CATHETER-ASSOCIATED BACTEREMIA WITH NOCARDIA NOVA WITH SECONDARY PULMONARY INVOLVEMENT

Nocardiosis is uncommon in children, occurring primarily in immunocompromised patients and in patients with severe, chronic pulmonary disease. The most common site of acquisition of this infection is the respiratory tract, with clinical manifestations that include bronchopneumonia, lobar or necrotizing pneumonia and empyema. In some patients secondary hematogenous dissemination can lead to metastatic lesions. Primary cutaneous infections with Nocardia asteroides has been reported in immunocompetent patients, usually after local trauma to the skin, and has not been associated with secondary dissemination. Although many immunocompromised patients have central venous catheters, infections of these devices with Nocardia species have not been previously reported. In this report we describe a 4-year-old child with acute lymphocytic leukemia and a Nocardia nova central venous catheter infection complicated by secondary dissemination to the lungs. This case represents infection with a new Nocardia species, which has recently been identified in about 20% of clinically significant isolates.