TABLE 3

Main characteristics of the 13 patients with probable nocardiosis diagnosed solely using PCR results

Patient no.Age (yr)SexaClinical or radiological involvementSample(s) for Nocardia PCROther tests and findingsConcurrent pathogenNocardiosis risk factorsPositive species PCRSXT prophylaxis (weekly dose of SMT [mg])Prior antibiotic treatmentTreatment (overall treatment duration)Outcome at 6 mo
168MCutaneousCutaneous biopsy specimen (PCR positive)Cutaneous biopsy (negative bacterial, mycological, and mycobacterial cultures, polymorphous inflammatory infiltrate on histological exam, PAS, Ziehl, and Grocott staining negative); Crypto Ag, CMV PCR, and BDG negativeNoHematological malignancyNoYes (2,400)NoIPM-AMK then CRO-AMK then IPM-CIP then TZP-LZD then CXM-SXT (6 mo)Cure
224MMuscular abscessMuscular abscess specimen (PCR positive) and blood sample (PCR positive)Abscess puncture (negative Nocardia and mycobacterial cultures, polymorphonuclear cells on histological exam); BDG, GM, A. fumigatus PCR, and Toxoplasma gondii PCR negativeYes (Staphylococcus aureus)Hematopoietic stem cell transplantationYes (N. farcinica)Noβ-LactamsLZD then AMC then AMK then AMC (4 mo)Cure
363FDisseminated (lung infection and muscular abscess)Muscular abscess specimen (PCR positive) and BAL fluid sample (PCR positive)BAL (negative bacterial, mycological, and mycobacterial cultures and GM test); abscess puncture (negative bacterial and mycobacterial cultures and broad-range 16S rRNA PCR); BDG, GM, and A. fumigatus PCR negativeNoHematopoietic stem cell transplantation and ISNoNoNAIPM-AMK then LZD then CRO-AMK then SXT-AMK (7 mo)Cure
434MLung infectionBAL fluid sample (PCR positive) and pulmonary biopsy specimen (PCR negative)BAL (negative bacterial, mycological, and mycobacterial cultures, histological exam, and GM test); pulmonary biopsy (negative bacterial, mycological, and mycobacterial cultures, epithelioid granuloma on histological exam); BDG positiveNoSOT, CGD, and ISYes (N. farcinica)Yes (5,600)NoIPM-SXT then SXT (6 mo)Cure
554MLung infectionBAL fluid sample (PCR positive)BAL (negative bacterial, mycological, and mycobacterial cultures, GM test, and histological exam); pulmonary biopsy (negative bacterial, mycological, and mycobacterial cultures, eosinophilic necrosis); BDG, GM, A. fumigatus PCR, Crypto Ag, and CMV PCR negativeNoHematological malignancy and chronic bronchopulmonary diseaseNoYes (2,400)NoIPM, AMK, SXT (NA)NA
660FLung infectionBAL fluid sample (PCR positive)BAL (negative bacterial, mycological, and mycobacterial cultures and GM test, filamentous form on histological exam, Ziehl staining negative)NoChronic bronchopulmonary diseaseYes (N. farcinica)NoNoAMC (1 mo), LZD (5 mo)Relapse 7 mo later
722MDisseminated (subcutaneous abscess and lymph node)Lymph node biopsy specimen (PCR positive) and cutaneous abscess specimen (PCR positive)Lymph node biopsy and cutaneous abscess puncture (negative Nocardia, mycological, and mycobacterium cultures); CMV PCR negativeYes (S. aureus and Staphylococcus epidermidis)Autologous stem cell transplantation and corticosteroidsYes (N. farcinica)Yes (2,400)β-Lactams, aminoglycosidesIPM-SXT-AMK then SXT then LZD (4 mo)Death
882FMuscular abscessMuscular abscess specimen (PCR positive)Abscess puncture (negative bacterial, mycological, and mycobacterial cultures, polymorphonuclear cells on histological exam); BDG positive, GM and A. fumigatus PCR negativeNoCorticosteroids and ISYes (N. farcinica)NoNoIPM-AMK (0.2 mo)Death
954FDisseminated (lung and bone infection)BAL fluid sample (PCR positive)BAL (negative bacterial, mycological, and mycobacterial cultures and histological exam); pulmonary biopsy (negative mycological and mycobacterial cultures, giant cell granuloma with epithelioid cells without necrosis on histological exam)NoHematological malignancyYes (N. farcinica)NoNoIPM-SXT then AMK-SXT then SXT (12 mo)Cure
1064MLung infectionBAL fluid sample (PCR positive) and lung biopsy specimen (PCR positive)BAL (negative bacterial, mycological, and mycobacterial cultures, GM test and virus PCR negative); pulmonary biopsy (negative bacterial and mycobacterial cultures); BDG positive, GM negativeYes (P. jirovecii and A. fumigatus)SOT, corticosteroids, and ISNoNoSulfonamidesSXT then SXT-IPM (NA)Death
1151MLung infectionBAL fluid sample (PCR positive)BAL (negative Nocardia, mycological, and mycobacterial cultures); BDG and GM negativeYes (Moraxella and Actinomyces naeslundii)Hematopoietic stem cell transplantationYes (N. farcinica)Noβ-LactamsCXM (6.4 mo)Cure
1248MDisseminated (meningitis and lung infection)CSF sample (PCR positive) and bronchial sampling specimen (PCR positive)BAL and CSF sampling (negative bacterial, mycological, and mycobacterial cultures); Crypto Ag negativeNoHIVNoNoNoIPM-AMK then IPM-SXT then SXT-MXF (6 mo)Cure
1340MLung infectionBAL fluid sample (PCR negative) and lung biopsy specimen (PCR positive)BAL and pulmonary biopsy (negative Nocardia, mycological, and mycobacterial cultures)NoAsthmaNoNoβ-Lactams, sulfonamides, aminoglycosidesIMP-SXT-AMK then IMP-SXT then SXT (6 mo)Cure
  • a M, male; F, female; AMC, amoxicillin-clavulanic acid; AMK, amikacin; BAL, bronchoalveolar lavage; BDG, β-d-glucan; CGD, chronic granulomatous disease; CIP, ciprofloxacin; CMV, cytomegalovirus; CRO, ceftriaxone; Crypto Ag, Cryptococcus antigen; CSF, cerebrospinal fluid; CXM, cefuroxime; GM, galactomannan antigen; HIV, human immunodeficiency virus; IPM, imipenem; IS, immunosuppressive treatment; LZD, linezolid; MXF, moxifloxacin; NA, not available; PAS, periodic acid-Schiff; SMT, sulfamethoxazole; SOT, solid organ transplantation; TZP, piperacillin-tazobactam; SXT, sulfamethoxazole-trimethoprim.