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Different faces of N ocardia infection in renal transplant recipients
Author(s) -
Shrestha Shailendra,
Kanellis John,
Korman Tony,
Polkinghorne Kevan R,
Brown Fiona,
Yii Ming,
Kerr Peter G,
Mulley William
Publication year - 2016
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12585
Subject(s) - medicine , renal transplant , nocardiosis , pneumonia , trimethoprim , antibiotics , opportunistic infection , gastroenterology , transplantation , surgery , nocardia , immunology , human immunodeficiency virus (hiv) , viral disease , biology , bacteria , microbiology and biotechnology , genetics
Aim N ocardia infections are an uncommon but important cause of morbidity and mortality in renal transplant recipients. The present study was carried out to determine the spectrum of N ocardia infections in a renal transplant centre in A ustralia. Methods A retrospective chart analysis of all renal transplants performed from 2008 to 2014 was conducted to identify cases of culture proven N ocardia infection. The clinical course for each patient with nocardiosis was examined. Results Four of the 543 renal transplants patients developed N ocardia infection within 2 to 13 months post‐transplant. All patients were judged at high immunological risk of rejection pre‐transplant and had received multiple sessions of plasmaphoeresis and intravenous immunoglobulin before the onset of the infection. Two patients presented with pulmonary nocardiosis and two with cerebral abscesses. One case of pulmonary nocardiosis was complicated by pulmonary aspergillosis and the other by cytomegalovirus pneumonia. All four patients improved with combination antibiotic therapy guided by drug susceptibility testing. At the time of N ocardia infection all four patients were receiving primary prophylaxis with trimethoprim/sulphamethoxazole ( TMP / SMX ) 160/800 mg, twice weekly. Conclusion Plasmaphoeresis may be risk factor for Nocardia infection and need further study. N ocardia infection may coexist with other opportunistic infections. Identification of the N ocardia species and drug susceptibility testing is essential in guiding the effective management of patients with N ocardia. Intermittent TMP‐SMX (one double strength tablet, twice a week) appears insufficient to prevent N ocardia infection in renal transplant recipients.