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Nocardiosis following hematopoietic stem cell transplantation.

Abstract Nocardia species are ubiquitous environmental organisms that can cause a diverse spectrum of disease. Clinical manifestations range from localized skin and soft tissue infections to life-threatening pulmonary, central nervous system, and/or disseminated infections. Patients with hematologic malignancies undergoing hematopoietic stem cell transplantation (HSCT) are at risk for nocardiosis, and further data in regard to characteristics of disease in this population are warranted.
PMID
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Authors

Mayor MeshTerms
Keywords

Nocardia

hematopoietic stem cell transplant

Journal Title transplant infectious disease : an official journal of the transplantation society
Publication Year Start




PMID- 26809666
OWN - NLM
STAT- MEDLINE
DCOM- 20170109
LR  - 20170110
IS  - 1399-3062 (Electronic)
IS  - 1398-2273 (Linking)
VI  - 18
IP  - 2
DP  - 2016 Apr
TI  - Nocardiosis following hematopoietic stem cell transplantation.
PG  - 169-75
LID - 10.1111/tid.12499 [doi]
AB  - BACKGROUND: Nocardia species are ubiquitous environmental organisms that can
      cause a diverse spectrum of disease. Clinical manifestations range from localized
      skin and soft tissue infections to life-threatening pulmonary, central nervous
      system, and/or disseminated infections. Patients with hematologic malignancies
      undergoing hematopoietic stem cell transplantation (HSCT) are at risk for
      nocardiosis, and further data in regard to characteristics of disease in this
      population are warranted. METHODS: We performed retrospective chart review of
      patients post allogeneic HSCT at Moffitt Cancer Center in Florida diagnosed with 
      nocardiosis from 2003 to 2013. RESULTS: In a decade, 15 cases of nocardiosis were
      identified. The majority of patients were men (11/15). The median age was 55
      years (range 25-65). The most common type of transplant was matched-related donor
      (n = 8), followed by matched-unrelated donor (n = 3), mismatched-unrelated donor 
      (n = 3), and double umbilical cord (n = 1). Ten received myeloablative
      conditioning (MAC) regimens. Twelve of 15 patients were on prednisone, 10 of
      which were on a total daily dose >/=20 mg. The median time from transplant to
      first positive culture was 10 months (range 1.5-93). Pulmonary nocardiosis was
      the most prevalent manifestation at 87%. Disseminated disease (2 or more sites of
      infection) was seen in 47%, whereas blood cultures were positive in 27% of the
      total cohort. The most common species was Nocardia nova (n = 4). At the time of
      diagnosis, 20% of the patients were receiving prophylaxis for Pneumocystis
      jirovecii pneumonia (PJP) with trimethoprim-sulfamethoxazole (TMP-SMX).
      Susceptibility data were available for 8 patients: all 8 samples were susceptible
      to TMP-SMX. Nocardiosis was treated with 2 or more active drugs in 93% of the
      patients. Overall mortality was 53%, with nocardiosis attributed as the cause in 
      62.5% (5/8). The absolute lymphocyte count at time of diagnoses was significantly
      lower in patients who ultimately experienced treatment failure. CONCLUSION:
      Infection with Nocardia species in allogeneic HSCT recipients appears to be a
      late complication of transplantation and most commonly involves the lung.
      Two-thirds of the cohort received a MAC regimen and the majority of the patients 
      were receiving steroids at the time of diagnosis. Most patients were not
      receiving TMP-SMX for PJP prophylaxis at the time of nocardiosis diagnosis, and
      TMP-SMX may therefore have a protective effect.
CI  - (c) 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
FAU - Shannon, K
AU  - Shannon K
AD  - Department of Pharmacy, Morton Plant Hospital, BayCare Health System, Clearwater,
      Florida, USA.
FAU - Pasikhova, Y
AU  - Pasikhova Y
AD  - Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute,
      Tampa, Florida, USA.
FAU - Ibekweh, Q
AU  - Ibekweh Q
AD  - Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute,
      Tampa, Florida, USA.
FAU - Ludlow, S
AU  - Ludlow S
AD  - Department of Pharmacy, H. Lee Moffitt Cancer Center and Research Institute,
      Tampa, Florida, USA.
FAU - Baluch, A
AU  - Baluch A
AD  - Department of Infectious Diseases, H. Lee Moffitt Cancer Center and Research
      Institute, Tampa, Florida, USA.
LA  - eng
PT  - Journal Article
DEP - 20160329
PL  - Denmark
TA  - Transpl Infect Dis
JT  - Transplant infectious disease : an official journal of the Transplantation
      Society
JID - 100883688
RN  - 0 (Anti-Bacterial Agents)
RN  - 0 (Antineoplastic Agents)
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Antineoplastic Agents/therapeutic use
MH  - Female
MH  - Hematopoietic Stem Cell Transplantation/*adverse effects
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Male
MH  - Middle Aged
MH  - Nocardia Infections/*drug therapy/*etiology/mortality
MH  - Retrospective Studies
MH  - Risk Factors
OTO - NOTNLM
OT  - Nocardia
OT  - hematopoietic stem cell transplant
EDAT- 2016/01/27 06:00
MHDA- 2017/01/10 06:00
CRDT- 2016/01/27 06:00
PHST- 2015/06/09 00:00 [received]
PHST- 2015/10/29 00:00 [revised]
PHST- 2015/11/07 00:00 [accepted]
PHST- 2016/01/27 06:00 [entrez]
PHST- 2016/01/27 06:00 [pubmed]
PHST- 2017/01/10 06:00 [medline]
AID - 10.1111/tid.12499 [doi]
PST - ppublish
SO  - Transpl Infect Dis. 2016 Apr;18(2):169-75. doi: 10.1111/tid.12499. Epub 2016 Mar 
      29.