Nocardia farcinica lung infection in a patient with cystic fibrosis: a case report

Abstract

Introduction: Respiratory tract infections are the major causes of morbidity and mortality in patients with cystic fibrosis. Nocardia are rarely implicated in these infections and few reports of the involvement of this species are found in the literature.

Case presentation: We describe a case of lung infection followed by chronic colonization of trimethoprim and sulfamethoxazole resistant Nocardia farcinica in a patient with cystic fibrosis. The chronic colonization of this uncommon bacterium in patients with cystic fibrosis was proved using a newly developed real-time polymerase chain reaction assay, which indicates that this bacterium, despite treatment, is difficult to eradicate.

Conclusion: Our case report confirms that this organism can be recovered in persons with cystic fibrosis. Its eradication is necessary especially if the patient is to undergo lung transplantation.

Figure 1

Phylogenetic tree showing the position of N. farcinica (isolate 7400458, GenBank accession number EU861514) in bold and underlined within other Nocardia species. The tree was based on 16S rDNA comparison (1441 bp) using the neighbor-joining method from MEGA 4.0 software.

Figure 2

Nocardia farcinica DNA detection in different sputa recovered from the patient according the number of months and antibiotic treatment. Month 0 = January, 2006. Blue point = Nocardia farcinica positive culture. Tri-SMX = trimethoprim-sulfamethoxazole.