Nocardia nova causing empyema necessitatis afterlung re-transplantation: a case report

We report herein a case of thoracic infection due to Nocardia nova following lung re-transplantation performed for emphysema related to alpha-1-antitrypsin deficiency. The infection extended from the lung into the pleural space, thoracic wall, and mediastinum, presenting as pericarditis and empyema necessitatis. Nocardia nova was identified by 16S ribosomal deoxyribonucleic acid (rDNA) sequencing and phylogenetic analysis. According to a literature search of PubMed, LILACS and MEDLINE databases, we describe herein the first case of empyema necessitatis caused by N. nova species in a transplanted patient.

Keywords:
Nocardia nova; Pericarditis; Empyema necessitatis

Authorship

Cecília Bittencourt Severo

Laboratório de Micologia, Hospital Santa Rita, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Santa Casa de Misericórdia de Porto AlegreBrazilPorto Alegre, Rio Grande do Sul, BrazilLaboratório de Micologia, Hospital Santa Rita, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Departamento de Ciências Básicas, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Universidade Federal de Ciências da Saúde de Porto AlegreBrazilPorto Alegre, Rio Grande do Sul, BrazilDepartamento de Ciências Básicas, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

Letícia Beatriz Matter

Departamento de Ciências da Saúde, Universidade Regional Integrada do Alto Uruguai e das Missões, Santo Ângelo, Rio Grande do Sul, Brazil. Universidade Regional Integrada do Alto Uruguai e das MissõesBrazilSanto Ângelo, Rio Grande do Sul, BrazilDepartamento de Ciências da Saúde, Universidade Regional Integrada do Alto Uruguai e das Missões, Santo Ângelo, Rio Grande do Sul, Brazil.

Departamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil. Universidade Federal de Santa MariaBrazilSanta Maria, Rio Grande do Sul, BrazilDepartamento de Medicina Veterinária Preventiva, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil.

Flávio de Mattos Oliveira

Agueda Palmira Castagna Vargas

Sadi Marcelo Schio

Serviço de Transplante Pulmonar, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil. Santa Casa de Misericórdia de Porto AlegreBrazilPorto Alegre, Rio Grande do Sul, BrazilServiço de Transplante Pulmonar, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil.

José de Jesus Peixoto Camargo

Bruno Hochhegger

Serviço de Radiologia, Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre, Rio Grande do Sul, Brazil. Santa Casa de Misericórdia de Porto AlegreBrazilPorto Alegre, Rio Grande do Sul, BrazilServiço de Radiologia, Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre, Rio Grande do Sul, Brazil.

Luiz Carlos Severo

Departamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.Universidade Federal do Rio Grande do SulBrazilPorto Alegre, Rio Grande do Sul, BrazilDepartamento de Medicina Interna, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

Corresponding author: Dr. Luiz Carlos Severo. e-mail: severo@santacasa.tche.br

SCIMAGO INSTITUTIONS RANKINGS

Figures

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FIGURE 1
Nocardia nova pictures. (A) Purulent pleural fluid obtained via aspiration of the pleural cavity. (B) Staining performed directly from the pleural effusion showing Gram-positive rod-shaped bacteria. (C) Partially acid-fast branching filaments showed by Kinyoun Staining. Note: Figures B and C were observed by microscopy at 1,000-times magnification.

Thumbnail

FIGURE 2
Nucleotide sequence analysis. Phylogenetic relationship derived from 16S rDNA sequences showing the homology between Nocardia nova (samples SBP 72a/12 and SBP 72b/12) and 16S rDNA sequences of other Nocardia species. The phylogenetic tree was built in the MEGA 5.2 software program, using the Neighbor-Joining algorithm and the Tamura 3-parameter substitution model. Rhodococcus opacus B4 (AP011115.1) was used as the out group reference. The percentage of replicate trees in which the associated taxa clustered together in the bootstrap test (1,000 replicates) is shown next to each branch. SBP72a/12 was isolated from pleural fluid and SBP72b/12 was isolated from the pleural cavity. N: Nocardia; rDNA: ribosomal deoxyribonucleic acid; SBP: Setor de Bacteriologia e Pesquisa; MEGA: Molecular Evolutionary Genetics Analysis.

FIGURE 1 Nocardia nova pictures. (A) Purulent pleural fluid obtained via aspiration of the pleural cavity. (B) Staining performed directly from the pleural effusion showing Gram-positive rod-shaped bacteria. (C) Partially acid-fast branching filaments showed by Kinyoun Staining. Note: Figures B and C were observed by microscopy at 1,000-times magnification.

FIGURE 2 Nucleotide sequence analysis. Phylogenetic relationship derived from 16S rDNA sequences showing the homology between Nocardia nova (samples SBP 72a/12 and SBP 72b/12) and 16S rDNA sequences of other Nocardia species. The phylogenetic tree was built in the MEGA 5.2 software program, using the Neighbor-Joining algorithm and the Tamura 3-parameter substitution model. Rhodococcus opacus B4 (AP011115.1) was used as the out group reference. The percentage of replicate trees in which the associated taxa clustered together in the bootstrap test (1,000 replicates) is shown next to each branch. SBP72a/12 was isolated from pleural fluid and SBP72b/12 was isolated from the pleural cavity. N: Nocardia; rDNA: ribosomal deoxyribonucleic acid; SBP: Setor de Bacteriologia e Pesquisa; MEGA: Molecular Evolutionary Genetics Analysis.

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Nocardia nova causing empyema necessitatis afterlung re-transplantation: a case report

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[1] Corresponding author: Dr. Luiz Carlos Severo. e-mail: severo@santacasa.tche.br