Nocardia infections are uncommon in recipients of heart, lung, or heart-lung transplants, but such
infections are well described. Frequent episodes of rejection, high-dose
prednisolone treatment, renal impairment, and prolonged respiratory support have all been shown to increase the risk of
Nocardia infection in this group. In this retrospective review of 540 recipients of heart, lung, or heart-lung transplants, 10 patients developed
Nocardia infection (frequency, 1.85%).
Infection occurred at a mean +/- standard deviation of 13+/-14.5 months after
transplantation. All patients had
pulmonary disease with no evidence of extrapulmonary disease. The
Nocardia infection did not contribute directly to patient deaths.
Coinfection with other pathogens was present in 6 patients, and 2 patients had sequential
infections. Radiological findings varied. All isolates were susceptible to
trimethoprim-sulfamethoxazole,
amikacin, and
imipenem. Treatment regimens varied. Two (30%) of 6 patients treated with
trimethoprim-sulfamethoxazole developed adverse reactions, which necessitated a change in
antibiotic therapy. The optimal treatment regimen, which comprises both the
antimicrobial agent and the length of treatment, is unclear.