Journal article
Nocardiosis in the tropical Northern Territory of Australia, 1997-2014
- Abstract:
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Background
Nocardia is an opportunistic pathogen that can cause life-threatening disease. We aimed to characterise the epidemiological, microbiological and clinical features of nocardiosis in the tropical north of Australia.
Methods
We conducted a retrospective cohort study of nocardiosis diagnosed between 1997 and 2014. Population-based incidences were calculated using district population data.
Results
Clinically significant nocardiosis was identified in sixty-one patients. The unadjusted population-based annual incidence of nocardiosis was 2.02 (95% confidence interval [CI] 1.55-2.60) per 100,000 people and was 1.7 (95% CI 0.96-2.90) fold higher in Indigenous compared with non-Indigenous persons (p=0.027). Of 61 patients, 47 (77%) had chronic lung disease, diabetes and/or hazardous alcohol consumption; 22 (36%) were immunocompromised; and 8 (13%) had no identified comorbidities. Disease presentations included pulmonary (69%; 42/61), cutaneous (13%, 8/61) and disseminated nocardiosis (15%, 9/61). The most commonly identified species were N. asteroides and N. cyriacigeorgica (each 11%). Linezolid was the only antimicrobial to which isolates were universally susceptible; 89% (48/54), 60% (32/53) and 48% (26/54) of isolates were susceptible to trimethoprim-sulfamethoxazole, ceftriaxone and imipenem, respectively. 18 patients (30%) required intensive care unit (ICU) admission and one-year mortality was 31%.
Conclusions
he incidence of nocardiosis in tropical Australia is amongst the highest reported globally. Nocardiosis occurs in both immunocompromised and immunocompetent hosts, and is associated with high rates of ICU-admission, 1-year mortality and resistance to commonly-recommended antimicrobials. Diagnosis should be considered in patients with consistent clinical features, particularly if they are Indigenous or have chronic lung disease.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 310.2KB, Terms of use)
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- Publisher copy:
- 10.1093/ofid/ofw208
Authors
- Publisher:
- Oxford University Press
- Journal:
- Open Forum Infectious Diseases More from this journal
- Publication date:
- 2016-10-01
- Acceptance date:
- 2016-10-06
- DOI:
- ISSN:
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2328-8957
- Keywords:
- Pubs id:
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pubs:657010
- UUID:
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uuid:148beeb3-75ff-407b-a6ab-ad77471bcdb5
- Local pid:
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pubs:657010
- Source identifiers:
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657010
- Deposit date:
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2016-11-03
Terms of use
- Copyright holder:
- Price et al
- Copyright date:
- 2016
- Notes:
- © The Author 2016. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact [email protected].
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