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Asteroid nocardia infection in two HIV infected patients as the first episode of opportunistic infection.
Daniele A; Masini R; Macias J; F.J. Muniz Hospital, Buenos Aires,
December 30, 1994
Int Conf AIDS. 1994 Aug 7-12;10(2):134 (abstract no. PB0551). Unique

PURPOSE: Description of the clinical and therapeutical characteristics of two patients native from Argentina with asteroid nocardia infection and HIV infection. Patient 1: Age: 29. Sex: male. Cause of hospitalization: febrile syndrome, productive cough, dyspnea and loss of weight. Formerly adicted to intravenous and breathing in drugs. Heterosexual. First opportunistic infection suffered by the patient. The physical examination shows a patient who seems severely ill. Condensation syndrome in the right lung middle field and left middle and lower field. Tachypnea. Hepatomegaly. Mucopurulent expectoration, once hemoptoic. Skin and mucosa jaundice. Splenomegaly. Thorax X-rays with mixed interstice-alveolar-type infiltrate in the right middle lung field and left middle and lower fields. CD4 less than 50/mm3. Asteroid Nocardia sputum examination. Sulfadiazine and imipenem treatment. Patient 2: Age: 19. Sex: male. Cause of hospitalization: febrile syndrome, diarrhea and subcutaneous nodules on the left upper limb, head and left pectoral area. Formerly addicted to intravenous drugs. Heterosexual. First opportunistic infection. First physical examination shows a patient who seems severely ill. Nodules on the left upper limb left parietal area and left pectoral area of about 5 cm to 8 cm in diameter; painful, soft, seem slightly swelling. Drainage of pectoral tumor and upper limb with abundant purulent secretion. Thorax X-rays with extended bilateral micronodulillar infiltrate from vertex to base. CD4 less than 50/mm3. Patient develops a Lyell syndrome in his evolution. Asteroid nocardia isolated in the purulent material of the subcutaneous nodules. Treatment with sulfadizine and amikacine. CONCLUSIONS: Nocardiosis is not commonly found in HIV patients. It must be included in the differential diagnostic of HIV patients with fever mainly showing respiratory, neurologic and cutaneous evidences. It was present among our patients as the first episode of opportunistic infection, although these were patients with advanced immunosuppression. We further evaluated the efficiency of the sulfadiazine association to imipenem and amikacine.

Adult Amikacin/ADMINISTRATION & DOSAGE Antibiotics, Combined/ADMINISTRATION & DOSAGE AIDS-Related Opportunistic Infections/*COMPLICATIONS/DRUG THERAPY Case Report Connective Tissue Diseases/COMPLICATIONS/DRUG THERAPY Human Imipenem/ADMINISTRATION & DOSAGE Male *Nocardia asteroides Nocardia Infections/*COMPLICATIONS/DRUG THERAPY Pneumonia/COMPLICATIONS/DRUG THERAPY Substance Abuse, Intravenous/COMPLICATIONS Sulfadiazine/ADMINISTRATION & DOSAGE ABSTRACT