title: Disseminated Nocardia farcinica: literature review and fatal outcome in an immunocompetent patient.
abstract: BACKGROUND
  Nocardia farcinica is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete. Nocardia spp. are opportunistic pathogens, and N. farcinica is the least common species of clinical importance.
  
  
  METHODS
  Review of the recent literature and description of a immunocompetent patient with no known risk factors who contracted fatal N. farcinica sepsis.
  
  
  RESULTS
  Positive pre-mortem and post-mortem cultures from the lung and synovium correlated with acute bronchopneumonia and synovitis at autopsy. Colonies of filamentous bacteria, which were not apparent in conventional hematoxylin and eosin-stained sections, were observed with gram and methenamine silver stains, but acid-fast stains were negative. A literature review revealed that disseminated N. farcinica often is associated with an underlying malignant tumor or autoimmune disease (88% of patients). Chemotherapy or corticosteroid treatments are additional risk factors.
  
  
  CONCLUSIONS
  Trimethoprim-sulfamethoxazole typically is the first-line therapy for N. farcinica; treatment with amikacin and imipenem-cilastatin is used less often (7% of patients). Despite aggressive therapy, we observed that the death rate (39%) associated with N. farcinica in recent publications was eight percentage points higher than reported in a review from 2000.
authors.affiliation: Department of Pathology, Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Budzik
authors.forename: Mojgan
authors.initials: M
authors.lastname: Hosseini
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Mackinnon
authors.forename: Jerome B
authors.initials: JB
authors.lastname: Taxy
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D017809:Fatal Outcome; D006801:Humans; D007121:Immunocompetence; D008297:Male; D009617:Nocardia Infections / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D013585:Synovitis / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination