Nocardia infections in lung transplant recipients (LxTR)

INTRODUCTION: The various species of Nocardia are pathogenic staining Gram-positive bacteria which frequently occurs as an opportunistic infection in immunocompromised patients. There are few data in the literature regarding nocardia infections after LTx. METHODS: A retrospective observational study was conducted in patients who developed postoperative nocardiosis. From 01/2005 to 01/2014, 241 patients underwent consecutively LTx (n=241) at the Marseille transplant center (France). RESULTS: Nocardia infection was encountered in 4 patients (1.7%) who were transplanted for sarcoidosis (2), emphysema (1) cystic fibrosis (1). All patients experienced slowly progressive pneumonia, fever, fatigue, dyspnea with no concomitant extrapulmonary involvement. Mean time for diagnosis was 5.8 po months. The mean duration of follow up was 9.6 mo (26-832). An acute rejection requiring corticosteroids was noted in the previous 6 mo (n=2). Nocardia species cultured from sputum (2), BAL (2), mediastinal lymphadenopathy (1) samples with N.cyriacigeorgica (2), N.wallacei (1), no specified (1).None of the recipients received an antibiotic trimethoprim-sulfamethoxazole prophylaxis on diagnosis. Antibiotic therapy consisted of amoxicillin (n=2) + clavulanic acid (n=2), with a mean total duration of 4.5 mo. Total recovery, with good clinical outcome and no recurrence of nocardiosis were observed in all cases. One patient died at 22 po months, with no evident link such infection. Nocardiosis is a rare complication after LTx. The diagnosis remains difficult due to nonspecific clinical symptoms and imaging. Prolonged amoxicillin therapy has been effective and well tolerated in the 4 LTR patients avoiding the potential toxicities of TMP-SMX prophylaxis.