Nocardia/Nocardiosis

Clasificación

Características generales

Nocardia Nocardia Nocardia is a branching, filamentous, gram-positive bacilli. It is partially acid fast due to the presence of mycolic acids in the cell wall. Nocardia is a ubiquitous soil organism that most commonly affects immunocompromised patients. Nocardia is transmitted via inhalation of aerosolized bacteria or less commonly, via direct contact with wounds. Nocardia/Nocardiosis

• Características generales:
  • Estructura:
    • Varillas ramificadas, filamentosas
    • Los LOS Neisseria filamentos se fragmentan fácilmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum formas cocobacilares.
  • Tinción de Gram: gram positivo
  • Otra(s) mancha(s): débilmente acidorresistente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la tinción modificada (Kinyoun) debido a los LOS Neisseria ácidos micólicos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la pared celular
  • Enzima producida: ureasa positiva, catalasa positiva
  • Formación de esporas: no formadoras de esporas
  • Necesidad de oxígeno: aerobio obligado
• Medio de cultivo: crece en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la mayoría de los LOS Neisseria medios de laboratorio comunes (como el agar sangre)
• Nocardiosis (enfermedad causada):
  • Frecuentemente una infección oportunista, manifestándose como una enfermedad pulmonar o diseminada.
  • Ocasiona enfermedad localizada, y por lo general se presenta como un síndrome cutáneo.

Especies clínicamente relevantes

• El previamente llamado complejo N. asteroides se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia reclasificado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum múltiples especies según susceptibilidad y datos moleculares:
  • Complejo N. abscessus
  • Complejo N. brevicatena-paucivorans
  • Complejo N.nova
  • Complejo N. transvalensis
  • N. farcinica N. farcinica Nocardia/Nocardiosis
  • N. cyriacigeorgica
• Nocardia brasiliensis Nocardia brasiliensis Nocardia/Nocardiosis ( N. brasiliensis N. brasiliensis Nocardia/Nocardiosis)

Epidemiología

• Incidencia de nocardiosis: 500–1 000 casos por año en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria Estados Unidos
• La infección afecta a hombres > mujeres
• Todas las edades son susceptibles a la infección.

Patogénesis

Reservorio y transmisión

• Reservorio(s): suelo, materia orgánica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum descomposición, agua
• Transmisión:
  • Inhalación:
    • Vía principal de exposición
    • Principalmente con especies del antiguo complejo N. asteroides, causando enfermedad pulmonar
  • Exposición ambiental a través de traumatismos o contaminación de heridas:
    • Principalmente con N. brasiliensis N. brasiliensis Nocardia/Nocardiosis
    • Las infecciones afectan la piel y los LOS Neisseria ganglios linfáticos.

Virulencia

• Mecanismos de Nocardia Nocardia Nocardia is a branching, filamentous, gram-positive bacilli. It is partially acid fast due to the presence of mycolic acids in the cell wall. Nocardia is a ubiquitous soil organism that most commonly affects immunocompromised patients. Nocardia is transmitted via inhalation of aerosolized bacteria or less commonly, via direct contact with wounds. Nocardia/Nocardiosis spp:
  • Resistencia a la fagocitosis: cuando el crecimiento bacteriano está en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum fase logarítmica
  • Resistencia a la hidrólisis: Si se produce fagocitosis, se detiene la fusión del fagosoma y el lisosoma.
  • Resistencia a la acción antimicrobiana de los LOS Neisseria neutrófilos:
    • Superóxido dismutasa de la superficie celular
    • Aumento de catalasa
• N. farcinica N. farcinica Nocardia/Nocardiosis:
  • Más virulento que otras especies
  • Con resistencia antimicrobiana
  • Asociado a infección diseminada
• Formas L:
  • Variantes microbianas sin una pared celular estructuralmente intacta
  • Se encontró que persiste en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum modelos animales ( en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum líquido cefalorraquídeo)
  • Se cree que está relacionado con la recaída o el desarrollo de signos neurológicos incluso después del tratamiento

Proceso de enfermedad

• La nocardia Nocardia Nocardia is a branching, filamentous, gram-positive bacilli. It is partially acid fast due to the presence of mycolic acids in the cell wall. Nocardia is a ubiquitous soil organism that most commonly affects immunocompromised patients. Nocardia is transmitted via inhalation of aerosolized bacteria or less commonly, via direct contact with wounds. Nocardia/Nocardiosis se introduce después de una lesión local en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la piel y se produce una infección:
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes inmunocompetentes: permanece localizado
  • En EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes inmunocomprometidos: con potencial de diseminación a otros órganos
• Nocardiosis pleuropulmonar:
  • La infección sigue después de la inhalación de gotas contaminadas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aerosol.
  • La mayoría de los LOS Neisseria pacientes están inmunocomprometidos.

Factores de riesgo del huésped

• Con frecuencia, los LOS Neisseria inmunocomprometidos, particularmente con inmunidad celular alterada:
  • Infección por el virus Virus Viruses are infectious, obligate intracellular parasites composed of a nucleic acid core surrounded by a protein capsid. Viruses can be either naked (non-enveloped) or enveloped. The classification of viruses is complex and based on many factors, including type and structure of the nucleoid and capsid, the presence of an envelope, the replication cycle, and the host range. Virology de la inmunodeficiencia humana (VIH): generalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con < 250 linfocitos T CD4+/μL
  • Receptores de trasplantes
  • Uso crónico de glucocorticoides
  • Inmunosupresión crónica
  • Malignidad
• Otros:
  • Alcoholismo
  • Diabetes Diabetes Diabetes mellitus (DM) is a metabolic disease characterized by hyperglycemia and dysfunction of the regulation of glucose metabolism by insulin. Type 1 DM is diagnosed mostly in children and young adults as the result of autoimmune destruction of β cells in the pancreas and the resulting lack of insulin. Type 2 DM has a significant association with obesity and is characterized by insulin resistance. Diabetes Mellitus
  • Afección pulmonar obstructiva crónica
  • Enfermedad inflamatoria intestinal

Presentación Clínica

Nocardiosis pulmonar

• Presentación clínica predominante
• Se presenta con fiebre, sudores nocturnos, disnea, pérdida de peso, tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome, dolor Dolor Inflammation torácico, pérdida de peso
• Visto principalmente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria inmunocomprometidos
• Radiografía de tórax/tomografía computarizada (TC): infiltrados, lesiones cavitarias, absceso o derrame pleural
• Puede simular tuberculosis Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis pero con prueba de derivado de proteína purificada (PPD) negativa

Nocardiosis diseminada

• 2 o más sitios no contiguos están afectados.
• Las infecciones pueden propagarse al AL Amyloidosis sistema nervioso central (SNC), causando abscesos cerebrales.
• Masa(s) de crecimiento lento que causan dolores de cabeza, fiebre, convulsiones y déficits neurológicos
• Pueden presentarse signos de meningitis Meningitis Meningitis is inflammation of the meninges, the protective membranes of the brain, and spinal cord. The causes of meningitis are varied, with the most common being bacterial or viral infection. The classic presentation of meningitis is a triad of fever, altered mental status, and nuchal rigidity. Meningitis.

Nocardiosis cutánea

• Comúnmente de N. brasiliensis N. brasiliensis Nocardia/Nocardiosis
• Ocurre después de un traumatismo (jardinería, cirugía, mordedura de animal)
• Afecta incluso a los LOS Neisseria inmunocompetentes
• Lesiones crónicas de progresión lenta.
• Presentación:
  • Infección cutánea primaria:
    • Celulitis o nódulo(s) eritematoso único/múltiple en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el sitio del trauma
    • Puede drenar material purulento
  • Nocardiosis linfocutánea:
    • Infección cutánea con linfadenitis, posiblemente ulceración y/o drenaje de material purulento
    • Similar a cómo se presenta la infección por Sporothrix schenckii (por lo tanto, también llamada “nocardiosis esporotricoidea”)
  • Micetoma:
    • Infección profunda progresiva y crónica de la piel
    • Puede extenderse a la fascia Fascia Layers of connective tissue of variable thickness. The superficial fascia is found immediately below the skin; the deep fascia invests muscles, nerves, and other organs. Cellulitis, músculo y hueso
    • Puede causar deformidades y trayectos sinusales
    • Puede ser una forma de infección diseminada en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes inmunocomprometidos

Diagnóstico y Tratamiento

Diagnóstico

• Cultivo:
  • Crece en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum medios de laboratorio ordinarios después de 3 a 5 días de incubación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum aire
  • Muestras: esputo, pus, líquido cefalorraquídeo o material de biopsia
• Examen microscópico: bastoncillos filamentosos, con morfología ramificada y globular
• La imagenologia están dictados por la presentación clínica:
  • Radiografía de tórax/TC del tórax: en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la nocardiosis pulmonar
  • TC del cerebro/RM: en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con síntomas neurológicos

Tratamiento

• Trimetoprim-sulfametoxazol
• Los LOS Neisseria betalactámicos más nuevos ( imipenem Imipenem Semisynthetic thienamycin that has a wide spectrum of antibacterial activity against gram-negative and gram-positive aerobic and anaerobic bacteria, including many multiresistant strains. It is stable to beta-lactamases. Clinical studies have demonstrated high efficacy in the treatment of infections of various body systems. Its effectiveness is enhanced when it is administered in combination with cilastatin, a renal dipeptidase inhibitor. Carbapenems and Aztreonam, meropenem Meropenem A thienamycin derivative antibacterial agent that is more stable to renal dehydropeptidase I than imipenem, but does not need to be given with an enzyme inhibitor such as cilastatin. It is used in the treatment of bacterial infections, including infections in immunocompromised patients. Carbapenems and Aztreonam, cefotaxima) pueden ser efectivos.
• Drenaje quirúrgico para absceso

Comparaciones

Actinomices y Nocardia Nocardia Nocardia is a branching, filamentous, gram-positive bacilli. It is partially acid fast due to the presence of mycolic acids in the cell wall. Nocardia is a ubiquitous soil organism that most commonly affects immunocompromised patients. Nocardia is transmitted via inhalation of aerosolized bacteria or less commonly, via direct contact with wounds. Nocardia/Nocardiosis

Mycobacterium Mycobacterium Mycobacterium is a genus of the family Mycobacteriaceae in the phylum Actinobacteria. Mycobacteria comprise more than 150 species of facultative intracellular bacilli that are mostly obligate aerobes. Mycobacteria are responsible for multiple human infections including serious diseases, such as tuberculosis (M. tuberculosis), leprosy (M. leprae), and M. avium complex infections. Mycobacterium y Nocardia Nocardia Nocardia is a branching, filamentous, gram-positive bacilli. It is partially acid fast due to the presence of mycolic acids in the cell wall. Nocardia is a ubiquitous soil organism that most commonly affects immunocompromised patients. Nocardia is transmitted via inhalation of aerosolized bacteria or less commonly, via direct contact with wounds. Nocardia/Nocardiosis

Diagnóstico diferencial

• Esporotricosis: infección causada por Sporothrix schenckii. La infección linfocutánea es la forma más común y se presenta como nocardiosis cutánea (inoculación de suelo a través de la piel con lesiones nodulares eritematosas a lo largo de los LOS Neisseria canales linfáticos). El cultivo del material aspirado ayuda a distinguir los LOS Neisseria organismos.
• Infección micobacteriana: la infección pulmonar por Mycobacterium tuberculosis Mycobacterium tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis (M. tuberculosis Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis) también se presenta con fiebre, sudores nocturnos, pérdida de peso, tos TOS Thoracic outlet syndrome (TOS) is a broad term used for a spectrum of syndromes related to the general region of the thoracic outlet, which involves the compression or irritation of elements of the brachial plexus, subclavian artery, or subclavian vein. Thoracic Outlet Syndrome, hemoptisis y disnea. Ambos son organismos acidorresistentes, pero Nocardia Nocardia Nocardia is a branching, filamentous, gram-positive bacilli. It is partially acid fast due to the presence of mycolic acids in the cell wall. Nocardia is a ubiquitous soil organism that most commonly affects immunocompromised patients. Nocardia is transmitted via inhalation of aerosolized bacteria or less commonly, via direct contact with wounds. Nocardia/Nocardiosis es solo parcialmente acidorresistente y se ve VE Ventilation: Mechanics of Breathing como una varilla ramificada (que se asemeja a las hifas fúngicas). La infección reciente con M. tuberculosis Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis da como resultado una prueba de PPD positiva.
• Metástasis cerebral: tanto la metástasis cerebral como la nocardiosis del SNC se presentan de manera insidiosa y la imagenología puede mostrar múltiples lesiones en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum uno o ambos hemisferios cerebrales. Los LOS Neisseria antecedentes ayudan a diagnosticar estas acciones; la nocardiosis diseminada generalmente proviene de una infección pulmonar. La investigación pulmonar con imagenología y los LOS Neisseria cultivos también ayudan a diferenciar la nocardiosis.