Selected article for: "antimicrobial treatment and susceptibility testing"
Author: Yaemsiri, S.; Sykes, J.E.
Title: Successful Treatment of Disseminated Nocardiosis Caused by Nocardia veterana in a Dog
  • Document date: 2017_11_4
    • ID: 1d1jqjv3_11
    Snippet: Identification of the Nocardia species involved is important because it can predict susceptibility to antimicrobials, which differs among Nocardia species, and can be difficult to determine accurately through in vitro susceptibility testing. 23 Nocardia veterana tends to be resistant to many antimicrobial drugs. 24 In this case, the N. veterana isolate was susceptible to TMS, imipenem, amikacin, and clarithromycin. The TMS was chosen because of i.....
    Document: Identification of the Nocardia species involved is important because it can predict susceptibility to antimicrobials, which differs among Nocardia species, and can be difficult to determine accurately through in vitro susceptibility testing. 23 Nocardia veterana tends to be resistant to many antimicrobial drugs. 24 In this case, the N. veterana isolate was susceptible to TMS, imipenem, amikacin, and clarithromycin. The TMS was chosen because of its recognized activity against Nocardia spp., low cost, and oral formulation, despite the breed predisposition to keratoconjunctivitis sicca and the history of IMPA. No adverse effects of TMS were noted during treatment, although there was concern that the profound hypercholesterolemia that developed after discontinuation of prednisone could have resulted from sulfonamide-induced hypothyroidism. When nocardiosis is severe or refractory to monotherapy, combination antimicrobial treatment can be instituted. 8 The optimal duration of treatment is not known but is generally recommended for at least 6 months in people with disseminated nocardiosis, and recurrence of disease is common. 25 In this case, treatment with TMS was only for 3 months, but the granulomatous masses in the small intestinal tract were surgically excised and the underlying immunosuppression was reversible, which likely also facilitated elimination of the pathogen. Additionally, early intervention with appropriate antimicrobial treatment with the aid of MALDI-TOF MS may have played a role in the successful treatment of this dog. In this case, identification of Nocardia spp. by MALDI-TOF MS occurred 7 days before results of secA1 gene sequencing were available. The decision to discontinue treatment early was due to resolution of skin lesions, lameness, and hematologic abnormalities within about 6-8 weeks. The absence of clinical relapse 1 year after discontinuing antimicrobial treatment suggests infection was eliminated.

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