<i>Nocardia</i> Infection in Heart Transplant Patients

Abstract

Infection due to Nocardia asteroides was observed in seven heart transplant patients in a 22-month period. In six the diagnosis was made during life, and in one a clinically inapparent lesion was discovered at autopsy. Diagnosis during life was made by initial percutaneous lung aspirate in four and by a second lung aspirate in two patients. The infection was confined to the lungs in five cases and disseminated to the skin in two others. In one patient extensive destruction of muscles of the leg due to spread of nocardial infection from an adjacent subcutaneous abscess necessitated amputation of the leg. All the patients were treated with sulfisoxazole. No patient died as a result of the nocardial infection. The aggressive diagnostic approach taken toward these immunologically compromised hosts with pulmonary infection resulted in the rapid diagnosis of Nocardia infection and undoubtedly was instrumental in their survival.