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Nocardiosis at an organ transplant center in Saudi Arabia: 15 years' experience
Ihab Weheba1, Abeer Abdelsayed2, Abdulrahman A Alrajhi3, Sahar I Al-Thawadi4, Abdullah Mobeireek3
1 Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Department of Medicine, National Research Centre, Cairo, Egypt
2 Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia; Department of Medicine, Ain Shams University, Cairo, Egypt
3 Department of Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
4 Department of Laboratory Medicine and Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
Correspondence Address:
Abdullah Mobeireek,
Department of Medicine, King Faisal Specialist Hospital and Research Centre, PO Box 3354 (MBC 46), Riyadh 11211
Saudi Arabia
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/jgid.jgid_66_20
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Background: No cardiosis is a rare infection that affects immunocompromised patients on immunosuppressive medications used for transplantation and cancer therapy. Such therapies are becoming more widely available in the Middle East region. Yet, reports on nocardiosis are scarce. Materials and Methods: This was a retrospective analysis of patients who were diagnosed with nocardiosis from 2004 to 2018 at a transplantation and cancer center. Nocardiosis were defined per the European Organization for Research and Treatment of Cancer criteria. Results: During the study period, 35 patients with nocardiosis (male: 68.5%) were identified. The most common underlying associated condition was transplantation 11 (31.4%), followed by malignancy 7 (20%), connective tissue disease and sarcoidosis 7 (20%), chronic lung disease 5 (14%), miscellaneous conditions 4 (11%), and one patient with human immunodeficiency virus. Nocardia was disseminated in 8 patients (22.9%) and isolated in 27 (77.1%); the latter included 13 patients (37.1%) with bronchial form, 11 (31.4%) with isolated visceral form, and 3 (8.6%) with cutaneous form. Pulmonary involvement occurred in 90% of the cases with cough, fever, and dyspnea being the most common symptoms. The main strain isolate was Nocardia asteroides, and the cure rate was 90%. Mortality related to nocardiosis occurred in 3 transplant patients (8.6%). Conclusion: Wider use of immunosuppressive therapy warrants vigilance to nocardiosis, which can present in a myriad of clinical forms. In our series, mortality was confined to the transplantation group, probably because of the relatively heavy immunosuppression. Nonetheless, prognosis is favorable if the infection is recognized and treated early. |
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