Abstract
Infections due to Nocardia transvalensis are extremely rare: only four disseminated infections with this pathogen have been reported, three of which ended fatally. This is the first report of a liver transplant recipient with Nocardia transvalensis infection. The patient had disseminated infection with pulmonary involvement, which presented as pulmonary infarction. Despite a ten-day delay in the administration of correct therapy, he responded rapidly to trimethoprim-sulfamethoxazole. The pitfalls of differentiating nocardial infection from pulmonary thromboembolism in solid organ transplant recipients and the diagnostic considerations unique to liver transplant recipients are discussed.
Article PDF
Similar content being viewed by others
References
Wilson JP, Turner HR, Kirchner KA, Chapman SW: Nocardial infections in renal transplant recipients. Medicine 1989, 68: 38–57.
Lumbreras C, Lizasoain M, Moreno E, Aguado JM, Gomez R, Garcia I, Gonzalez I, Loinaz C, Loinaz C, Cisneros C, Noriega AR: Major bacterial infections following liver transplantation: a prospective study. Hepato-Gastroenterology 1992, 39: 362–365.
Schroter GPJ, Hoelscher M, Putnam CW, Porter KA, Hansbrough JF, Starzl TE: Infections complicating orthotopic liver transplantation. A study emphasizing graft-related septicemia. Archives of Surgery 1976, 111: 1337–1347.
Forbes GM, Harvey FAH, Philpott-Howard JN, O'Grady JG, Jensen RD, Sahathevan M, Casewell MW, Williams R: Nocardiosis in liver transplantation: variation in presentation, diagnosis and therapy. Journal of Infection 1990, 20: 11–19.
Kusne S, Dummer JS, Singh N, Iwatsuki S, Makowka L, Esquivel C, Tzakis AG, Starzl TE, Ho M: Infections after liver transplantation. An analysis of 101 consecutive cases. Medicine 1988, 67: 132–143.
Colonna JO II, Winston DJ, Brill JE, Goldstein LI, Hoff MP, Hiatt JR, Quinones-Baldrich W, Ramming KP, Busuttil RW: Infectious complications in liver transplantation. Archives of Surgery 1988, 123: 360–364.
Saint-Vil D, Luks FI, Lebel P, Brandt ML, Paradis K, Weber A, Guay J, Guttman FM, Benssoussan AL, Leberge JM, Blanchard H: Infectious complications of pediatric liver transplantation. Journal of Pediatric Surgery 1991, 26: 908–913.
George DL, Arnow PM, Fox AS, Baker AL, Thistlethwaite JR, Edmond JC, Whitington PF, Broelsch CE: Bacterial infection as a complication of liver transplantation: epidemiology and risk factors. Reviews of Infectious Diseases 1991, 13: 387–396.
Barkholt L, Ericzon BG, Tollemar J, Malmborg AS, Ehrnst A, Wilczek H, Andersson J: Infections in human liver recipients: different patterns early and late after transplantation. Transplant International 1993, 6: 77–84.
Philpott-Howard J: Update on human nocardiosis. Reviews in Medical Microbiology 1993, 4: 207–214.
Beaman BL, Beaman LV:Nocardia species: hostparasite relationship. Clinical Microbiology Reviews 1994, 7: 213–264.
McNeil MM, Brown JM, Magruder CH, Shearlock KT, Saul RA, Allred DP, Ajello L: DisseminatedNocardia transvalensis infection: an unusual opportunistic pathogen in severely immunocompromised patients. Journal of Infectious Diseases 1992, 165: 175–178.
McNeil MM, Brown JM, Georghiou PR, Allworth AM, Blacklock ZM: Infections due toNocardia transvalensis: clinical spectrum and antimicrobial therapy. Clinical Infectious Diseases 1992, 15: 453–463.
Baron JE, Finegold SM: Aerobic non-spore-forming gram-positive bacilli. In: Baron JE, Finegold SM (ed): Bailey & Scott's diagnostic microbiology. C. V. Mosby, St. Louis, 1990, p. 457–476.
McNeil MM, Brown JM, Jarvis WR, Ajello L: Comparison of species distribution and antimicrobial susceptibility of aerobic actinomycetes from clinical specimens. Reviews of Infectious Diseases 1990, 12: 778–783.
Clinicopathologic Conference: Cavitary lung disease following renal transplantation. American Journal of Medicine 1982, 72: 145–155.
Rubin RH, Greene R: Etiology and management of the compromised patient with fever and pulmonary infiltrates. In: Rubin RH, Young LS (ed): Clinical approach to infection in the compromised host. Plenum, New York, 1988, p. 131–163.
Case Records of the Massachusetts General Hospital: Weekly clinicopathological exercises. Case 13–1985. New England Journal of Medicine 1985, 312: 843–850.
Case Records of the Massachusetts General Hospital: Weekly clinicopathological exercises. Case 2–1978. New England Journal of Medicine 1978, 298: 154–159.
Chapman SW, Wilson JP: Nocardiosis in transplant recipients. Seminars in Respiratory Infections 1990, 5: 74–79.
Pijper A, Pullinger BD: South African nocardiosis. Journal of Tropical Medicine and Hygiene 1927, 30: 153–156.
Simpson GL, Stinson EB, Egger MJ, Remington JS: Nocardial infections in the immunocompromised host: a detailed study in a defined population. Reviews of Infectious Diseases 1981, 3: 492–507.
Arduino RC, Johnson PC, Miranda AG: Nocardiosis in renal transplant recipients undergoing immunosuppression with cyclosporine. Clinical Infectious Diseases 1993, 16: 505–512.
Conant EF, Wechsler RJ: Actinomycosis and nocardiosis of the lung. Journal of Thoracic Imaging 1992, 7: 75–84.
Feigin DS: Nocardiosis of the lung: chest radiographic findings in 21 cases. Radiology 1986, 159: 9–14.
Ettinger NE, Trulock EP: Pulmonary considerations of organ transplantation. Part 1. American Review of Respiratory Diseases 1991, 143: 1386–1405.
Raby N, Forbes G, Williams R: Nocardial infection in patients with liver transplants or chronic liver disease: radiologic findings. Radiology 1990, 174: 713–716.
Estol CJ, Lopez O, Brenner RP, Martinez AJ: Seizures after liver transplantation: a clinicopathologic study. Neurology 1989, 39: 1297–1301.
Boon AP, Carey MP, Adams DH, Buckels J, McMaster P: Central pontine myelinolysis in liver transplantation. Journal of Clinical Pathology 1991, 44: 909–914.
Singh N, Yu VL, Gayowski T: Central nervous system lesions in adult liver transplant recipients: clinical review with implications for management. Medicine 1994, 73: 110–118.
Wijdicks EFM, Wiesner RH, Dahlke LJ, Krom RAF: FK506-induced neurotoxicity in liver transplantation. Annals of Neurology 1991, 35: 498–501.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Weinberger, M., Eid, A., Schreiber, L. et al. DisseminatedNocardia transvalensis infection resembling pulmonary infarction in a liver transplant recipient. Eur. J. Clin. Microbiol. Infect. Dis. 14, 337–341 (1995). https://doi.org/10.1007/BF02116527
Issue Date:
DOI: https://doi.org/10.1007/BF02116527