NOCARDIOSIS IN PATIENTS INFECTED WITH THE HUMAN-IMMUNODEFICIENCY-VIRUS IN SPAIN

Background. Nocardia usually infects immunosuppressed patients, partic ularly with cellular immunity deficiency, Nevertheless, despite severe immunosuppression in patients infected with HIV, nocardiosis is rare among these patients. We report here two cases of nocardiosis in patie nts with HIV infection and review spanish literature up to 1993, with an analysis of the characteristics of this infection in our country. M ethods and results. The two patients consumed drugs parenterally and N ocardia organism were recovered in blood cultures after 48 hours of in oculation in standard culture media. The source of the infection was c utaneous in one patient, over an area of venipunction, and pulmonary i n the other patient, Previously, eleven cases of nocardiosis had been reported in the spanish literature in patients infected with HIV. Eigh ty-four percent were males, and all of them consumed drugs parenterall y and displayed a severe cellular immunodepression; the total CD4 lymp hocyte count was lower than 100/mm(3) in patients when this finding wa s available (6/13). At diagnosis only one patient received prophylaxis against other type of infection with antibiotics theoretically effect ive against Nocardia at diagnosis. The Nocardia species recovered more frequently was asteroides (77%) and the most common location was the skin (54%). Treatments more frequently employed were sulfametoxazole-t rimethoprim (45%) and sulfadiazine (36%), with a good response except in those with cerebral involvement, Conclusions. Nocardiosis in patien ts with HIV infection is rare in Spain, In contrast with other geograp hical areas skin involvement was the more common form of infection. Pr ophylaxis with sulfametoxazole-trimethoprim against other infections c ould be responsible for a lower than expected incidence among this typ e of patients.