Author/Authors :
Mardani، Massoud نويسنده Infectious Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran , , Aslani، Narges نويسنده Master of physical education, Department of sport science, shoushtsar Branch, Islamic azad university, shoushtar, Iran , , Geramishoar، Mohsen نويسنده Department of Medical Mycology and Parasitology, Tehran University of Medical Sciences, Tehran, Iran , , Khodavaisy، Sadegh نويسنده Department of Medical Parasitology and Mycology, Kurdistan University of Medical Sciences, Sanandaj, Iran. Khodavaisy, Sadegh , Mohseni، Sahar نويسنده Department of Microbiology, Sari Branch, Islamic Azad University, Sari, Iran , , Badali، Hamid نويسنده Department of Medical Mycology and Parasitology/Invasive Fungal Research Centre (IFRC), School of Medicine Mazandaran University of Medical Sciences, ,
Abstract :
Nocardia species are described as opportunistic pathogens that mainly cause pulmonary nocardiosis in immunocompromised individuals, particularly in patients with acquired immune deficiency syndrome (AIDS), intravenous drug abusers, strongly burned victims, the Cushing syndrome, the ones underlying transplantation, and prolonged use of corticosteroids. The current paper reported a case of disseminated nocardiosis in a 28-year-old Iranian male who had type 2 diabetes mellitus with prolonged use of corticosteroid for the last 5 years. He was admitted to the department of infectious diseases at Shahid Beheshti hospital, Tehran, Iran, following a complaint of pneumonia (chest pain) and presented a subcutaneous purple nodule on the left thigh without pain. Direct microscopic examination revealed numerous filamentous branching and rod-shaped bacilli. The tentative diagnosis of chronic inflammation with nocardiosis was made. In addition, tiny, chalky white and irregular colonies emitting an earthy odor appeared on blood and chocolate agar and were identified as Nocardia brasiliensis by sequencing of 16S rRNA gene as a valuable method to identify clinical isolates. Combination therapy was performed by entire surgical excisions and intravenous TMP-SMX (160/800 mg/bid; IV) and meropenem 1g/tid. The patient’s condition improved after 8 days and he was discharged. Combination therapy with surgical excision has a synergistic effect and appears to be the best treatment for extended lesions. However, new potent antibacterial drugs may help to improve the management of such infections when there are sufficient data on their in vitro activity.
