Nocardia Arthritis: 3 Cases and Literature Review.
Nocardia are Gram-positive filamentous bacteria responsible for infections ranging from opportunistic life-threatening disseminated diseases to chronic skin and soft-tissue infections.Even if virtually all organs can be infected, articular involvement is rare. Therefore, we report 3 recent cases and performed a literature review of cases of Nocardia arthritis in order to describe clinical features, therapeutic challenges, and outcome of these patients.Among 34 patients (31 in the literature plus our 3 cases), 21 (62%) were due to hematogenous dissemination, 9 (26%) were due to direct bacterial inoculation through the skin, and in 4 cases, the mechanism of infection was unknown. Four out of these 34 cases occurred on prosthetic joints.Whereas hematogenous infections mostly occurred in immunocompromised hosts (17 of 21, 81%), direct inoculation was mostly seen in immunocompetent patients.Eighty-two percent of patients (28 out of 34) received trimethoprim-sulfamethoxazole-containing regimens and median antibiotic treatment duration was 24 weeks (range, 12-120) for hematogenous infections and 12 weeks (range, 6-24) for direct inoculations. Outcome was favorable in 27 cases despite unsystematic surgical management (17 cases) without sequelae in 70% of the cases.Nocardia arthritis is rare but its management is complex and should rely on a combined approach with rheumatologist, infectious diseases expert, and surgeon.
From the Université Paris Descartes, Centre d'Infectiologie Necker-Pasteur, Hôpital Necker Enfants malades, Institut Imagine, Paris, France (HC, DL, BR, OL); Service de médecine interne et maladies infectieuses, Hôpital Bretonneau, Tours, France (GG, LB); Service de Pneumologie, Hôpital Foch, Suresnes, France (EC); Service de radiologie, Hôpital Necker EM, Paris, France (SP); Service de bactériologie, Hôpital Necker EM, Paris, France (HL); and Service d'orthopédie, Groupe Hospitalier Diaconesses Croix Saint Simon, Paris, France (VZ).
Hélène
H
Chaussade
David
D
Lebeaux
Guillaume
G
Gras
Emilie
E
Catherinot
Blandine
B
Rammaert
Sylvain
S
Poiree
Hervé
H
Lecuyer
Valérie
V
Zeller
Louis
L
Bernard
Olivier
O
Lortholary
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000188:drug therapy / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009617:Nocardia Infections / Q000188:drug therapy; D055815:Young Adult