A Rare Co-existence of Pulmonary Nocardiosis with E.coli Infection in Immunocompetent Host

• Main Authors: Amithash Marulaiah Prabhudev, Thomas Antony, Vyshak Uddur Surendra, Rahul Magazine, Febi Ann Roy
• Format: Article
• Language: English
• Published: JCDR Research and Publications Private Limited 2020-05-01
• Series: Journal of Clinical and Diagnostic Research
• Subjects: community acquired pneumonia; filamentous bacteria; rare acid fast bacilli
• Online Access: https://jcdr.net/articles/PDF/13674/43633_CE[Ra1]_F(SHU)_PF1(AG_KM)_PN(SL).pdf

Community Acquired Pneumonia (CAP) is the second leading cause of death worldwide. Diagnosis becomes difficult when these are associated with legionella or nocardiosis, as these are not easily grown in routine aerobic culture. In a setting of high burden countries for tuberculosis like India, an acid fast bacilli is always taken as Mycobacterium tuberculosis until and unless proved otherwise. This is a case report of 38-year-old female, with no co-morbid illness, with cough, breathlessness, and fever of two weeks duration. On sputum microbiological evaluation was found to have co-existence of Pulmonary Nocardiosis with Escherichia coli (E.coli) infection. This case is important in many levels; to begin with, considering the diagnosis, a sputum positive for acid fast staining confirms the diagnosis of pulmonary tuberculosis. Hence, diagnosis of other rare acid fast bacilli such as Nocardia may be missed. Secondly, aerobic bacteria causing mixed bacterial pneumonia are reported very rarely, and have a high mortality rate. Co-existence of Nocardia with E.coli causing pneumonia is rare. Its occurrence in an immunocompetent host makes it even more difficult for diagnosis. Patient not responding to antibiotic therapy or anti-tubercular therapy, necessitates further evaluation to rule out other co-existing potential pathogen or condition. Patient was started with cefoperazone sulbactum and amikacin along with suplhamethoxazole + trimethoprim for seven days. Suplhamethoxazole + trimethoprim, was continued for six months and she showed clinico-radiological improvement.