title: Fatal Nocardia farcinica Bacteremia Diagnosed by Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry in a Patient with Myelodysplastic Syndrome Treated with Corticosteroids.
abstract: Nocardia farcinica is a Gram-positive weakly acid-fast filamentous saprophytic bacterium, an uncommon cause of human infections, acquired usually through the respiratory tract, often life-threatening, and associated with different clinical presentations. Predisposing conditions for N. farcinica infections include hematologic malignancies, treatment with corticosteroids, and any other condition of immunosuppression. Clinical and microbiological diagnoses of N. farcinica infections are troublesome, and the isolation and identification of the etiologic agent are difficult and time-consuming processes. We describe a case of fatal disseminated infection in a patient with myelodysplastic syndrome, treated with corticosteroids, in which N. farcinica has been isolated from blood culture and identified by Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry. The patient died after 18 days of hospitalization in spite of triple antimicrobial therapy. Nocardia farcinica infection should be suspected in patients with history of malignancy, under corticosteroid therapy, suffering from subacute pulmonary infection,and who do not respond to conventional antimicrobial therapy. Matrix-Assisted Laser Desorption-Ionization Time of Flight Mass Spectrometry can be a valuable tool for rapid diagnosis of nocardiosis.
authors.affiliation: Microbiology Section, Department of Experimental Medicine and Biochemical Sciences, Santa Maria della Misericordia Hospital, Sant'Andrea delle Fratte, 06132 Perugia, Italy.
authors.forename: Christian
authors.initials: C
authors.lastname: Leli
authors.forename: Amedeo
authors.initials: A
authors.lastname: Moretti
authors.forename: Francesco
authors.initials: F
authors.lastname: Guercini
authors.forename: Angela
authors.initials: A
authors.lastname: Cardaccia
authors.forename: Leone
authors.initials: L
authors.lastname: Furbetta
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Agnelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Bistoni
authors.forename: Antonella
authors.initials: A
authors.lastname: Mencacci