Nocardia farcinica lung infection in a patient with cystic fibrosis and a lung transplant.

Autores de IIS La Fe

• Rosario Vicente Guillen

  Autor

• Fuencisla Ramos Fortea

  Autor

• Juan Porta Martín

  Autor

• Emilio Ansótegui Barrera

  Autor

Participantes ajenos a IIS La Fe

• Chacón CF
• Lopez Maldonado A

Grupos

• Anestesia y Cuidados Críticos

  Investigador Principal

  María Azucena Pajares Moncho

• Infecciones Respiratorias

  Investigador Principal

  Raúl Méndez Ocaña

Abstract

Patients with cystic fibrosis have a higher risk of developing chronic respiratory infectious diseases. The Nocardia farcinica lung infection is rare in this group of patients, and there are limited publications about this topic. Its diagnosis is complex, due to the clinical and the radiology signs being non-specific. Identification of the agent responsible in the sputum culture is occasionally negative. It is a slow growing organism and for this reason treatment is delayed, which can lead to an increase in complications, hospitable stays, and mortality. A case is reported on a 26 year-old woman with cystic fibrosis and chronic lung colonization by Nocardia farcinica and Aspergillus fumigatus, on long-term treatment with ciprofloxacin, trimethoprim-sulfamethoxazole, and posaconazole, who was admitted to ICU after bilateral lung transplantation. The initial post-operative progress was satisfactory. After discharge, the patient showed a gradual respiratory insufficiency with new chest X-ray showing diffuse infiltrates. Initially, the agent was not seen in the sputum culture. Prompt and aggressive measures were taken, due to the high clinical suspicion of a Nocardia farcinica lung infection. Treatment with a combination of amikacin and meropenem, and later combined with linezolid, led to the disappearance of the lung infiltrates and a clinical improvement. In our case, we confirm the rapid introduction of Nocardia farcinica in the new lungs. The complex identification and the delay in treatment increased the morbimortality. There is a special need for its eradication in patients with lung transplant, due to the strong immunosuppressive treatment.

Keywords

• Complicacion respiratoria; Cystic fibrosis; Fibrosis quistica; Infeccion posoperatoria; Lung transplant; Nocardia farcinica; Organismo resistente; Post-operative infection; Resistant organism; Respiratory complication; Trasplante pulmonar