Nocardia pseudobrasiliensis Co-infection in SARS-CoV-2 Patients

Abstract

During the SARS-CoV-2 pandemic, few cases of Nocar-dia spp. co-infection have been reported during or after a COVID-19 infection. Nocardia spp. are gram-positive aerobic actinomycetes that stain partially acid-fast, can infect immunocompromised patients, and may cause dis-seminated disease. We report the case of a 52-year-old immunocompromised man who had Nocardia pseudobrasiliensis pneumonia develop after a SARS-CoV-2 in-fection. We also summarize the literature for no-cardiosis and SARS-CoV-2 co-infections. Nocardia spp. infection should remain a part of the differential diagnosis for pneumonia in immunocompromised hosts, regardless of other co-infections. Sulfonamide/carbapenem combina-tions are used as empiric therapy for nocardiosis; species identification and susceptibility testing are required to se-lect the optimal treatment for each patient.

Keywords: Barajas-Ochoa A; COVID-19; Nocardia pseudobrasiliensis; Raybould JE. Nocardia pseudobrasiliensis co-infection in SARS-CoV-2 patients. Emerg Infect Dis. 2023 Apr [date cited]. https://doi.org/10.3201/eid2904.221439; SARS-CoV-2; Suggested citation for this article: Stamos DB; United States; bacteria; co-infection; coronavirus disease; nocardiosis; opportunistic infections; respiratory infections; severe acute respiratory syndrome coronavirus 2.

Figure 1

Computed tomography of the chest without contrast showing progression of illness in a 52-year-old immunocompromised man who experienced Nocardia pseudobrasiliensis pneumonia after a SARS-CoV-2 infection. A) Scan obtained 4 months before patient sought care. B) Scan on hospitalization day 5 shows development of lung nodules without ground-glass opacities in both lungs. C) Scan on hospitalization day 12 shows progression of nodules on the left lung. D) Scan obtained 28 days post-discharge shows improvement of pulmonary nodules.

Figure 2

Histopathology of samples from a 52-year-old immunocompromised man who experienced Nocardia pseudobrasiliensis pneumonia after a SARS-CoV-2 infection. A) Branching gram-positive rods (arrow) seen in Gram stain of Nocardia culture plate. Original magnification ×100. B) N. pseudobrasiliensis colonies seen on a Nocardia culture plate with characteristic chalky white and orange pigmentation.