Nocardial infection as a complication of HIV in South Africa

Objectives: To assess the occurrence, clinical and microbiological features of nocardial infections complicating HIV in Soweto, South Africa. Methods: A prospective study was carried out over a 2-year period. Patients were identified after isolation of Nocardia spp. from a clinical specimen. Clinical details were recorded. The nocardial isolates were identified to species level and susceptibility tests performed. Results: Ten patients were identified as having nocardial disease complicat ing HIV! Clinical presentations were pulmonary (five patients), pulmonary a nd cerebral (one patient), cerebral (one patient) and skin and soft tissue infection of the lower limb (three patients). Three infections were fatal. The isolates were Nocardia asteroides (seven patients), N. farcinica (two p atients) and Nocardia spp. (one). Isolates of N, farcinica demonstrated opa cification of Middlebrook agar. All isolates were sensitive to amiliacin an d minocycline. Most nocardial isolates were susceptible to cefotaxime, imip enem and coamoxiclav. In vitro resistance to cotrimoxazole was present in f ive. Conclusions: Nocardial infection occurs as a complication of HIV infection in the Republic of South Africa. Pulmonary cases may be difficult to distin guish from tuberculosis. Nocardia asteroides is the most common species iso lated. Nocardia asteroides has resistance to multiple antibacterial agents and demonstrates opacification of Middlebrook agar, a useful screening test for this species, Agents with good in vitro antinocardial activity were am iliacin, minocycline, cefotaxime, imipenem and coamoxiclav There was a high level of resistance ill vitro to cotrimoxazole. (C) 2000 The British Infec tion Society.