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Review
. 2022 Nov;28(11):2155-2164.
doi: 10.3201/eid2811.220262.

Multispecies Outbreak of Nocardia Infections in Heart Transplant Recipients and Association with Climate Conditions, Australia

Jonathan Li, Cindy Lau, Naomi Anderson, Fay Burrows, Feras Mirdad, Lilibeth Carlos, Andrew J Pitman, Kavitha Muthiah, David R Darley, David Andresen, Peter Macdonald, Deborah Marriott, Nila J Dharan
Review

Multispecies Outbreak of Nocardia Infections in Heart Transplant Recipients and Association with Climate Conditions, Australia

Jonathan Li et al. Emerg Infect Dis. 2022 Nov.

Abstract

A multispecies outbreak of Nocardia occurred among heart transplant recipients (HTR), but not lung transplant recipients (LTR), in Sydney, New South Wales, Australia, during 2018-2019. We performed a retrospective review of 23 HTR and LTR who had Nocardia spp. infections during June 2015-March 2021, compared risk factors for Nocardia infection, and evaluated climate conditions before, during, and after the period of the 2018-2019 outbreak. Compared with LTR, HTR had a shorter median time from transplant to Nocardia diagnosis, higher prevalence of diabetes, greater use of induction immunosuppression with basiliximab, and increased rates of cellular rejection before Nocardia diagnosis. During the outbreak, Sydney experienced the lowest monthly precipitation and driest surface levels compared with time periods directly before and after the outbreak. Increased immunosuppression of HTR compared with LTR, coupled with extreme weather conditions during 2018-2019, may explain this outbreak of Nocardia infections in HTR.

Keywords: Australia; Nocardia; bacteria; climate; disease outbreak; immunocompromised host; organ transplantation.

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Figures

Figure 1
Figure 1
Nocardia infections among HTR and LTR, by date of first positive specimen, Greater Sydney, New South Wales, Australia, June 2015–March 2021. During June 2015–December 2017, there were 6 Nocardia cases (0.19/mo), of which 2 (33%) were in HTR. During January 2018–December 2019, there were 13 Nocardia case-patients (0.54/mo), of which 12 (92%) were in HTR. During January 2020–March 2021, there were 4 Nocardia cases (0.26 per month) of which 2 (50%) were HTR. A) Nocardia cases over time by type of transplant. B) Nocardia cases over time by Nocardia species. HTR, heart transplant recipient; LTR, lung transplant recipient.
Figure 2
Figure 2
Location of Nocardia infections among heart and lung transplant recipients identified at St Vincent’s Hospital, Sydney, New South Wales, Australia, June 2015–March 2021. A) All Nocardia cases. Box indicates Greater Sydney region. B) All Nocardia cases within the Greater Sydney region.
Figure 3
Figure 3
Nocardia cases among heart and lung transplant recipients compared with precipitation and dryness in Greystanes, the central location for cases in Greater Sydney, New South Wales, Australia, June 2015–March 2021. We defined dryness as the ratio of evaporation to potential evaporation, such that 0.0 is perfectly dry and 1.0 is perfectly wet.
See this image and copyright information in PMC

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