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Sulfonamide resistance in a disseminated infection caused by Nocardia wallacei: a case report

INTRODUCTION: Nocardial infections, although rare, are challenging for clinicians to treat. Recent contradictory reports of sulfonamide resistance have raised concerns about using this drug to treat nocardial infections. CASE PRESENTATION: A 62-year-old immunocompetent Caucasian woman showed dissemi...

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Autores principales: Cassir, Nadim, Million, Matthieu, Noudel, Remy, Drancourt, Michel, Brouqui, Philippe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633055/
https://www.ncbi.nlm.nih.gov/pubmed/23577983
http://dx.doi.org/10.1186/1752-1947-7-103
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author Cassir, Nadim
Million, Matthieu
Noudel, Remy
Drancourt, Michel
Brouqui, Philippe
author_facet Cassir, Nadim
Million, Matthieu
Noudel, Remy
Drancourt, Michel
Brouqui, Philippe
author_sort Cassir, Nadim
collection PubMed
description INTRODUCTION: Nocardial infections, although rare, are challenging for clinicians to treat. Recent contradictory reports of sulfonamide resistance have raised concerns about using this drug to treat nocardial infections. CASE PRESENTATION: A 62-year-old immunocompetent Caucasian woman showed disseminated pulmonary nodules and a brain abscess by chest computed tomography and brain magnetic resonance imaging, respectively. Multidrug-resistant Nocardia wallacei was cultured from a stereotactic brain biopsy and confirmed by 16S ribosomal ribonucleic acid gene sequencing. After the first-line treatment failed, a long course of trimethoprim-sulfamethoxazole was prescribed with no evidence of recurrence. To the best of our knowledge, this is the first report of a Nocardia wallacei disseminated infection in an immunocompetent patient, and it is the first detailed description of successful treatment with trimethoprim-sulfamethoxazole despite the resistance observed in vitro. CONCLUSION: Species identification of clinical isolates is critical for diagnosis, a prediction of antimicrobial susceptibility and epidemiological tracking. In the case of Nocardia wallacei, the clinical outcome suggests that sulfonamides can be used for treatment despite ambiguous results from in vitro susceptibility tests.
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spelling pubmed-36330552013-04-24 Sulfonamide resistance in a disseminated infection caused by Nocardia wallacei: a case report Cassir, Nadim Million, Matthieu Noudel, Remy Drancourt, Michel Brouqui, Philippe J Med Case Rep Case Report INTRODUCTION: Nocardial infections, although rare, are challenging for clinicians to treat. Recent contradictory reports of sulfonamide resistance have raised concerns about using this drug to treat nocardial infections. CASE PRESENTATION: A 62-year-old immunocompetent Caucasian woman showed disseminated pulmonary nodules and a brain abscess by chest computed tomography and brain magnetic resonance imaging, respectively. Multidrug-resistant Nocardia wallacei was cultured from a stereotactic brain biopsy and confirmed by 16S ribosomal ribonucleic acid gene sequencing. After the first-line treatment failed, a long course of trimethoprim-sulfamethoxazole was prescribed with no evidence of recurrence. To the best of our knowledge, this is the first report of a Nocardia wallacei disseminated infection in an immunocompetent patient, and it is the first detailed description of successful treatment with trimethoprim-sulfamethoxazole despite the resistance observed in vitro. CONCLUSION: Species identification of clinical isolates is critical for diagnosis, a prediction of antimicrobial susceptibility and epidemiological tracking. In the case of Nocardia wallacei, the clinical outcome suggests that sulfonamides can be used for treatment despite ambiguous results from in vitro susceptibility tests. BioMed Central 2013-04-11 /pmc/articles/PMC3633055/ /pubmed/23577983 http://dx.doi.org/10.1186/1752-1947-7-103 Text en Copyright © 2013 Cassir et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Cassir, Nadim
Million, Matthieu
Noudel, Remy
Drancourt, Michel
Brouqui, Philippe
Sulfonamide resistance in a disseminated infection caused by Nocardia wallacei: a case report
title Sulfonamide resistance in a disseminated infection caused by Nocardia wallacei: a case report
title_full Sulfonamide resistance in a disseminated infection caused by Nocardia wallacei: a case report
title_fullStr Sulfonamide resistance in a disseminated infection caused by Nocardia wallacei: a case report
title_full_unstemmed Sulfonamide resistance in a disseminated infection caused by Nocardia wallacei: a case report
title_short Sulfonamide resistance in a disseminated infection caused by Nocardia wallacei: a case report
title_sort sulfonamide resistance in a disseminated infection caused by nocardia wallacei: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3633055/
https://www.ncbi.nlm.nih.gov/pubmed/23577983
http://dx.doi.org/10.1186/1752-1947-7-103
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