Molecular diagnosis of fatal Nocardia farcinica pneumonia in an HIV-negative patient.
Nocardiosis is a rare and potentially life-threatening infection caused by several species of the Nocardia genus. Most cases occur in immunocompromised patients, and a delay in establishing the diagnosis is common due to the non-specific clinical presentations and the difficulty in cultivating Nocardia. Although the majority of pulmonary nocardiosis cases are caused by Nocardia asteroides, cases of human infection due to N. farcinica are increasingly diagnosed due to recent developments in taxonomy and diagnostic methods. N. farcinica is a separate species from N. asteroides and appears to be more virulent and resistant to antibiotics. Herein, we describe the case of a 65-year-old HIV-negative immunocompromised patient with a fulminant bilateral pulmonary nocardiosis while on empirical treatment with trimethoprim/sulfamethoxazole and imipenem. Post-mortem diagnosis of N. farcinica infection was performed by means of DNA amplification and sequencing of the 65-kDa bacterial heat shock protein.
Bocchino
Marialuisa
M
Divisione Clinicizzata di Malattie Respiratorie, INMI L. Spallanzani IRCCS, Rome, Italy. mlbocchino@tiscali.it
Paglia
Maria Grazia
MG
Marruchella
Almerico
A
Contini
Silvia
S
Festa
Anna
A
Saltini
Cesare
C
D000368:Aged; D017809:Fatal Outcome; D005260:Female; D018023:HIV Seronegativity; D006360:Heat-Shock Proteins / Q000235:genetics*; D006801:Humans; D016867:Immunocompromised Host; D009615:Nocardia / Q000235:genetics / Q000302:isolation & purification*; D009617:Nocardia Infections / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D018410:Pneumonia, Bacterial / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA
D006360:Heat-Shock Proteins