Page 1 of 1: A 35 year old man is seen 6 months after a cadaveric renal..

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A 35 year old man is seen 6 months after a cadaveric renal allograft. The patient has been on azothioprine and prednisone since that procedure. He has, for the past week fever of 38.6 degree Celsius, anorexia and a cough with productive thick sputum. Chest X-ray reveals a left lower lobe (5 cms) nodule with central cavitation. Examination of the sputum reveals long, crooked branching, beaded gram-positive filaments. The most appropriate initial therapy would include the administration of which of the following antibiotics?

(1) Penicillin

(2) Amphotericin B

(3) Sulfisoxazole

(4) Minocycline????????????????????????????

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Nocardia is a bacterial inhabitant of soil and recognized by its crooked branching, beaded gram-positive filaments. Most nocardiae are acid-fast in direct smears if a weak acid is used. Diagnosis is confirmed using modified AFB stain and culture.

Subacute pneumonia with nodules and cavitation is typical. It may spread directly from lungs to involve adjacent tissues, causing pericarditis, mediastinitis, and superior vena caval obstruction. Growth of nocardiae from sputum may represent colonization and not disease. However, a positive culture of sputum from an immunosuppressed patient usually reflects disease. Extra-pulmonary manifestation is subacute or chronic abscess. CNS is the most common location for disseminated disease. The organism is not easily recoverd from CSF. Cellulitis, lymphocutaneous syndrome, or mycetoma may occur.

Sulfonamides are the drugs of choice. Minocycline is the alternative oral drug.

draditithegreat · Credits: 1247950 My Scrapbook

whats the % of acid used?

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