A kidney transplant recipient became seriously ill with brain abscesses after a gardening accident led to a rare and hard to diagnose infection.
Dr Varun Mamidi and Professor Tina Chrysochou, from the renal medicine department at Salford Royal Hospital, say transplant patients or those on immunosuppression should be advised to wear gloves and protective clothing when gardening, and thoroughly wash their hands after outdoor activities, due to the increased risk of infections from soil- borne pathogens.
In their Clinical Case Reports summary, the doctors emphasise that it’s crucial to consider nocardia infection in immunocompromised patients who have pulmonary and neurological symptoms.
In this case, the female patient was diagnosed with infection by nocardia paucivorans, a bacteria found in soil, decaying vegetation and water. Under a microscope, the colonies of bacteria resemble a starburst or asteroid pattern.
She had attended hospital after suddenly developing a fever, slurred speech and weakness on one side of the body. An initial CT scan of her brain didn’t show any signs of stroke but later scans revealed lesions in her brain and nodules in her lungs.
Immunocompromised
Because she was immunocompromised due to her previous transplant and type 1 diabetes, the team had further microbiological tests carried out on samples from her brain and lung abscesses, showing that she was infected with nocardia. An infected foot injury from gardening was the likely cause.
Treatment with antibiotics during her hospital stay and after her return home for a year eventually reduced the size of the abscesses – although this was not straightforward either.
Dr Mamidi (pictured) explained: “After receiving the recommended first-line intravenous antibiotic treatment, trimethoprim, our patient developed severe hyperkalemia – dangerously high potassium levels in the blood. We then switched to another antibiotic therapy, moxifloxacin, and the patient’s blood gradually normalised, alongside stabilised renal function.
“This was a very complex case and the patient stayed in hospital for several weeks before continuing her antibiotic treatment at home. Fortunately, our multidisciplinary and tailored approach between the renal, neurosurgery and microbiology teams enabled us to identify and treat this life-threatening infection.”