Nocardia kroppenstedtii: A rare pathogen isolated from the spinal vertebral abscess of a patient on long-term immunosuppressive therapy
Document Type
Article
Publication Date
1-1-2021
Abstract
OBJECTIVE: Nocardia kroppenstedtii was isolated from the spinal vertebral abscess of a 78-year-old patient presenting with mid-thoracic pain and bilateral lower limb weakness and numbness. The patient was on long-term immunosuppressive therapy with steroids for underlying autoimmune hemolytic anemia. Investigations showed a T5 pathological fracture and vertebra plana with the erosion of the superior and inferior endplates. There was evidence of paraspinal collection from the T4-T6 vertebrae with an extension into the spinal canal. Analysis of Nocardia 16S rRNA (99.9%, 1395/1396 nt) and secA1 gene (99.5%, 429/431 nt) fragments showed the highest sequence similarity with Nocardia kroppenstedtii type strain (DO157924), and next with Nocardia farcinica (Z36936). The patient was treated with intravenous carbapenem and oral trimethoprim-sulfamethoxazole for four weeks, followed by another six months of oral trimethoprim-sulfamethoxazole. Despite the improvement of neurological deficits, the patient required assistive devices to ambulate at discharge. This study reports the first isolation of N. kroppenstedtii from the spinal vertebral abscess of a patient from Asia. Infections caused by N. kroppenstedtii may be underdiagnosed as the bacterium can be misidentified as N. farcinica in the absence of molecular tests in the clinical laboratory.
Keywords
Nocardia kroppenstedtii, Nocardia farcinica, Spinal infection, 16SrDNA, secA1
Divisions
fac_med
Funders
Ministry of Energy, Science, Technology, Environment and Climate Change (MESTECC), Malaysia [Grant No: SF014-2015 & IIRG003C-19FNW ]
Publication Title
European Review for Medical and Pharmacological Sciences
Volume
25
Issue
2
Publisher
Verduci Publishers
Publisher Location
VIA GREGORIO VII, ROME, 186-00165, ITALY