title: Successful management of disseminated Nocardia transvalensis infection in a heart transplant recipient after development of sulfonamide resistance: case report and review.
abstract: Nocardia transvalensis is a rarely reported cause of clinically significant disease, and, to our knowledge, has not been reported previously as a cause of infection in the cardiac transplant population. We report a case of N transvalensis new taxon-2 pulmonary infection that disseminated to the brain and skin in a cardiac transplant recipient despite adequate sulfonamide serum levels. Subsequent isolates were resistant to sulfonamides, and molecular ribotyping of the primary and subsequent isolates confirmed that these were the same N transvalensis new taxon-2 strain. The taxonomic and diagnostic considerations, as well as the clinical significance of anti-microbial-resistant nocardia, are reviewed and discussed herein.
authors.affiliation: Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.
authors.forename: Fred A
authors.initials: FA
authors.lastname: Lopez
authors.forename: Frances
authors.initials: F
authors.lastname: Johnson
authors.forename: Denise M
authors.initials: DM
authors.lastname: Novosad
authors.forename: Blaine L
authors.initials: BL
authors.lastname: Beaman
authors.forename: Mark
authors.initials: M
authors.lastname: Holodniy
mesh_terms: D019980:Amoxicillin-Potassium Clavulanate Combination / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D002443:Ceftriaxone / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D004351:Drug Resistance; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009615:Nocardia / Q000187:drug effects / Q000472:pathogenicity*; D009617:Nocardia Infections / Q000188:drug therapy* / Q000209:etiology*; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D013449:Sulfonamides / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D013449:Sulfonamides; D002939:Ciprofloxacin; D019980:Amoxicillin-Potassium Clavulanate Combination; D002443:Ceftriaxone