DOCSLIB.ORG

Non-Commercial Use Only

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Non-Commercial Use Only Infectious Disease Reports 2014; volume 6:5327 A complicated case Introduction Correspondence: Chad J. Cooper, Department of of an immunocompetent Internal Medicine, Texas Tech University Health patient with disseminated Nocardia species are aerobic, gram positive Sciences Center, 4800 Alberta Ave, El Paso, TX nocardiosis filamentous branching bacteria that have the 79905, USA. potential to cause localized or disseminated Tel. +1.915.543.1009. E-mail: [email protected] Chad J. Cooper, Sarmad Said, infection. Nocardia species are ubiquitous in the environment as saprophytic components in Maryna Popp, Haider Alkhateeb, Key words: nocardia, lung abscess, brain abscess, dust, soil, water, decaying vegetation and stag- Carlos Rodriguez, septic emboli. nant matter.1 Nocardiosis mainly affects Mateo Porres Aguilar, Ogechika Alozie immunocompromised patients, although Contributions: the authors contributed equally. Department of Internal Medicine, Texas rarely immunocompetent individuals could Tech University Health Sciences Center, also be affected. The predominant form of Conflict of interests: the authors declare no El Paso, TX, USA nocardiosis is dependent on the species and potential conflict of interests. the geographical location.2 The majority of nocardiosis cases are caused by the N. aster- Received for publication: 28 January 2014. oides complex and N. brasiliensis. In the tropi- Revision received: 17 February 2014. Accepted for publication: 25 February 2014. Abstract cal climate cutaneous and lymphocutaneous infections caused by N. brasiliensis (myce- This work is licensed under a Creative Commons toma) predominate. In the temperate climate Nocardia species are aerobic, gram positive Attribution NonCommercial 3.0 License (CC BY- zone, pulmonary infections with N. asteroides NC 3.0). filamentous branching bacteria that have the complex will be more prevalent.2 The major potential to cause localized or disseminated risk factor for nocardia infection is being ©Copyright C.J. Cooper et al., 2014 infection. Nocardiosis is a rare disease that immunocomprised, specifically those with cell- Licensee PAGEPress, Italy usually affects immunocompromised patients Infectious Disease Reports 2014; 6:5327 mediated immunity defects.3 The main causes and presents as either pulmonary, cutaneous doi:10.4081/idr.2014.5327 of immunocompromise are hematopoietic only or disseminated nocardiosis. Forty-two year- stem cell or solid organ transplantation, HIV old hispanic male presented to our care with infection, chemotherapy, malignancy or gluco- extremity pain for 3 weeks, located at the bilateral lower extremity weakness, frontal corticoid therapy. Risks factors for pulmonary upper thighs with radiation down the legs. He headache, subjective fever, nausea, and vomit- nocardiosis are alcoholism and chronicuse lung also complained of a non-radiating severe, ing. Brain computed tomography (CT) disease. frontal, throbbing headache for one week, revealed multiple hyperdense lesions with Nocardiosis is a rare disease that usually associated with occasional episodes of diplop- vasogenic edema in the frontal, parietal and causes one of three clinical manifestations. ia, without a stiff neck or photophobia. Four left temporal lobes. Chest CT demonstrated Pulmonary nocardiosis is the most common days prior he developed bilateral lower extrem- bilateral cavitary nodules in the lung and right manifestation nocardiosis. Pulmonary infec- ity weakness and could not walk or stand on hilar lymphadenopathy. Brain magnetic reso- tion is acquired through the inhalation of the his own. Other complaints included nausea, nance imaging revealed multiple bilateral organism from dust or soil. Other sites of vomiting and a low-grade fever of 37.7°C. No supratentorial and infratentorial rim enhanc- nocardial dissemination include skin, subcuta- recent travel abroad or sick contacts. He had ing lesions involving the subcortical gray- neous tissues, and the central nervous sys- no medical problems or previous surgical white matter interface with vasogenic edema. tem.4 Disseminated disease is defined by the interventions. He admitted to a 20 pack year Patient was started on empiric therapy for presence of two or more organs infected by history of smoking and chronic alcohol intake unknown infectious etiology with no response. nocardia. Disseminated nocardiosis is charac- of four 8 oz cans of beer every day for the last He eventually expired and autopsy findings terized by hematogenous spread of microbes twenty years. He currently worked as a con- revealed a right hilar lung abscess and multi- into brain, eye, bone, joint, heart, kidney, skin struction worker. All vital signs were stable on ple brain abscesses. Microscopic and culture or other organs and tissues.5 Nocardiosis has admission and within normal range. Physical findings from tissue sample during autopsy the ability to disseminate any organ, most examination demonstrated somnolent but revealed nocardia wallacei speciesNon-commercial with mul- commonly the central nervous system (CNS) arousable patient in no acute distress. The tidrug resistance. The cause of death was stat- and has a tendency to relapse or progress complete neurological and lung examination ed as systemic nocadiosis (nocardia pneu- despite being given the appropriate therapy.6 were unremarkable except hypereflexia of the monitis and encephalitis). The presence of We are presenting a case of an immunocom- right brachioradialis and right biceps and a simultaneous lung and brain abscesses is a petent patient with risk factors of chronic alco- decrease of muscle strength of bilateral lower reliable indication of an underlying Nocardia hol abuse and environmental exposure as a extremities. All other body systems of physical infection. An increased awareness of the vari- construction worker that developed dissemi- examination were unremarkable. ous presentations of nocardiosis and a high nated nocardiosis. This case was further com- Initial laboratory work up (Table 1) was index of clinical suspicion can help in a rapid plicated by the inability to obtain a tissue sam- remarkable for mild hyponatremia, mild diagnosis and improve survival in an other- ple to characterize the nocardia species and transaminase elevation and hyperbilirubine- wise fatal disease. This case highlights the give the appropriate therapy. mia. The ammonia level was in the upper nor- importance of obtaining a tissue biopsy for mal range. Urinalysis, urine toxicology screen definitive diagnosis on the initial presentation and alcohol level, hepatitis serology panel and when an infectious process is considered in HIV were negative. Chest x-ray on admission the differential diagnosis and early treatment Case Report was unremarkable. Computer tomography can be initiated. (CT) of the brain (Figure 1A) on admission Forty-two year-old Hispanic male presented revealed multiple intraaxial hyperdense with severe and constant bilateral lower lesions with surrounding vasogenic edema in [Infectious Disease Reports 2014; 6:5327] [page 9] Case Report the frontal, parietal and left temporal lobes. Table 1. Initial laboratory work up. Hematogenous spread was suggested by the White blood cell count 10.05×103 UL (4.5-11.0×103/UL) presence of several lesions at the gray-white junction. Chest-CT (Figure 1B) on admission Hemoglobin 16.0 g/dL (12.0-15.0 g/dL) demonstrated bilateral cavitary nodules in the Hematocrit 43.4% (36.0-47.0%) lung and right hilar lymphadenopathy. Our dif- Platelet count 233×103/UL (150-450×103/UL) ferential diagnosis included metastatic versus Sodium 130 mmol/L (135-145 mmol/L) infectious etiology. We therefore started the Potassium 4.4 mmol/L (3.5-5.1 mmol/L) patient on empiric antibiotics of vancomycin 1 Serum glucose 137 mg/dL (70-100 mg/dL) gram every 12 hours, ceftriaxone 2 grams every 12 hours, and dexamethasone 6mg IV BUN 15 mg/dL (7-22 mg/dL) every 8 hours for cerebral edema. We then pro- Creatinine 0.8 mg/dL (0.60-1.30 mg/dL) ceeded to obtain a MRI of the brain (Figure 2) AST 66 IU/L (15-37 IU/L) which revealed multiple bilateral supratentori- ALT 66 IU/L (12-78 IU/L) al and infratentorial rim enhancing lesions Alkaline Phosphatase 104 IU/L (50-136 IU/L) involving the subcortical gray-white matter Ammonia 45 umol/L (10-40 umol/L) interface, superficial and deep white matter tracts, brainstem and cerebellum associated with vasogenic edema. These findings were more likely associated with an infectious etiol- ogy causing septic emboli. The initial blood and urine cultures on admission were nega- tive. The pulmonary service was consulted on the second hospital day for bronchoscopy for bron- Table 2. Cerebrospinal fluid studies. only choalveloar lavage (BAL). Bronchoscopy Appearance Clear and colorless revealed normal airway anatomy with diffusely erythematous mucosa and clear secretions. White blood cell count 18/uL BAL was obtained from the left upper lobe and Neutrophils use64% cytology report had no significant findings. Lymphocytes 25% The BAL cultures were negative for fungal, Monocytes 11% bacteria and mycobacteria. AFB stain was per- Red blood cell count 1/uL formed on the BAL and was also negative. The infectious disease service was also consulted Protein 37 mg/dL on the second hospital day and recommended Glucose 55 mg/ dL a PPD, Quaniferon Gold, coccidiodies serology, Corresponding serum glucose 128 mg/ dL aspergillus antigen, toxoplasma IgG antibody, Cerebrospinal fluid serology serum crytococcal antigen and a lumbar punc- Cryptococcal antigen Negative
Load more

Recommended publications
  • Primary Cutaneous Nocardiosis: a Case Study and Review
    Study Primary cutaneous nocardiosis: A case study and review Arun C. Inamadar, Aparna Palit Department of Dermatology, Venereology & Leprosy, BLDEA’s SBMP Medical College, Hospital & Research Centre, Bijapur, India. Address for correspondence: Dr. Arun C. Inamadar, Professor & Head, Department of Dermatology, Venereology & Leprosy, BLDEA’s SBMP Medical College, Hospital & Research Centre, Bijapur - 586103, India. E-mail: [email protected]. ABSTRACT Background: Primary cutaneous nocardiosis is an uncommon entity. It usually occurs among immunocompetent but occupationally predisposed individuals. Aim: To study clinical profile of patients with primary cutaneous nocardiosis in a tertiary care hospital and to review the literature. Methods: The records of 10 cases of primary cutaneous nocardiosis were analyzed for clinical pattern, site of involvement with cultural study and response to treatment. Results: All the patients were agricultural workers (nine male) except one housewife. The commonest clinical type was mycetoma. Unusual sites like the scalp and back were involved in two cases. Culture was positive in six cases with N. brasiliensis being commonest organism. N. nova which was previously unreported cause of lymphocutaneous nocardiosis, was noted in one patient, who had associated HIV infection. All the patients responded to cotrimaxazole. Conclusion: Mycetoma is the commonest form of primary cutaneous nocardiosis and responds well to cotrimoxazole. KEY WORDS: Primary cutaneous nocardiosis, Mycetoma, Lymphocutaneous nocardiosis INTRODUCTION infection is prevalent. Many of the large series on nocardial infections mention the incidence of Cutaneous nocardiosis presents either as a part of cutaneous nocardiosis without specifying whether the disseminated infection or as a primary infection infection is primary or secondary. Indian reports of resulting from inoculation.
    [Show full text]
  • Accuprobe Mycobacterium Avium Complex Culture
    non-hybridized and hybridized probe. The labeled DNA:RNA hybrids are measured in a Hologic luminometer. A positive result is a luminometer reading equal to or greater than the cut-off. A value below this cut-off is AccuProbe® a negative result. REAGENTS Note: For information on any hazard and precautionary statements that MYCOBACTERIUM AVIUM may be associated with reagents, refer to the Safety Data Sheet Library at www.hologic.com/sds. COMPLEX CULTURE Reagents for the ACCUPROBE MYCOBACTERIUM AVIUM COMPLEX IDENTIFICATION TEST CULTURE IDENTIFICATION TEST are provided in three separate reagent kits: INTENDED USE The ACCUPROBE MYCOBACTERIUM AVIUM COMPLEX CULTURE ACCUPROBE MYCOBACTERIUM AVIUM COMPLEX PROBE KIT IDENTIFICATION TEST is a rapid DNA probe test which utilizes the Probe Reagent. (4 x 5 tubes) technique of nucleic acid hybridization for the identification of Mycobacterium avium complex Mycobacterium avium complex (M. avium complex) isolated from culture. Lysing Reagent. (1 x 20 tubes) Glass beads and buffer SUMMARY AND EXPLANATION OF THE TEST Infections caused by members of the M. avium complex are the most ACCUPROBE CULTURE IDENTIFICATION REAGENT KIT common mycobacterial infections associated with AIDS and other Reagent 1 (Lysis Reagent). 1 x 10 mL immunocompromised patients (7,15). The incidence of M. avium buffered solution containing 0.04% sodium azide complex as a clinically significant pathogen in cases of chronic pulmonary disease is also increasing (8,17). Recently, several Reagent 2 (Hybridization Buffer). 1 x 10 mL laboratories have reported that the frequency of isolating M. avium buffered solution complex is equivalent to or greater than the frequency of isolating M.
    [Show full text]
  • Granulomatous Diseases: Disease: Tuberculosis Leprosy Buruli Ulcer
    Granulomatous diseases: Disease: Tuberculosis Leprosy Buruli ulcer MOTT diseases Actinomycosis Nocardiosis Etiology Mycobacterium M. leprae M. ulcerans M. kansasii Actinomyces israelii Nocardia asteroides tuberculosis M. scrofulaceum M. africanum M. avium- M. bovis intracellulare M. marinum Reservoir Humans (M. tuberculosis, HUMANS only Environment Environment HUMANS only Environment M. africanum*) (uncertain) Animals (M. bovis) Infects animals Transmission Air-borne route Air-borne route Uncertain: Air-borne NONE Air-borne route to humans Food-borne route Direct contact traumatic Traumatic inoculation endogenous infection Traumatic (M. bovis) inoculation, Habitat: oral cavity, inoculation insect bite? intestines, female genital tract Clinical Tuberculosis (TB): Leprosy=Hansen’s Disseminating Lung disease Abscesses in the skin Broncho-pulmonary picture pulmonary and/or disease skin ulcers Cervical lymphadenitis adjacent to mucosal surfaces (lung abscesses) extra-pulmonary Tuberculoid leprosy Disseminated (cervicofacial actinomycosis), Cutaneous infections (disseminated: kidneys, Lepromatous leprosy infection in the lungs (pulmonary) or such as: mycetoma, bones, spleen, meninges) Skin infections in the abdominal cavity lymphocutaneous (peritonitis, abscesses in infections, ulcerative appendix and ileocecal lesions, abscesses, regions) cellulitis; Dissemination: brain abscesses Distribution All over the world India, Brazil, Tropical disease All over the world All humans Tropical disease * Africa Indonesia, Africa (e.g. Africa, Asia, (e.g.
    [Show full text]
  • 17110-Disseminated-Nocardiosis-A-Case-Report.Pdf
    Open Access Case Report DOI: 10.7759/cureus.5294 Disseminated Nocardiosis: A Case Report Ines M. Leite 1 , Frederico Trigueiros 1 , André M. Martins 1 , Marina Fonseca 1 , Tiago Marques 2 1. Serviço De Medicina 2, Hospital De Santa Maria, Lisboa, PRT 2. Serviço De Doenças Infecciosas, Hospital De Santa Maria, Lisboa, PRT Corresponding author: Ines M. Leite, [email protected] Abstract Disseminated nocardiosis is a rare infection associated with underlying immunosuppression, and patients usually have some identifiable risk factor affecting cellular immunity. Due to advances in taxonomy and microbiology identification methods, infections by Nocardia species are more frequent, making the discussion of its approach and choice of antibiotherapy increasingly relevant. A 77-year-old man presented to the emergency department with marked pain on the right lower limb, weakness, and upper leg edema. He had been diagnosed with organized cryptogenic pneumonia one year before and was chronically immunosuppressed with methylprednisolone 32 mg/day. Blood cultures isolated Nocardia cyriacigeorgica. Computed tomography revealed a gas collection in the region of the right iliacus muscle with involvement of the gluteal and obturator muscles upwardly and on the supragenicular plane inferiorly. Triple therapy with imipenem, amikacin, and cotrimoxazole was started, and the patient was submitted for emergent surgical decompression, fasciotomy, and drainage due to acute compartment syndrome. The patient had a good outcome and was discharged from the hospital after 30 days of intravenous therapy. This case illustrates the severity of Nocardia infection and highlights the need for a meticulous approach in the diagnosis and treatment of these patients. Categories: Internal Medicine, Infectious Disease Keywords: nocardia, nocardia infection, immunosuppression Introduction In the suborder of Corynebacterineae, three genera have strains that may be pathological to humans, with some characteristics similar to Fungi: Mycobacterium, Corynebacterium, and Nocardia.
    [Show full text]
  • Actinomycesspp & Nocardiaspp
    PLUMB’S THERAPEUTICS BRIEF h PATHOGEN PROFILE h PEER REVIEWED Actinomyces spp & Nocardia spp J. Scott Weese, DVM, DVSc, DACVIM University of Guelph Actinomyces spp and Nocardia spp are members of class Acti- Nocardia spp nobacteria, which can cause opportunistic infections in dogs, The Nocardia genus contains more than 30 saprophytic species cats, and other species. Both can cause pyogranulomatous or that are widely, if not ubiquitously, disseminated in the environ- suppurative disease that is often slowly progressing and chal- ment. Disease occurs following inoculation of the bacterium into lenging to diagnose; however, some differences in organism tissue or via inhalation. and characteristics exist (Table 1, next page). The incidence of h Nocardia spp are regionally variable, with higher rates of disease caused by either is undefined and likely low. infection in dry, dusty, and windy regions (eg, southwestern United States, parts of Australia). Actinomyces spp h Nocardiosis is classically divided into 3 clinical forms: Many different species are present, and taxonomy continues to pulmonary, disseminated (systemic), and cutaneous/ change; some species previously known as Actinomyces have subcutaneous.11-15 been reclassified in other genera, such as Arcanobacterium spp • Clinical presentations are as would be expected with pul- and Trueperella spp. Regardless, disease aspects remain monary, systemic, or cutaneous infections. Pulmonary or unchanged. Commonly found as part of the oral, GI, and genital cutaneous disease can progress to disseminated disease. microbiotas,1-3 Actinomyces spp and related genera are of lim- ited virulence unless inoculated into tissue (eg, via bites, foreign Diagnosis bodies, or trauma). Early diagnosis may be missed.
    [Show full text]
  • Pediatric Nocardial Brain Abscesses in Acquired Immunodeficiency Syndrome
    C S & lini ID ca A l f R o e l Chotey et al., J AIDS Clin Res 2016, 7:11 s a e Journal of n a r r c DOI: 10.4172/2155-6113.1000628 u h o J ISSN: 2155-6113 AIDS & Clinical Research Case Report Open Access Pediatric Nocardial Brain Abscesses in Acquired Immunodeficiency Syndrome Chotey NA1, Ramdial PK1*, Miles E1, Nargan K2 and Mubaiwa L3 1Department of Anatomical Pathology, National Health Laboratory Service & University of KwaZulu-Natal, Durban, South Africa 2KwaZulu-Natal Research Institute for Tuberculosis and HIV, Durban, KwaZulu-Natal, South Africa 3Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa Abstract Nocardiosis is relatively uncommon in children and adults with acquired immunodeficiency syndrome (AIDS), despite the profound associated cellular immunodeficiency. Acquired most often by inhalation and less commonly by percutaneous inoculation, subsequent hematogenous dissemination may lead to infection of almost any organ, with a particular predilection for the central nervous system. Nocardial brain abscesses are rare. To the best of our knowledge, pediatric Nocardial brain abscesses have not been documented in Human Immunodeficiency Virus (HIV)-infected children in the English-language literature, to date. In reporting two Nocardial brain abscesses in a 9 year old AIDS patient with intermittent seizures, we highlight the difficulty associated with the ante-mortem diagnosis of Nocardial brain abscesses, and the need for cognizance of rare entities occurring in HIV-infected children. Furthermore, we emphasize the pivotal role of the autopsy in finalizing the nature of the cerebral pathology, the cause of the seizures albeit post-mortem, a cause of death and in providing a platform for continued learning in the AIDS era.
    [Show full text]
  • Case Report Widespread Nocardiosis in a Patient with Refractory ANCA-Associated Vasculitides: Relapse Or Mimics? a Case Report and Literature Review
    Int J Clin Exp Med 2019;12(6):7878-7886 www.ijcem.com /ISSN:1940-5901/IJCEM0089770 Case Report Widespread nocardiosis in a patient with refractory ANCA-associated vasculitides: relapse or mimics? A case report and literature review Wo Yao1, Jing Xue2 Departments of 1Allergy, 2Rheumatology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, P.R. China Received December 13, 2018; Accepted April 9, 2019; Epub June 15, 2019; Published June 30, 2019 Abstract: Immunocompromised patients are at high risk of Nocardia, however infection in these patients can also mimic relapsed or refractory autoimmune disease and that make diagnosis difficult. Herein is described a 60-year- old male diagnosed with anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) who presented with fever, short of breath, cough, headache, and a subcutaneous mass in his right forearm after 3 months therapy with full-dose oral corticosteroid and intravenous cyclophosphamide. Given that the currently available laboratory tests and associated imaging features are nonspecific, it was quite difficult to differentiate between a recurrence of the patient’s AVV and infection as a complication. The patient was finally diagnosed with systemic nocardiosis base on a subcutaneous abscess puncture fluid culture after 3 weeks of hospitalization. Trimethoprim-sulfamethoxazole (TMP-SMX) was administered while the steroid was tapered, after which the patient’s systemic manifestations grad- ually resolved. A literature review identified 24 cases of nocardiosis as a complication of systemic vasculitis was performed. Male patients with systemic vasculitis (especially AAV or Behcet’s disease) aged ≥ 60 years who were treated with corticosteroid in conjunction with or without immunosuppressant therapy were at high risk of Nocardia infection.
    [Show full text]
  • Evaluation Ofapi Coryne System for Identifying Coryneform Bacteria
    756 Y Clin Pathol 1994;47:756-759 Evaluation of API Coryne system for identifying coryneform bacteria J Clin Pathol: first published as 10.1136/jcp.47.8.756 on 1 August 1994. Downloaded from A Soto, J Zapardiel, F Soriano Abstract that are aerobe or facultatively aerobe, non- Aim-To identify rapidly and accurately spore forming organisms of the following gen- coryneform bacteria, using a commercial era: Corynebacterium, Listeria, Actinomyces, strip system. Arcanobacterium, Erysipelothrix, Oerskovia, Methods-Ninety eight strains of Cory- Brevibacterium and Rhodococcus. It also per- nebacterium species and 62 additional mits the identification of Gardnerella vaginalis strains belonging to genera Erysipelorix, which often has a diphtheroid appearance and Oerskovia, Rhodococcus, Actinomyces, a variable Gram stain. Archanobacterium, Gardnerella and We studied 160 organisms in total from dif- Listeria were studied. Bacteria were ferent species of the Corynebacterium genus, as identified using conventional biochemi- well as from other morphological related gen- cal tests and a commercial system (API- era or groups, some of them not included in Coryne, BioMerieux, France). Fresh rab- the API Coryne database. bit serum was added to fermentation tubes for Gardnerella vaginalis isolates. Results-One hundred and five out ofthe Methods 160 (65.7%) organisms studied were cor- The study was carried out on Gram positive rectly and completely identified by the bacilli belonging to the genera Coryne- API Coryne system. Thirty five (21.8%) bacterium, Erysipelothrix, Oerskovia, Rhodococcus, more were correctly identified with addi- Actinomyces, Arcanobacterium, Gardnerella and tional tests. Seventeen (10-6%) organisms Listeria included in the API Coryne database were not identified by the system and (table 1).
    [Show full text]
  • Mycobacterium Marinum Infection: a Case Report and Review of the Literature
    CONTINUING MEDICAL EDUCATION Mycobacterium marinum Infection: A Case Report and Review of the Literature CPT Ryan P. Johnson, MC, USA; CPT Yang Xia, MC, USA; CPT Sunghun Cho, MC, USA; MAJ Richard F. Burroughs, MC, USA; COL Stephen J. Krivda, MC, USA GOAL To understand Mycobacterium marinum infection to better manage patients with the condition OBJECTIVES Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Identify causes of M marinum infection. 2. Describe methods for diagnosing M marinum infection. 3. Discuss treatment options for M marinum infection. CME Test on page 50. This article has been peer reviewed and approved Einstein College of Medicine is accredited by by Michael Fisher, MD, Professor of Medicine, the ACCME to provide continuing medical edu- Albert Einstein College of Medicine. Review date: cation for physicians. December 2006. Albert Einstein College of Medicine designates This activity has been planned and imple- this educational activity for a maximum of 1 AMA mented in accordance with the Essential Areas PRA Category 1 CreditTM. Physicians should only and Policies of the Accreditation Council for claim credit commensurate with the extent of their Continuing Medical Education through the participation in the activity. joint sponsorship of Albert Einstein College of This activity has been planned and produced in Medicine and Quadrant HealthCom, Inc. Albert accordance with ACCME Essentials. Drs. Johnson, Xia, Cho, Burroughs, and Krivda report no conflict of interest. The authors report no discussion of off-label use. Dr. Fisher reports no conflict of interest. Mycobacterium marinum is a nontuberculous findings, the differential diagnosis, the diagnostic mycobacteria that is often acquired via contact methods, and the various treatment options.
    [Show full text]
  • Development of a SYBR Green Multiplex Real Time PCR For
    Development of a SYBR Green… Safar Ali. A. et al 241 ORIGINAL ARTICLE Development of a SYBR Green Multiplex Real Time PCR for Simultaneous Detection of Mycobacterium Tuberculosis and Nocardia Asteroides in Respiratory Samples Safar Ali Alizadeh1*, Amir Javadi2, Jalal Mardaneh3,4, Neda Nasirian5, Sajjad Alizadeh6, Maryam Mohammadbeigi7, Siamak Heidarzadeh8 5Department of pathology, School of Medicine, Qazvin University of Medical Sciences, OPEN ACCESS Qazvin, Iran. 6Medical Doctor, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Citation: Safar Ali Alizadeh, Amir 7Department of Microbiology and Immunology, School of Medicine, Qazvin University of Javadi, Jalal Mardaneh, Neda Nasirian, Medical Sciences, Qazvin, Iran. Sajjad Alizadeh, Maryam 8Department of Microbiology and Virology, School of Medicine, Zanjan University of Mohammadbeigi, Siamak Heidarzadeh. Medical Sciences, Zanjan, Iran. Development of an SYBR Green *Email: [email protected] Multiplex Real Time PCR for Simultaneous Detection of ABSTRACT Mycobacterium Tuberculosis and Nocardia Asteroides in Respiratory Samples. Ethiop J Health Sci. 2021; BACKGROUND፡ Nocardia asteroides and Mycobacterium 31(2):241 tuberculosis are worldwide-distributed bacteria. These infectious doi:http://dx.doi.org/10.4314/ejhs.v31i2.6 Received: October 27, 2020 agents can cause many infections in humans, especially in Accepted: November 23, 2020 immunocompromised individuals. Pulmonary infections are more Published: March 1, 2021 common and have similar clinical symptoms. Proper diagnosis Copyright : © 2021 Safar A.A.., et al. This is an open access article distributed and treatment of these patients are important for accurate under the terms of the Creative treatment and could be lifesaving. Commons Attribution License, which permits unrestricted use, distribution, METHODS: In this study, a multiplex real-time PCR assay was and reproduction in any medium, established for the simultaneous detection of the N.
    [Show full text]
  • Infectious Diseases of the Philippines
    INFECTIOUS DISEASES OF THE PHILIPPINES Stephen Berger, MD Infectious Diseases of the Philippines - 2013 edition Infectious Diseases of the Philippines - 2013 edition Stephen Berger, MD Copyright © 2013 by GIDEON Informatics, Inc. All rights reserved. Published by GIDEON Informatics, Inc, Los Angeles, California, USA. www.gideononline.com Cover design by GIDEON Informatics, Inc No part of this book may be reproduced or transmitted in any form or by any means without written permission from the publisher. Contact GIDEON Informatics at [email protected]. ISBN-13: 978-1-61755-582-4 ISBN-10: 1-61755-582-7 Visit http://www.gideononline.com/ebooks/ for the up to date list of GIDEON ebooks. DISCLAIMER: Publisher assumes no liability to patients with respect to the actions of physicians, health care facilities and other users, and is not responsible for any injury, death or damage resulting from the use, misuse or interpretation of information obtained through this book. Therapeutic options listed are limited to published studies and reviews. Therapy should not be undertaken without a thorough assessment of the indications, contraindications and side effects of any prospective drug or intervention. Furthermore, the data for the book are largely derived from incidence and prevalence statistics whose accuracy will vary widely for individual diseases and countries. Changes in endemicity, incidence, and drugs of choice may occur. The list of drugs, infectious diseases and even country names will vary with time. Scope of Content: Disease designations may reflect a specific pathogen (ie, Adenovirus infection), generic pathology (Pneumonia - bacterial) or etiologic grouping (Coltiviruses - Old world). Such classification reflects the clinical approach to disease allocation in the Infectious Diseases Module of the GIDEON web application.
    [Show full text]
  • Cord Factor (A,A-Trehalose 6,6'-Dimycolate) Inhibits Fusion Between Phospholipid Vesicles (Trehalose/Membrane Fusion/Liposomes/Tuberculosis/Nocardiosis) B
    Proc. Nati. Acad. Sci. USA Vol. 88, pp. 737-740, February 1991 Biochemistry Cord factor (a,a-trehalose 6,6'-dimycolate) inhibits fusion between phospholipid vesicles (trehalose/membrane fusion/liposomes/tuberculosis/nocardiosis) B. J. SPARGO*t, L. M. CROWE*, T. IONEDAf, B. L. BEAMAN§, AND J. H. CROWE* *Department of Zoology and §Department of Medical Microbiology and Immunology, University of California, Davis, CA 95616; and tUniversidade de Sio Paulo, Instituto de Quimica, 05508 Sao Paulo, S.P., Brazil Communicated by John D. Baldeschwieler, October 15, 1990 ABSTRACT The persistence of numerous pathogenic bac- antitumor activity (11), immunomodulation (12, 13), and teria important in disease states, such as tuberculosis, in granulomagenic activity (14). Indirect evidence has been humans and domestic animals has been ascribed to an inhibi- provided that CF might be responsible for inhibiting fusion tion of fusion between the phagosomal vesicles containing the between adjacent membranes in vivo (6). This finding is bacteria and lysosomes in the host cells [Elsbach, P. & Weiss, particularly appealing in view of the work of Goodrich and J. (1988) Biochim. Biophys. Adia 974, 29-52; Thoen, C. 0. Baldeschwieler (15, 16) and Hoekstra and coworkers (17, 18), (1988)J. Am. Vet. Med. Assoc. 193, 1045-1048]. In tuberculosis where carbohydrates anchored to the membrane by a hydro- this effect has been indirectly attributed to the production of phobic group have been shown to confer an inhibition of cord factor (a,a-trehalose 6,6'-dimycolate). We show here that fusion in model membrane systems. Goodrich and Balde- cord factor is extraordinarily effective at inhibiting Ca2+- schwieler (15, 16) reported that galactose anchored to cho- induced fusion between phospholipid vesicles and suggest a lesterol prevents fusion damage to liposomes during freezing mechanism by which cord factor confers this effect.
    [Show full text]