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      Disseminated Nocardia farcinica: Literature Review and Fatal Outcome in an Immunocompetent Patient

      case-report

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          Abstract

          Background

          Nocardia farcinica is a gram-positive, partially acid-fast, methenamine silver-positive aerobic actinomycete. Nocardia spp. are opportunistic pathogens, and N. farcinica is the least common species of clinical importance.

          Methods

          Review of the recent literature and description of a immunocompetent patient with no known risk factors who contracted fatal N. farcinica sepsis.

          Results

          Positive pre-mortem and post-mortem cultures from the lung and synovium correlated with acute bronchopneumonia and synovitis at autopsy. Colonies of filamentous bacteria, which were not apparent in conventional hematoxylin and eosin-stained sections, were observed with gram and methenamine silver stains, but acid-fast stains were negative. A literature review revealed that disseminated N. farcinica often is associated with an underlying malignant tumor or autoimmune disease (88% of patients). Chemotherapy or corticosteroid treatments are additional risk factors.

          Conclusions

          Trimethoprim–sulfamethoxazole typically is the first-line therapy for N. farcinica; treatment with amikacin and imipenem-cilastatin is used less often (7% of patients). Despite aggressive therapy, we observed that the death rate (39%) associated with N. farcinica in recent publications was eight percentage points higher than reported in a review from 2000.

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          Author and article information

          Journal
          Surg Infect (Larchmt)
          Surg Infect (Larchmt)
          sur
          Surgical Infections
          Mary Ann Liebert, Inc. (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
          1096-2964
          1557-8674
          June 2012
          : 13
          : 3
          : 163-170
          Affiliations
          [ 1 ]Department of Pathology, Pritzker School of Medicine , Chicago, Illinois.
          [ 2 ]Department of Pathology, University of Chicago Medical Center , Chicago, Illinois.
          [ 3 ]Department of Pathology, Medical College of Wisconsin , Milwaukee, Wisconsin.
          Author notes
          Address correspondence to: Dr. Alexander C. Mackinnon, Jr., Department of Pathology, Medical College of Wisconsin, Room 1176 FMLH West, Milwaukee, WI 53226. E-mail: amackinnon@ 123456mcw.edu
          Article
          PMC3375863 PMC3375863 3375863 10.1089/sur.2011.012
          10.1089/sur.2011.012
          3375863
          22612440
          c2e35d36-11a1-4463-8447-9c6fca7bbe7f
          Copyright 2012, Mary Ann Liebert, Inc.
          History
          Page count
          Figures: 2, Tables: 3, References: 44, Pages: 8
          Categories
          Case Reports

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