title: Diagnosis and management of nocardiosis after bone marrow stem cell transplantation in adults: lack of lymphocyte recovery as a major contributing factor.
abstract: Hematopoietic cell transplantation (HCT) is a curative treatment for hematological malignancies. This therapeutic approach is associated with a profound immune deficiency and an increased rate of opportunistic infections. Nocardiosis is a rare bacterial infection occurring mainly in patients with deficient cell-mediated immunity, such as AIDS patients or transplant recipients. Diagnosis of nocardiosis can be challenging, as signs and symptoms are non-specific. Routine prophylaxis with trimethoprin/sulfamethoxazole (TMP/SMZ) does not prevent the risk of infection. Between May 2001 and December 2009, five cases of nocardiosis were diagnosed from the 366 allogeneic HCT recipients in our centre. Four patients developed a disseminated nocardiosis within the first year after HCT. The fifth patient presented a localized cutaneous nocardiosis. In disseminated cases, median total CD4+ T-cells were below 100 cells/μL. Naive CD4+ CD45RA+/RO- T-cells were almost undetectable. CD8(+) T-cells and NK cells were below the normal range and CD19+ B-cell reconstitution was completely deficient. In a localized case, we observed a lack of naive thymic emigrants CD4+ CD45RA+/RO- T-cells.
authors.affiliation: Service d'hématologie, CHU de Besançon, 1, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: L
authors.initials: L
authors.lastname: Mansi
authors.affiliation: Service d'hématologie, CHU de Besançon, 1, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Daguindau
authors.affiliation: Inserm UMR1098, bâtiment Inserm, 20, rue Françoise-Dolto, 25000 Besançon, France; SFR FED 4234, bâtiment Inserm, université de Franche-Comté, 20, rue Françoise-Dolto, 25000 Besançon, France; Plateforme de biomonitoring, EFS Bourgogne Franche-Comté, 2, boulevard Fleming, 25020 Besançon cedex, France; Centre d'investigation clinique en biothérapies 506, CHU de Besançon, 1, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: P
authors.initials: P
authors.lastname: Saas
authors.affiliation: Activité d'ingénierie et de thérapie cellulaire, EFS Bourgogne Franche-Comté, 2, boulevard Fleming, 25020 Besançon cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Pouthier
authors.affiliation: Inserm UMR1098, bâtiment Inserm, 20, rue Françoise-Dolto, 25000 Besançon, France; SFR FED 4234, bâtiment Inserm, université de Franche-Comté, 20, rue Françoise-Dolto, 25000 Besançon, France; Plateforme de biomonitoring, EFS Bourgogne Franche-Comté, 2, boulevard Fleming, 25020 Besançon cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Ferrand
authors.affiliation: Laboratoire HLA, EFS Bourgogne Franche-Comté, 2, boulevard Fleming, 25020 Besançon cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Dormoy
authors.affiliation: Service de bactériologie, CHU de Besançon, 1, boulevard Fleming, 250030 Besançon cedex, France.
authors.forename: I
authors.initials: I
authors.lastname: Patry
authors.affiliation: Inserm UMR1098, bâtiment Inserm, 20, rue Françoise-Dolto, 25000 Besançon, France; SFR FED 4234, bâtiment Inserm, université de Franche-Comté, 20, rue Françoise-Dolto, 25000 Besançon, France; Plateforme de biomonitoring, EFS Bourgogne Franche-Comté, 2, boulevard Fleming, 25020 Besançon cedex, France; Centre d'investigation clinique en biothérapies 506, CHU de Besançon, 1, boulevard Fleming, 25030 Besançon cedex, France.
authors.forename: F
authors.initials: F
authors.lastname: Garnache
authors.affiliation: Service d'hématologie, CHU de Besançon, 1, boulevard Fleming, 25030 Besançon cedex, France; Inserm UMR1098, bâtiment Inserm, 20, rue Françoise-Dolto, 25000 Besançon, France; SFR FED 4234, bâtiment Inserm, université de Franche-Comté, 20, rue Françoise-Dolto, 25000 Besançon, France.
authors.forename: P-S
authors.initials: PS
authors.lastname: Rohrlich
authors.affiliation: Service d'hématologie, CHU de Besançon, 1, boulevard Fleming, 25030 Besançon cedex, France; Inserm UMR1098, bâtiment Inserm, 20, rue Françoise-Dolto, 25000 Besançon, France; SFR FED 4234, bâtiment Inserm, université de Franche-Comté, 20, rue Françoise-Dolto, 25000 Besançon, France.
authors.forename: E
authors.initials: E
authors.lastname: Deconinck
authors.affiliation: Service d'hématologie, CHU de Besançon, 1, boulevard Fleming, 25030 Besançon cedex, France. Electronic address: flarosa@chu-besancon.fr.
authors.forename: F
authors.initials: F
authors.lastname: Larosa
mesh_terms: D000328:Adult; D064591:Allografts / Q000276:immunology; D000754:Anemia, Refractory, with Excess of Blasts / Q000628:therapy; D019072:Antibiotic Prophylaxis; D016026:Bone Marrow Transplantation; D018791:CD4 Lymphocyte Count; D018414:CD8-Positive T-Lymphocytes / Q000276:immunology; D051799:Delayed Graft Function; D005260:Female; D006085:Graft Survival; D019337:Hematologic Neoplasms / Q000628:therapy; D006410:Hematopoiesis; D006801:Humans; D007694:Killer Cells, Natural / Q000276:immunology; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets / Q000276:immunology; D008231:Lymphopenia / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000188:drug therapy* / Q000209:etiology / Q000276:immunology
keywords: Allogeneic hematopoietic transplantation; Allogreffe de CSH; Déficit immunitaire; Immune deficiency; Immune recovery; Lymphopoiesis; Lymphopoïèse; Nocardia; Restauration immunitaire