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01-08-2019 | Soft Tissue Infection | Skin, Soft Tissue, Bone and Joint Infectious Disease (N Safdar and A Pop-Vicas, Section Editors)

Updates on Nocardia Skin and Soft Tissue Infections in Solid Organ Transplantation

Authors: Marion Hemmersbach-Miller, Jelena Catania, Jennifer L. Saullo

Published in: Current Infectious Disease Reports | Issue 8/2019

Abstract

Purpose of Review

Due to their immunocompromised status, solid organ transplant (SOT) recipients are at risk for Nocardia infections. These infections often necessitate early invasive diagnostics alongside prolonged, often combination antimicrobial therapy. This review summarizes the importance of this pathogen in skin and soft tissue infections (SSTIs) in SOT recipients inclusive of recently reported cases in the literature and an update on the epidemiology, diagnostics, and management.

Recent Findings

Six studies with 13 isolated SSTIs due to Nocardia have been published in the last 5 years in SOT recipients. The most common underlying type of transplant was kidney and time from transplantation to infection varied from 6 months to 16 years. Misdiagnosis was frequent. Available identified species included N. brasiliensis (2), N. farcinica (2), N. flavorosea (1), N. abscessus (1), N. anaemiae (1), N. asteroides (1), N. nova (1), and N. vinacea (1). Treatment choice and duration varied widely, and trimethoprim-sulfamethoxazole was utilized most often with no documented infection relapse.

Summary

Nocardia SSTIs can occur both in isolation and as a component of a disseminated infection. Overall, isolated Nocardia SSTIs are uncommon in SOT recipients and are often initially misdiagnosed. They present multiple challenges to the clinician including evaluation for potential co-pathogens and/or non-infectious processes and ruling out the presence of disseminated infection. While trimethoprim-sulfamethoxazole remains the agent of choice for management of most isolated SSTIs, therapy must be tailored to the individual patient based on species-specific susceptibility patterns and formal susceptibility testing, site(s) of infection, and patient tolerability.

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Title: Updates on Nocardia Skin and Soft Tissue Infections in Solid Organ Transplantation
Authors: Marion Hemmersbach-Miller
Jelena Catania
Jennifer L. Saullo
Publication date: 01-08-2019
Publisher: Springer US
Keyword: Soft Tissue Infection
Published in: Current Infectious Disease Reports / Issue 8/2019
Print ISSN: 1523-3847
Electronic ISSN: 1534-3146
DOI: https://doi.org/10.1007/s11908-019-0684-7

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