Rhodococcus hoagii: Difference between revisions

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Rhodococcus hoagii
m (Text replacement - "[[Cellular shape::" to "[[Shape::")
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*Most commonly infects people with cell-mediated immunodeficiency, particularly [[HIV]], with or without a notable infectious exposure
 
*Most commonly infects people with cell-mediated immunodeficiency, particularly [[HIV]], with or without a notable infectious exposure
   
=== Risk Factors ===
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===Risk Factors===
   
* HIV accounts for 65% of cases
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*HIV accounts for 65% of cases
* Solid organ and hematopoietic stem cell transplantation
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*Solid organ and hematopoietic stem cell transplantation
* Diabetes
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*Diabetes
* Alcohol abuse
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*Alcohol abuse
* Chronic renal failure
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*Chronic renal failure
* Leukemia, lymphoma, lung cancer
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*Leukemia, lymphoma, lung cancer
* Sarcoidosis
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*Sarcoidosis
* Preterm infants
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*Preterm infants
   
 
==Clinical Manifestations==
 
==Clinical Manifestations==
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==Management==
 
==Management==
   
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*Recommend using at least two agents given increasing rates of resistance
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**First-line: combination of [[macrolide]] or [[fluoroquinolone]] plus [[rifampin]]
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**First-line: combination of [[macrolide]] or [[fluoroquinolone]] plus two of: [[vancomycin]], [[imipenem]], [[linezolid]], or an [[aminoglycoside]]
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**Doses are:
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***[[Azithromycin]] 500 mg PO/IV once followed by 250 mg PO/IV daily
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***Fluoroquinolones: [[moxifloxacin]] 400 mg PO daily (preferred), [[levofloxacin]] 500 mg PO daily, or [[ciprofloxacin]] 750 mg PO BID
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***[[Rifampin]] 600 mg PO once daily
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**Increasing resistance to [[doxycycline]], [[rifampin]], and [[TMP-SMX]]
 
*Treatment usually 6 months or longer
 
*Treatment usually 6 months or longer
 
{{DISPLAYTITLE:''Rhodococcus equi''}}
 
{{DISPLAYTITLE:''Rhodococcus equi''}}

Revision as of 10:11, 15 March 2021

Background

Microbiology

  • Facultative intracellular, non-spore-forming, Gram-positive, weakly acid-fast coccobacillus
  • Within the family Nocardiaceae and order Actinomycetes
  • Obligate aerobic and facultatively intracellular
  • Found in dry and dusty soil
  • Makes red pigment, hence the name

Epidemiology

  • Infects domesticated animals: Horses (and in foals it causes pneumonia), Goats, Pigs, Sheep, and Cattle
  • Most commonly infects people with cell-mediated immunodeficiency, particularly HIV, with or without a notable infectious exposure

Risk Factors

  • HIV accounts for 65% of cases
  • Solid organ and hematopoietic stem cell transplantation
  • Diabetes
  • Alcohol abuse
  • Chronic renal failure
  • Leukemia, lymphoma, lung cancer
  • Sarcoidosis
  • Preterm infants

Clinical Manifestations

  • Necrotizing pneumonia is usual presentation, as well as nodules, cavitation, pleural effusion, and lung abscess
    • Typically subacute onset with fever, cough, and fatigue, as well as pleuritic chest pain
  • Specifically in immunocompromised patients, it can cause a cavitary lung disease and is on the differential with mycobacteria and nocardiosis
  • Extrapulmonary disease can occur with or without pulmonary involvement
    • In conjunction with other infections, can have abscesses in liver, spleen, thyroid, kidney, psoas, bone, prostate, intraabdominal cavity, and paraspinous tissue
  • Extrapulmonary disease without pulmonary involvement has three main presentations:
    • Localized infection following traumatic inoculation, causing wound infection, traumatic septic arthritis, or endophthalmitis
    • Isolated bacteremia with fever, typically recently after chemotherapy causing neutropenia
    • Gastrointestional inoculation followed by lymphatic dissemination, causing peritonitis, pelvic masses, and mesenteric adenitis
    • Others include otitis media with mastoiditis, colonic polyp infection, and osteomyelitis

Management