J Korean Soc Transplant.  2001 Dec;15(2):208-216.

Nocardiosis Following Renal Transplantation

• Kim TH
• Kim SC
• Sohn JH
• Sung HS
• Kim MN
• Han DJ

Abstract

PURPOSE: Infection with Nocardia species is an uncommon yet important cause of morbidity and mortality in renal transplant recipients.
METHODS
We experienced 6 cases of nocardiosis among 239 renal transplant recipients maintained on tacrolimus- or cyclosporine-based immunosuppression from May 1999 to February 2001.
RESULTS
All the six patients had pulmonary nocardiosis from 36 to 220 (mean 82) days after renal transplantation. Due to a multiplicity of infection sites, cerebral abscess was detected in 2 patients, soft tissue abscess in 2, allograft abscess in 1 and subretinal abscess in 1. Comparing the routine trimethoprim/ sulfamethoxazole (TMP/SMX) prophylaxis after transplantation, 5 out of 6 patients took TMP/SMX for a mean of 1.8 months due to an increased AST/ALT. All the cases required invasive diagnostic procedures such as percutaneous needle aspiration (PC NA) or stereotactic aspiration. In the antimicrobial susceptibility test, isolates were sensitive to TMP/SMX, amikacin and imipenem. In the early stage of infection, we used triple chemotherapy (TMP/SMX, amikacin, imipenem) for cerebral nocardiosis and dual therapy (TMP/SMX, amikacin) for localized pulmonary infection. There were no mortality and all the graft maintained stable function.
CONCLUSION
After organ transplantation, pneumonia accompanied with satellite soft tissue infection should be considered as a nocardiosis. Pro- phylactic use of TMP/SMX is crucial for effective prevention of nocardiosis.

Keyword

Nocardiosis; Brain; Allograft; Pulmonary; Subretinal abscess

MeSH Terms

Abscess
Allografts
Amikacin
Brain
Brain Abscess
Drug Therapy
Humans
Imipenem
Immunosuppression
Kidney Transplantation*
Mortality
Needles
Nocardia
Nocardia Infections*
Organ Transplantation
Pneumonia
Soft Tissue Infections
Sulfamethoxazole
Transplantation
Transplants
Amikacin
Imipenem
Sulfamethoxazole