title: Different faces of Nocardia infection in renal transplant recipients.
abstract: OBJECTIVE
  Nocardia infections are an uncommon but important cause of morbidity and mortality in renal transplant recipients. The present study was carried out to determine the spectrum of Nocardia infections in a renal transplant centre in Australia.
  
  
  METHODS
  A retrospective chart analysis of all renal transplants performed from 2008 to 2014 was conducted to identify cases of culture proven Nocardia infection. The clinical course for each patient with nocardiosis was examined.
  
  
  RESULTS
  Four of the 543 renal transplants patients developed Nocardia infection within 2 to 13 months post-transplant. All patients were judged at high immunological risk of rejection pre-transplant and had received multiple sessions of plasmaphoeresis and intravenous immunoglobulin before the onset of the infection. Two patients presented with pulmonary nocardiosis and two with cerebral abscesses. One case of pulmonary nocardiosis was complicated by pulmonary aspergillosis and the other by cytomegalovirus pneumonia. All four patients improved with combination antibiotic therapy guided by drug susceptibility testing. At the time of Nocardia infection all four patients were receiving primary prophylaxis with trimethoprim/sulphamethoxazole (TMP/SMX) 160/800 mg, twice weekly.
  
  
  CONCLUSIONS
  Plasmaphoeresis may be risk factor for Nocardia infection and need further study. Nocardia infection may coexist with other opportunistic infections. Identification of the Nocardia species and drug susceptibility testing is essential in guiding the effective management of patients with Nocardia. Intermittent TMP-SMX (one double strength tablet, twice a week) appears insufficient to prevent Nocardia infection in renal transplant recipients.
authors.affiliation: Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.|Department of Internal Medicine, Nobel Medical College and Teaching Hospital, Biratnagar, Nepal.
authors.forename: Shailendra
authors.initials: S
authors.lastname: Shrestha
authors.affiliation: Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.|Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kanellis
authors.affiliation: Department of Infectious Disease and Microbiology, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: Tony
authors.initials: T
authors.lastname: Korman
authors.affiliation: Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.|Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Kevan R
authors.initials: KR
authors.lastname: Polkinghorne
authors.affiliation: Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Brown
authors.affiliation: Department of Vascular Surgery, Monash Medical Centre, Melbourne, Victoria, Australia.
authors.forename: Ming
authors.initials: M
authors.lastname: Yii
authors.affiliation: Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.|Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kerr
authors.affiliation: Department of Nephrology, Monash Medical Centre, Melbourne, Victoria, Australia.|Department of Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: William
authors.initials: W
authors.lastname: Mulley
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D060085:Coinfection; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009615:Nocardia / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification / Q000472:pathogenicity*; D009617:Nocardia Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D010956:Plasmapheresis / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014739:Victoria
chemical_list: D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination
keywords: Nocardia; immunosuppression; infections; plasmaphoeresis; renal transplant