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Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics

OBJECTIVE: To describe the clinical and radiographic findings in a large cohort of patients with positive cultures for Nocardia emphasizing the differences between invasive disease and colonization. PATIENTS AND METHODS: We conducted a single-center, retrospective cohort study of 133 patients with a...

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Autores principales: Dumitrascu, Adrian G., Rojas, Carlos A., Stancampiano, Fernando, Johnson, Elizabeth M., Harris, Dana M., Chirila, Razvan M., Omer, Mohamed, Hata, D. Jane, Meza-Villegas, Diana M., Heckman, Michael G., White, Launia J., Alvarez, Salvador
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9798119/
https://www.ncbi.nlm.nih.gov/pubmed/36589733
http://dx.doi.org/10.1016/j.mayocpiqo.2022.11.002
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author Dumitrascu, Adrian G.
Rojas, Carlos A.
Stancampiano, Fernando
Johnson, Elizabeth M.
Harris, Dana M.
Chirila, Razvan M.
Omer, Mohamed
Hata, D. Jane
Meza-Villegas, Diana M.
Heckman, Michael G.
White, Launia J.
Alvarez, Salvador
author_facet Dumitrascu, Adrian G.
Rojas, Carlos A.
Stancampiano, Fernando
Johnson, Elizabeth M.
Harris, Dana M.
Chirila, Razvan M.
Omer, Mohamed
Hata, D. Jane
Meza-Villegas, Diana M.
Heckman, Michael G.
White, Launia J.
Alvarez, Salvador
author_sort Dumitrascu, Adrian G.
collection PubMed
description OBJECTIVE: To describe the clinical and radiographic findings in a large cohort of patients with positive cultures for Nocardia emphasizing the differences between invasive disease and colonization. PATIENTS AND METHODS: We conducted a single-center, retrospective cohort study of 133 patients with a positive Nocardia isolate between August 1, 1998, and November 30, 2018, and a computed tomography (CT) of the chest within 30 days before or after the bacteria isolation date. RESULTS: Patients with colonization were older (71 vs 65 years; P=.004), frequently with chronic obstructive pulmonary disease (56.8% vs 16.9%; P<.001) and coronary artery disease (47.7% vs 27%, P=.021), and had Nocardia isolated exclusively from lung specimens (100% vs 83.1%; P=.003). On CT of the chest, they had frequent airway disease (84.1% vs 51.7%; P<.001). Patients with invasive nocardiosis had significantly (P<.05) more diabetes, chronic kidney disease, solid organ transplant, use of corticosteroids, antirejection drugs, and prophylactic sulfa. They had more fever (25.8% vs 2.3%; P<.001), cutaneous lesions (14.6% vs 0%; P=.005), fatigue (18% vs 0%; P=.001), pulmonary nodules (52.8% vs 27.3%; P=.006), and free-flowing pleural fluid (63.6% vs 29.4%; P=.024). The patterns of nodule distribution were different—diffuse for invasive nocardiosis and peribronchiolar for Nocardia colonization. CONCLUSION: The isolation of Nocardia in sputum from a patient with respiratory symptoms does not equal active infection. Only by combining clinical and chest CT findings, one could better differentiate between invasive nocardiosis and Nocardia colonization.
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spelling pubmed-97981192022-12-30 Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics Dumitrascu, Adrian G. Rojas, Carlos A. Stancampiano, Fernando Johnson, Elizabeth M. Harris, Dana M. Chirila, Razvan M. Omer, Mohamed Hata, D. Jane Meza-Villegas, Diana M. Heckman, Michael G. White, Launia J. Alvarez, Salvador Mayo Clin Proc Innov Qual Outcomes Original Article OBJECTIVE: To describe the clinical and radiographic findings in a large cohort of patients with positive cultures for Nocardia emphasizing the differences between invasive disease and colonization. PATIENTS AND METHODS: We conducted a single-center, retrospective cohort study of 133 patients with a positive Nocardia isolate between August 1, 1998, and November 30, 2018, and a computed tomography (CT) of the chest within 30 days before or after the bacteria isolation date. RESULTS: Patients with colonization were older (71 vs 65 years; P=.004), frequently with chronic obstructive pulmonary disease (56.8% vs 16.9%; P<.001) and coronary artery disease (47.7% vs 27%, P=.021), and had Nocardia isolated exclusively from lung specimens (100% vs 83.1%; P=.003). On CT of the chest, they had frequent airway disease (84.1% vs 51.7%; P<.001). Patients with invasive nocardiosis had significantly (P<.05) more diabetes, chronic kidney disease, solid organ transplant, use of corticosteroids, antirejection drugs, and prophylactic sulfa. They had more fever (25.8% vs 2.3%; P<.001), cutaneous lesions (14.6% vs 0%; P=.005), fatigue (18% vs 0%; P=.001), pulmonary nodules (52.8% vs 27.3%; P=.006), and free-flowing pleural fluid (63.6% vs 29.4%; P=.024). The patterns of nodule distribution were different—diffuse for invasive nocardiosis and peribronchiolar for Nocardia colonization. CONCLUSION: The isolation of Nocardia in sputum from a patient with respiratory symptoms does not equal active infection. Only by combining clinical and chest CT findings, one could better differentiate between invasive nocardiosis and Nocardia colonization. Elsevier 2022-12-21 /pmc/articles/PMC9798119/ /pubmed/36589733 http://dx.doi.org/10.1016/j.mayocpiqo.2022.11.002 Text en © 2022 The Authors https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Dumitrascu, Adrian G.
Rojas, Carlos A.
Stancampiano, Fernando
Johnson, Elizabeth M.
Harris, Dana M.
Chirila, Razvan M.
Omer, Mohamed
Hata, D. Jane
Meza-Villegas, Diana M.
Heckman, Michael G.
White, Launia J.
Alvarez, Salvador
Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics
title Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics
title_full Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics
title_fullStr Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics
title_full_unstemmed Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics
title_short Invasive Nocardiosis Versus Colonization at a Tertiary Care Center: Clinical and Radiological Characteristics
title_sort invasive nocardiosis versus colonization at a tertiary care center: clinical and radiological characteristics
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9798119/
https://www.ncbi.nlm.nih.gov/pubmed/36589733
http://dx.doi.org/10.1016/j.mayocpiqo.2022.11.002
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