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      Primary facial cutaneous nocardiosis in a HIV patient and review of cutaneous nocardiosis in India

      case-report

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          Abstract

          Nocardiosis is an acute, subacute or chronic bacterial infection caused by several species of geophilic aerobic bacteria of the genus Nocardia. Cutaneous nocardiosis is an uncommon infectious disease that presents as primary cutaneous infection or as a sequale of disseminated pulmonary nocardiosis. Its rarity and as nocardiosis is not an AIDS defined disease it is often underreported. The global incidence of cutaneous nocardiosis is not exactly known. The frequency of nocardiosis in HIV patients has increased from 0.3 to1.85%. In Immunocompetent persons Primary Cutaneous Nocardiosis is more commonly seen among gardeners and agriculturists. We report a case of extensive primary facial cutaneous nocardiosis due to Nocardia asteroides, in an adult immunocompromised lady who had no pulmonary focus. The lesions were seen as sinus tracts on the zygomatic arch, preauricular and Infraauricular regions. Bacteriological examination of the pus confirmed the presence of N. asteroides. The rarity of the presentation and Cutaneous nocardiosis in India is reviewed.

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          Most cited references33

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          Primary cutaneous Nocardia asteroides infection with dissemination.

          In a 77 year old previously healthy man with mild adult-onset diabetes mellitus, a primary cutaneous Nocardia asteroides infection developed on the hand following inoculation of a traumatic injury. Initially untreated, the infection became locally invasive and resulted in dissemination to the lungs and normal skin. This represents the first known reported case of a N. asteroides actinomycetoma associated with dissemination.
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            Primary cutaneous nocardiosis with craniocerebral extension: a case report.

            A 26-year-old male, a fisherman by occupation, presented with boggy swelling of the scalp and multiple discharging sinuses over the fronto-parietal area for one year. He described a history of periodic trauma to the scalp beginning about one year prior to the onset of the scalp condition. Histopathology suggested a chronic granulomatous suppuration. Magnetic resonance imaging showed intracranial and intra-orbital involvement. Tissue cultures of the sample identified Nocardia brasilienses. The patient was successfully treated with a modified Welsh regimen, given for eight months.
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              Cutaneous nocardiosis complicating management of Crohn's disease with infliximab and prednisone.

              Infliximab is a chimeric anti-tumour necrosis factor-alpha antibody that is efficacious in treating Crohn's disease. However, its immunomodulatory properties increase susceptibility to opportunistic infections. We present a case of cutaneous Nocardia infection in a patient who was taking infliximab for Crohn's disease. The case illustrates the challenges in the diagnosis and management of this disease and serves as a reminder of the complications associated with the use of immunomodulatory agents.
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                Author and article information

                Journal
                Indian J Sex Transm Dis
                IJSTD
                Indian Journal of Sexually Transmitted Diseases
                Medknow Publications (India )
                0253-7184
                1998-3816
                Jan-Jun 2011
                : 32
                : 1
                : 40-43
                Affiliations
                [1]Department of Microbiology, JSS Medical College, JSS University, Mysore 570015, Karnataka, India. E-mail: gsvijaykumar@ 123456yahoo.com
                Author notes
                Address for correspondence: Dr. G. S. Vijay Kumar, Department of Microbiology, JSS Medical College, JSS University, Mysore 570015, India. E mail: gsvijaykumar@ 123456yahoo.com
                Article
                IJSTD-32-40
                10.4103/0253-7184.81254
                3139288
                21799576
                bfbb7b86-3648-4235-bd76-462b7a924657
                © Indian Journal of Sexually Transmitted Diseases and AIDS

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Case Report

                Sexual medicine
                hiv,nocardiosis,n. asteroides,cutaneous nocardiosis,infraauricular
                Sexual medicine
                hiv, nocardiosis, n. asteroides, cutaneous nocardiosis, infraauricular

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