Pathogenic nocardiae

Fifty-three Nocardia strains were the subject of a restriction polymorphic ribosomal RNA analysis (ribotyping) designed to distinguish between representatives of clinically significant species and related strains.

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Nocardiosis refers to disease caused by bacteria of the genus Nocardia. Pneumonia and disseminated disease are most common. Other forms include cellulitis, lymphocutaneous syndrome, actinomycetoma, and keratitis. Microbiology Nocardiae are saprophytic aerobic actinomycetes and are common worldwide in soil, where they contribute to decay of organic matter. Nocardial taxonomy is complex and incompletely understood. As taxonomy continues to evolve, any nocardiae isolated from a human should be considered potential pathogens.

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Middle-Period Infections T. gondii (Chap. 207) residing in the heart of a seropositive donor may be transmitted to a seronegative recipient. Thus serologic screening for T. gondii infection is important before and in the months after cardiac transplantation. Rarely, active disease can be introduced at the time of transplantation. The overall incidence of toxoplasmosis is so high in the setting of heart transplantation that some prophylaxis is always warranted.

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Middle-Period Infections Because of continuing immunosuppression, kidney transplant recipients are predisposed to lung infections characteristic of those in patients with T cell deficiency (i.e., infections with intracellular bacteria, mycobacteria, nocardiae, fungi, viruses, and parasites). The high mortality rates associated with Legionella pneumophila infection (Chap. 141) led to the closing of renal transplant units in hospitals with endemic legionellosis.

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Kidney transplant recipients are also subject to infections with other intracellular organisms. These patients may develop pulmonary infections with Nocardia, Aspergillus, and Mucor as well as infections with other pathogens in which the T cell/macrophage axis plays an important role. In patients without IV catheters, L. monocytogenes is a common cause of bacteremia ≥1 month after renal transplantation and should be seriously considered in renal transplant recipients presenting with fever and headache.

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