[Disseminated nocardiosis in a child with acute lymphoblastic leukemia].

Abstract

Nocardiosis is a rare infectious disease in children. We report here a disseminated nocardiosis in a child with acute lymphoblastic leukemia. The patient presented prolonged febrile neutropenia and nodular pneumopathy. Based on the amplification of a 16S rDNA, a PCR assay detected Nocardia sp. in the patient's bronchoalveolar lavage (BAL) fluid. Culture of BAL samples yielded Nocardia nova colonies after 2 weeks of incubation. Hepatic, splenic, renal and cerebral localisations were detected on extension checkup. trimethoprime-sulfamethoxazole and amikacine were started given the results of PCR assay, with a good response. Improvement of the patient's general condition led to complete chemotherapy under ciprofloxacine and ceftriaxone treatment, without nocardiosis reactivation. Nocardiosis is a rare complication in children with acute lymphoblastic leukemia. trimethoprime-sulfamethoxazole prophylaxis is widely used to prevent Pneumocystis jiroveci infection in children with haematologic malignancies. As Nocardia species are usually sensible, trimethoprime-sulfamethoxazole could play a role in Nocardia prophylaxis in such population. In our patient, compliance with trimethoprime-sulfamethoxazole had been low. Nocardia species are relatively fastidious growth bacteria and are difficult to isolate with classical bacteriological techniques. Molecular methods are now available, with a good sensitivity and fast results allowing to start an appropriate antibiotherapy before culture results, as early treatment is a major prognosis factor in nocardiosis. Nocardia infection should be suspected in case of nodular pneumopathy in immunocompromised children. An extension checkup should be performed to detect secondary localisations.

• Authors: D Bernoux, V Mialou, V Rodríguez-Nava, P Boiron, A-L Guibal, N Moreux, Y Bertrand, J-M André
• Journal: Archives de pediatrie : organe officiel de la Societe francaise de pediatrie (Arch Pediatr) Vol. 15 Issue 3 Pg. 275-8 (Mar 2008) ISSN: 0929-693X [Print] France
• Vernacular Title: Nocardiose viscérale disséminée chez un enfant atteint de leucémie aiguë lymphoblastique.
• PMID: 18321687 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Adolescent
• Anti-Bacterial Agents (therapeutic use)
• Bronchoalveolar Lavage Fluid
• Drug Therapy, Combination
• Humans
• Magnetic Resonance Imaging
• Male
• Nocardia Infections (complications, diagnostic imaging, pathology)
• Precursor Cell Lymphoblastic Leukemia-Lymphoma (complications, diagnostic imaging, pathology)
• Radiography