Nocardia infection in renal transplant recipient: diagnostic and therapeutic considerations Infecção por Nocardia cm transplante renal: considerações diagnósticas e terapêuticas

• Published in: Revista do Instituto de Medicina Tropical de São Paulo
• Main Authors: L.T. Santamaria Saber, J.F.C. Figueiredo, S.B. Santos, C.E. Levy, M.A. Reis, A.S. Ferraz
• Format: Article in Journal/Newspaper
• Language: English
• Published: Universidade de São Paulo (USP) 1993
• Subjects: Renal transplant; Nocardia infection; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doi.org/10.1590/S0036-46651993000500006; https://doaj.org/article/748bab9bf288417aa3330e8ad27763f6

In the present report the authors discuss the diagnostic difficulties, therapeutic measures and the clinical course of Nocardia infection which occurred among renal transplant recipients at the University Hospital of the Faculty of Medicine of Ribeirão Preto, University of São Paulo (UH-FRP), from 1968 to 1991. Among 500 individuals submitted to renal transplant, 9 patients developed Nocardiosis at varying times after transplant (two months to over two years). All the patients had pulmonary involvement and their most common symptoms were fever, cough and pleural pain. Dissemination of the process is common and three patients presented cutaneous abscesses, four CNS involvement and one had pericarditis due to Nocardia. The diagnostic is quite difficult since there is no specific clinical picture, concomitant infections are frequent and the microorganism presents slow growth in culture (ranging from four to forty days, in our experience). In this report, three cases were only diagnosed by necropsy. The treatment of choice is a combination of Sulfamethoxazole and Trimethoprim (SMX-TMP). In the present series, overall mortality was 77% (7 cases) and in five of the patients who died the diagnosis was late. All the patients who had CNS involvement died. Foram analisados retrospectivamente 500 prontuários de pacientes transplantados renais no período de 1968 a 1991, sendo identificados 9 casos de Nocardiose; 7 do sexo masculino e 2 do sexo feminino. A idade mediana destes pacientes foi de 33 anos e a infecção ocorreu nos primeiros 6 meses em 6 pacientes, havendo relação direta com pulsoterapia em apenas um paciente. Manifestações pulmonares ocorreram em 100% dos casos, sendo que os sintomas mais frequentes foram febre, tosse e dor pleural. As alterações radiológicas observadas compreenderam infiltrados nodulares em 55% e abcessos em 22% dos casos. Houve disseminação para a pele em 3 pacientes, para o SNC em 4 pacientes, e 1 paciente apresentou, além de comprometimento pulmonar, pericardite por Nocardia. Em nossa ...