Successful management of disseminated Nocardia transvalensis infection in a heart transplant recipient after development of sulfonamide resistance: case report and review.

Fred A Lopez, Frances Johnson, Denise M Novosad, Blaine L Beaman, Mark Holodniy

Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation 2003;22(4):492-7

PMID: 12681430

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Abstract

Nocardia transvalensis is a rarely reported cause of clinically significant disease, and, to our knowledge, has not been reported previously as a cause of infection in the cardiac transplant population. We report a case of N transvalensis new taxon-2 pulmonary infection that disseminated to the brain and skin in a cardiac transplant recipient despite adequate sulfonamide serum levels. Subsequent isolates were resistant to sulfonamides, and molecular ribotyping of the primary and subsequent isolates confirmed that these were the same N transvalensis new taxon-2 strain. The taxonomic and diagnostic considerations, as well as the clinical significance of anti-microbial-resistant nocardia, are reviewed and discussed herein.

Address: Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA.

DOI: 10.1016/s1053-2498(02)00663-0

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MeSH Terms: Amoxicillin-Potassium Clavulanate Combination, Anti-Bacterial Agents, Cardiomyopathy, Dilated, Ceftriaxone, Ciprofloxacin, Drug Resistance, Heart Transplantation, Humans, Male, Middle Aged, Nocardia, Nocardia Infections, Outcome Assessment, Health Care, Postoperative Complications, Sulfonamides