed to death. Co-existent bacterial and viral infections were present in all patients who died. In vitro susceptibility of the organism to co-trimoxazole was variable and did not necessarily reflect clinical efficacy. In one patient, a good clinical response was achieved with co-trimoxazole despite apparently reduced in vitro susceptibility.
Liver Unit, King's College Hospital, London, U.K.
G M
GM
Forbes
F A
FA
Harvey
J N
JN
Philpott-Howard
J G
JG
O'Grady
R D
RD
Jensen
M
M
Sahathevan
M W
MW
Casewell
R
R
Williams
D000328:Adult; D004352:Drug Resistance, Microbial; D005260:Female; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D009616:Nocardia asteroides / Q000302:isolation & purification; D013411:Sulfadiazine / Q000627:therapeutic use*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D013411:Sulfadiazine; D015662:Trimethoprim, Sulfamethoxazole Drug Combination