title: Nocardia infection in lung transplant recipients.
abstract: Nocardia is a well-recognized pathogen in immunocompromised hosts, but the incidence of Nocardia infections in lung transplant recipients is not well defined. A chart review from 1990 to 2007 at Clarian Hospital Lung Transplant Center and Indiana University Medical Center revealed Nocardia infections in four of 410 lung transplant recipients despite prophylaxis. All infections were confined to lung and occurred at a median time of 315 d after transplantation. Nocardia nova was isolated in two patients, Nocardia farcinica in one, and unspecified Nocardia sp. in one. Nocardia isolates were susceptible to trimethoprim sulfa (TMP/SMX). Our data suggest that the dose of TMP/SMX, commonly used for Pneumocystis prophylaxis is not protective for Nocardia. Contrary to historic data reporting 40% mortality, none of the patients in our study died because of Nocardia. Nocardia infection is an under-recognized entity in lung transplant recipients, and the optimal duration of therapy and prophylaxis are unclear.
authors.affiliation: Department of Medicine, Indiana University School of Medicine, Medical Science Building 224C, Indianapolis, IN, USA.
authors.forename: Babar A
authors.initials: BA
authors.lastname: Khan
authors.forename: Michael
authors.initials: M
authors.lastname: Duncan
authors.forename: John
authors.initials: J
authors.lastname: Reynolds
authors.forename: David S
authors.initials: DS
authors.lastname: Wilkes
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D016040:Lung Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D009894:Opportunistic Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000517:prevention & control; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination