CUTANEOUS NOCARDIA-FARCINICA INFECTION IN A NONIMMUNOCOMPROMISED PATIENT - CASE-REPORT AND REVIEW

Nocardia farcinica, the etiologic agent of bovine farcy, is microbiolo gically related to but distinct from Nocardia asteroides. N. farcinica is noted for its propensity to cause serious systemic infection in bo th normal and immunocompromised hosts and its marked degree of resista nce to multiple antimicrobial agents. We present a case in which a non immunocompromised patient who sustained a contaminated facial lacerati on developed an abscess due to N. farcinica with underlying osteomyeli tis. The severity of the infection necessitated surgical debridement f ollowed by administration of intravenous amikacin therapy. The isolate was susceptible to amikacin and trimethoprim-sulfamethoxazole but res istant to erythromycin in vitro. Therapy with trimethoprim-sulfamethox azole was started but was discontinued because of the patient's intole rance to the drug. Intramuscular amikacin was substituted, resulting i n complete resolution of the infection. The history, epidemiology, and microbiological characteristics of this interesting and unusual micro organism are reviewed.