Infection and Drug Resistance (Dec 2020)
Invasive Nocardiosis: Disease Presentation, Diagnosis and Treatment – Old Questions, New Answers?
Abstract
Emmanuel Lafont,1,* Pierre-Louis Conan,2,* Véronica Rodriguez-Nava,3 David Lebeaux4,5 1Department of Infectious Diseases and Tropical Medicine, Université de Paris, Necker-Enfants Malades University Hospital, Centre d’Infectiologie Necker-Pasteur, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris, France; 2Service de Maladies Infectieuses et Tropicales, Hôpital d’Instruction des Armées Bégin, Saint-Mandé, France; 3Research Group on Bacterial Opportunistic Pathogens and Environment UMR5557 Écologie Microbienne, French Observatory of Nocardiosis, Université de Lyon 1, CNRS, VetAgro Sup, Lyon, France; 4Université de Paris, Paris 75006, France; 5Service de Microbiologie, Unité Mobile d’Infectiologie, Hôpital Européen Georges Pompidou, Assistance Publique – Hôpitaux de Paris (AP-HP), Paris 75015, France*These authors contributed equally to this workCorrespondence: David LebeauxService de Microbiologie, Unité Mobile d’Infectiologie, Hôpital Européen Georges Pompidou, Assistance Publique – Hôpitaux de Paris (AP-HP), 20 Rue Leblanc, Paris 75015, FranceTel +33 1 56 09 29 69Fax +33 1 56 09 24 46Email [email protected]: Nocardia spp. is an environmental filamentous Gram-positive bacterium that may cause infections in humans and, despite recent progress, many challenges remain regarding the management of nocardiosis. This review aims at describing most recently published data regarding the diagnosis, treatment and follow-up of patients with invasive nocardiosis. As nocardiosis mainly affects patients with cell-mediated immunity defects, a comprehensive workup is mandatory in case of invasive nocardiosis occurring in ”apparently healthy patients”. Indeed, invasive nocardiosis might reveal an unknown primary immunodeficiency or the presence of anti-GM-CSF autoantibodies. Even if the diagnosis of nocardiosis mostly relies on direct examination and bacterial culture, a genus-specific PCR may be used for the detection of Nocardia, when directly performed on a clinical sample. Brain imaging should always be performed, even in the absence of neurological symptoms. Cotrimoxazole (trimethoprim/sulfamethoxazole), linezolid, parenteral cephalosporins, carbapenems and amikacin may be used as initial antibiotics to treat nocardiosis. Cotrimoxazole or linezolid can be used as monotherapy in selected patients without brain involvement. Although treatment duration has historically been set to at least 6 months in the absence of central nervous system involvement, shorter durations (< 120 days) seem to be associated with a favourable outcome.Keywords: opportunistic infection, dissemination, anti-GM-CSF autoantibodies, brain imaging, molecular biology, antibiotic susceptibility testing, cotrimoxazole
