Abstract: PUB324
Nocardiosis in Renal Transplantation: A Single Center Study From India
Session Information
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Gupta, Anurag, Sir Ganga Ram Hospital, New Delhi, Delhi, India
- Tiwari, Vaibhav, Sir Ganga Ram Hospital, New Delhi, Delhi, India
- Bhandari, Gaurav Mahendra, Sir Ganga Ram Hospital, New Delhi, Delhi, India
- Bhargava, Vinant, Sir Ganga Ram Hospital, New Delhi, Delhi, India
- Malik, Manish, Sir Ganga Ram Hospital, New Delhi, Delhi, India
- Bhalla, Anil, Sir Ganga Ram Hospital, New Delhi, Delhi, India
- Gupta, Ashwani, Sir Ganga Ram Hospital, New Delhi, Delhi, India
- Rana, Devinder S., Sir Ganga Ram Hospital, New Delhi, Delhi, India
Background
Nocardiosis is a rare opportunistic infection seen in kidney transplant patients which is caused by an aerobic actinomycete. Disease manifestations can vary from a localized infection to multisystem organ failure. Despite the high mortality, there are limited data on nocardiosis in kidney transplant patients because of low incidence, non-specific clinical presentation, presence of coinfections that preclude further workup for nocardiosis.
Methods
Kidney transplant patients with age more than 18 years diagnosed with Nocardiosis on gram-stain, modified acid-fast stain, and culture between 2010 to 2019 were included. Clinical and microbiological data of these patients were retrospectively analyzed.
Results
A total of 1801 kidney transplants were done from 2010 to 2019. Sixteen cases of nocardiosis were identified. The median time from transplant to Nocardiosis was 21 months (IQR 9.75-45). Acute rejection episodes and CMV infection within 6 months of nocardiosis were found in 12.5% and 25% respectively. In the form of immunosuppressants, 15 out of 16 patients (93.75%) received Anti thymocyte globulin (ATG) while 1 patient received Grafalon (ATG-Fresenius). The most common organ involvement was the lungs (75%) followed by the brain (12.5%). Only 1 patient showed cutaneous involvement (6.25%). The severe form of the disease in the form of disseminated infection was seen in one patient.
Sub-species identification was possible in the last 3 years of study after the introduction of MALDI TOF. Six patients were diagnosed with nocardiosis from 2017 to 2019, of which Nocardia farcinica was the most common type (4 out of 6 patients) and was resistant to cotrimoxazole.
The mortality rate was 31.25%. Patients with brain involvement and disseminated infection had 100% mortality.
Conclusion
Though nocardiosis in kidney transplant patients has a very low incidence but is an important cause of mortality. Nocardia farcinica is the predominant species which is mostly resistant to cotrimoxazole. Cerebral and disseminated nocardiosis have a poor prognosis. Drug sensitivity, if available, is an important tool to guide treatment.