Successful treatment of disseminated nocardiosis diagnosed by metagenomic next-generation sequencing: A case report and review of literature

Table 1 Efficacy before and after treatment

	April 25, 2020	May 23, 2020	June 16, 2020
Cough	2	1	0
Hemoptysis	20-30 mL	0	0
Dyspnea index	2	1	0
Supplemental O2 in L/min	4 L/min	2 L/min	0
Oxygenation index	265 mmHg	388 mmHg	412 mmHg

Cough index: 0: NO cough; 1: Occasionally have a cough; 2: Frequent cough, mild impact on daily life; 3: Frequent cough, serious impact on daily life. Hemoptysis volume: Small amount: < 100 mL/24 h; Moderate amount: 100-500 mL/24 h; Massive amount: > 500 mL/24 h or > 100 mL at one time. Dyspnea index: 0: Asymptomatic while climbing stairs; 1: Symptomatic while climbing stairs; 2: Symptomatic after walking 100 m on flat ground; 3: Symptomatic with the least effort (e.g., talking, getting dressed); 4: Symptomatic in bed, at rest. Oxygenation index: partial blood oxygen divided by oxygen concentration.

Table 2 Therapeutic strategy and the laboratory examinations

	April 9, 2020	May 30, 2020	May 31, 2020	June 16, 2020	June 23, 2020
Treatment	TMP-SMZ 0.96 g q8 h + linezolid 0.6 g q12 h		TMP-SMZ 0.96 g q12 h + linezolid 0.6 g qd	TMP-SMZ 0.96 g q12 h + ceftriaxone 2 g/d	TMP-SMZ 0.96 g q12 h and minocyline 100 mg q12 h
WBC (109/L)	4.03		3.34	4.07	3.91
PLT (109 /L)	379		130	219	185
The dose of linezolid (mg/L)	No		9.36	6.38	No

TMP-SMZ: Trimethoprim-sulfamethoxazole; WBC: White Blood Cell; PLT: Platelet.

Table 3 Cases of pulmonary nocardiosis reported in recent 10 yr

Ref.	Predisposing or underlying condition	Affected organ (s)	Positive specimen (s)	Anti-biotic therapy	Outcome
Komiya et al[20], 2013	Hypersensitivity pneumonitis	Lung	sputum	Meropenem, TMP-SMZ	Improved
Yasar et al[21], 2014	No	Lung	Lung tissue	TMP-SMZ	Improved
Cooper et al[22], 2014	Smoking and alcohol consumption	Lung +Brain	Tissue of lung and brain	Vancomycin, Ceftriaxone, Amphotericin B, TMP-SMZ	Dead
Yagi et al[23], 2014	Mycobacterium avium	Lung	Sputum	TMP-SMZ	Improved
Ibrahim et al[24], 2016	Hematopoietic stem cell transplant	Lung +Brain	Lung tissue	TMP-SMZ	Improved
Mendonca et al[25], 2016	Multiple Myeloma	Lung	BALF	TMP-SMZ, Meropenem, Tigecycline	Improved
Jayaschandran et al[26], 2016	Idiopathic CD4 T-lymphocytopenia	Lung	BALF	Meropenemz, TMP-SMZ	Improved
Khadka et al[27], 2017	Renal transplant, Pulmonary tuber-culosis	Lung+Brain+ Celiac lymph nodes	BALF	TMP-SMZ	Improved
Kobayashi et al[28], 2018	Olfactory neuroblastoma, Ectopic adrenocorticotropic hormone	Lung	BALF	TMP-SMZ	Improved
Khaliq et al[29], 2019	Cladophialophora bantiana Cerebral Phaeohyphomycosis	Lung	Lung tissue	TMP-SMZ, Meropenem, Voriconazole, Liposomal amphotericin	Died
Miyaoka et al[30], 2019	Smoking	Lung	BALF	Meropenem, TMP-SMZ	Improved
Kato et al[31], 2019	Radiation pneumonitis treated with prednisolone [PSL (50 mg/d)]	Lung	The PCR of 16S rRNA gene of the BALF	TMP-SMZ, Doripenem	Improved
Deterding et al[32], 2020	heart transplant recipient requiring dialysis	lung	BALF	Amikacin, Imipenem	Improved
Campoli et al[33], 2020	Liver transplant, Cutaneous infection by Alternaria alternata	Lung	BALF	TMP-SMZ, Linezolid, Ceftriaxone	Improved
Meena et al[34], 2020	Pulmonary tuberculosis and COPD	Lung	BALF	TMP-SMZ	Improved
Wu et al[35], 2021	Pulmonary alveolar proteinosis	Lung	Lung tissue	TMP-SMZ	Improved
Atemnkeng et al[36], 2021	COVID-19 Pneumonia	Lung +Brain	BALF	Meropenem, TMP-SMZ, Linezolid	Improved

TMP-SMZ: Trimethoprim-sulfamethoxazole; BALF: Bronchoalveolar lavage fluid; PCR: Polymerase Chain Reaction; COPD: Chronic obstructive pulmonary disease.