Disseminated Nocardiosis in Renal Transplant Recipients: A Review of Published Cases

Abstract

Background: Nocardia species cause opportunistic infection in renal transplant recipients, in whom dissemination to the central
nervous system may be present without any neurological complaint. Objective: To examine whether every recipient with nocardiosis needs brain imaging and whether reported sulfonamide resistance reflects biology or susceptibility testing. Methods: Narrative review of published case-control studies, registry analyses, single-centre series and case reports. Findings: In a European cohort of 117 transplant recipients, 30 had central nervous system nocardiosis and 13 of those 30 (43.3%) had no neurological symptoms; cerebral involvement extended median therapy to 499 days against 296 days among survivors overall. Reference-method testing found trimethoprim-sulfamethoxazole resistance in 2% of 1299 isolates, against 42% among referred isolates. Conclusions: The published record supports brain imaging at diagnosis in every recipient; it does not resolve whether prophylaxis prevents nocardiosis, nor does prophylaxis exclude the diagnosis.