Nocardial infection as a complication of HIV in South Africa.
OBJECTIVE
To assess the occurrence, clinical and microbiological features of nocardial infections complicating HIV in Soweto, South Africa.


METHODS
A prospective study was carried out over a 2-year period. Patients were identified after isolation of Nocardia spp. from a clinical specimen. Clinical details were recorded. The nocardial isolates were identified to species level and susceptibility tests performed.


RESULTS
Ten patients were identified as having nocardial disease complicating HIV. Clinical presentations were pulmonary (five patients), pulmonary and cerebral (one patient), cerebral (one patient) and skin and soft tissue infection of the lower limb (three patients). Three infections were fatal. The isolates were Nocardia asteroides (seven patients), N. farcinica (two patients) and Nocardia spp. (one). Isolates of N. farcinica demonstrated opacification of Middlebrook agar. All isolates were sensitive to amikacin and minocycline. Most nocardial isolates were susceptible to cefotaxime, imipenem and coamoxiclav. In vitro resistance to cotrimoxazole was present in five.


CONCLUSIONS
Nocardial infection occurs as a complication of HIV infection in the Republic of South Africa. Pulmonary cases may be difficult to distinguish from tuberculosis. Nocardia asteroides is the most common species isolated. Nocardia farcinica has resistance to multiple antibacterial agents and demonstrates opacification of Middlebrook agar, a useful screening test for this species. Agents with good in vitro antinocardial activity were amikacin, minocycline, cefotaxime, imipenem and coamoxiclav. There was a high level of resistance in vitro to cotrimoxazole.
Jones
N
N
Department of Microbiology, Chris Hani Baragwanath Hospital, South African Institute for Medical Research, Hospital Street, Johannesburg 2000, PO Box 1038, RSA.
Khoosal
M
M
Louw
M
M
Karstaedt
A
A
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001922:Brain Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009615:Nocardia / Q000187:drug effects / Q000302:isolation & purification; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011446:Prospective Studies; D018461:Soft Tissue Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D013019:South Africa / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000453:epidemiology
D000900:Anti-Bacterial Agents