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Nocardia Infections in Transplantation: Diagnosis, Management, and Impact on Outcomes

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Emerging Transplant Infections

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Abstract

Nocardia species are ubiquitous, environmental, Gram-positive bacteria belonging to the Actinomycetaceae family. Immunocompromised hosts such as recipients of solid organ and hematopoietic stem cell transplants are more susceptible to infection, and the most commonly affected organ is the lung. The net state of immunosuppression is an important risk factor for development of infection in transplant recipients. Isolation of Nocardia spp. in culture from a clinically suspected site of infection is sufficient for the diagnosis. As part of the evaluation, disease involvement of the central nervous system should always be ruled out with imaging even if no neurological symptoms are present. Successful treatment entails reduction of immunosuppression and months of antimicrobial therapy guided by antimicrobial susceptibility testing. The use of combination antimicrobials and surgical debridement may be warranted in select circumstances, in particular central nervous system disease. In transplant recipients, myelosuppression and nephrotoxicity are important treatment-associated toxicities and warrant close monitoring and potential adjustment of therapy. Although trimethoprim-sulfamethoxazole (TMP-SMX) has proven in vitro and in vivo activity against Nocardia spp., its use as prophylaxis for Pneumocystis jirovecii pneumonia should not be considered efficacious against Nocardia infection in transplant recipients.

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Author information

Authors and Affiliations

  1. Division of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Reuben J. Arasaratnam

  2. Division of Infectious Diseases, Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA

    Alejandro Restrepo

Authors
  1. Reuben J. Arasaratnam
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  2. Alejandro Restrepo
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Correspondence to Reuben J. Arasaratnam .

Editor information

Editors and Affiliations

  1. Miller School of Medicine, University of Miami, Miami, FL, USA

    Michele I. Morris

  2. Massachusetts General Hospital, Harvard University, Boston, MA, USA

    Camille Nelson Kotton

  3. Duke University, Durham, NC, USA

    Camille Wolfe

Section Editor information

  1. Infectious Diseases Division, Harvard University Medical School, Boston, MA, USA

    Camille Nelson Kotton

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Arasaratnam, R.J., Restrepo, A. (2020). Nocardia Infections in Transplantation: Diagnosis, Management, and Impact on Outcomes. In: Morris, M., Kotton, C., Wolfe, C. (eds) Emerging Transplant Infections. Springer, Cham. https://doi.org/10.1007/978-3-030-01751-4_18-1

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  • DOI: https://doi.org/10.1007/978-3-030-01751-4_18-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-01751-4

  • Online ISBN: 978-3-030-01751-4

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