Nocardial infection as a complication of HIV in South Africa.

OBJECTIVES To assess the occurrence, clinical and microbiological features of nocardial infections complicating HIV in Soweto, South Africa. METHODS A prospective study was carried out over a 2-year period. Patients were identified after isolation of Nocardia spp. from a clinical specimen. Clinical details were recorded. The nocardial isolates were identified to species level and susceptibility tests performed. RESULTS Ten patients were identified as having nocardial disease complicating HIV. Clinical presentations were pulmonary (five patients), pulmonary and cerebral (one patient), cerebral (one patient) and skin and soft tissue infection of the lower limb (three patients). Three infections were fatal. The isolates were Nocardia asteroides (seven patients), N. farcinica (two patients) and Nocardia spp. (one). Isolates of N. farcinica demonstrated opacification of Middlebrook agar. All isolates were sensitive to amikacin and minocycline. Most nocardial isolates were susceptible to cefotaxime, imipenem and coamoxiclav. In vitro resistance to cotrimoxazole was present in five. CONCLUSIONS Nocardial infection occurs as a complication of HIV infection in the Republic of South Africa. Pulmonary cases may be difficult to distinguish from tuberculosis. Nocardia asteroides is the most common species isolated. Nocardia farcinica has resistance to multiple antibacterial agents and demonstrates opacification of Middlebrook agar, a useful screening test for this species. Agents with good in vitro antinocardial activity were amikacin, minocycline, cefotaxime, imipenem and coamoxiclav. There was a high level of resistance in vitro to cotrimoxazole.

[1]  P. Burgel,et al.  The case of drug-resistant pulmonary tuberculosis was nocardiosis! , 1999, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[2]  M. Dosso,et al.  [Prevalence of nocardiosis in an area of endemic tuberculosis]. , 1998, Revue des maladies respiratoires.

[3]  A. Karstaedt,et al.  The bacteriology of pulmonary tuberculosis in a population with high human immunodeficiency virus seroprevalence. , 1998, The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[4]  J. F. Sanchez Muñoz-Torrero,et al.  [Nocardiosis in patients with human immunodeficiency virus infection in Spain]. , 1995, Revista clinica espanola.

[5]  C. Peacock,et al.  Nocardiosis in HIV-positive patients: an autopsy study in West Africa. , 1994, Tubercle and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease.

[6]  M. McNeil,et al.  The medically important aerobic actinomycetes: epidemiology and microbiology , 1994, Clinical Microbiology Reviews.

[7]  M. Saubolle,et al.  Comparative evaluation of the E test for susceptibility testing of Nocardia species. , 1994, Diagnostic microbiology and infectious disease.

[8]  M. Fischl,et al.  Nocardiosis in 30 patients with advanced human immunodeficiency virus infection: clinical features and outcome. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  T. D. Ray,et al.  Disseminated Nocardia asteroides infection presenting as septic arthritis in a patient with AIDS. , 1994, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  M. Diomande,et al.  The mortality and pathology of HIV infection in a West African city , 1993, AIDS.

[11]  E. Desmond,et al.  Opacification of Middlebrook agar as an aid in identification of Nocardia farcinica , 1993, Journal of clinical microbiology.

[12]  M. McNeil,et al.  Cutaneous nocardiosis caused by Nocardia nova occurring in an HIV-infected individual: a case report and review of the literature. , 1993, Journal of acquired immune deficiency syndromes.

[13]  R. Coker,et al.  Nocardia infection in AIDS: a clinical and microbiological challenge. , 1992, Journal of clinical pathology.

[14]  K. Schaal,et al.  Actinomycete infections in humans--a review. , 1992, Gene.

[15]  G. Wormser,et al.  Nocardiosis in Patients with Human Immunodeficiency Virus Infection Report of 2 Cases and Review of the Literature , 1992, Medicine.

[16]  A. Ledo,et al.  Cutaneous Nocardiosis and Human Immunodeficiency Virus Infection , 1991, International journal of dermatology.

[17]  J. Ellner,et al.  Nocardiosis mimicking pulmonary tuberculosis in Ugandan AIDS patients. , 1991, Chest.

[18]  H. Gugnani,et al.  Incidence of pulmonary infection due to Nocardia. species in Nigeria , 1991, Mycoses.

[19]  M. Grieco,et al.  Nocardial infection as a complication of AIDS: report of six cases and review. , 1991, Reviews of infectious diseases.

[20]  R. Wallace,,et al.  Cefotaxime-resistant Nocardia asteroides strains are isolates of the controversial species Nocardia farcinica , 1990, Journal of clinical microbiology.

[21]  M. Kramer,et al.  The radiographic appearance of pulmonary nocardiosis associated with AIDS. , 1990, Chest.

[22]  R. Wallace,,et al.  Antimicrobial susceptibility patterns of Nocardia asteroides , 1988, Antimicrobial Agents and Chemotherapy.

[23]  P. Boiron,et al.  In-vitro susceptibility testing of Nocardia spp. and its taxonomic implication. , 1988, The Journal of antimicrobial chemotherapy.

[24]  V. Robertson,et al.  Nocardiosis: a neglected chronic lung disease in Africa? , 1988, Thorax.

[25]  M. Egger,et al.  Nocardial infections in the immunocompromised host: A detailed study in a defined population. , 1981, Reviews of infectious diseases.

[26]  S. Mishra,et al.  Identification of nocardiae and streptomycetes of medical importance , 1980, Journal of clinical microbiology.

[27]  D. Musher,et al.  Disk diffusion susceptibility testing of Nocardia species. , 1977, The Journal of infectious diseases.

[28]  M. Szuba,et al.  Adrenal insufficiency, recurrent bacteremia, and disseminated abscesses caused by Nocardia asteroides in a patient with acquired immunodeficiency syndrome. , 1996, Diagnostic microbiology and infectious disease.