The Role of 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) in Management of Nocardiosis: A Retrospective Study and Review of the Literature

Overview

Journal Infect Dis Ther

Specialty Infectious Diseases

Date 2021 Jul 20

PMID 34283408

Citations 4

Authors

Ili Margalit

Anat Yahav

Yaara Ben Ari

Haim Ben-Zvi

Avivit Shoham

Elad Goldberg

Michal Weiler-Sagie

Noam Tau

Khitam Muhsen

Jihad Bishara

Mical Paul

Hanna Bernstine

Dafna Yahav

Affiliations

Soon will be listed here.

Abstract

Introduction: 18-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a well-established tool for managing metastatic infections. Nocardiosis, a primarily pulmonary infection, disseminates at high rates. Routine imaging includes chest CT and brain imaging. We examined the use of FDG-PET/CT in nocardiosis and assessed its contribution to diagnosis and management.

Methods: A retrospective study in two tertiary medical centers during 2011-2020. Individuals with nocardiosis for whom FDG-PET/CT was implemented for any reason were included and their medical records were reviewed. A board-certified nuclear medicine physician independently reviewed all scans. Additionally, a systematic review was conducted according to the PRISMA guidelines, to extract data from publications reporting FDG-PET/CT use for the management of nocardiosis.

Results: FDG-PET/CT contributed to the management of all seven patients who met inclusion criteria. It assisted in ruling out an underlying malignancy (29%, 2/7); establishing a wide infection extent (57%, 4/7); and affecting decisions regarding treatment (57%, 4/7), including drug regimen, oral step-down, and duration of therapy. We identified 20 published case reports on this topic. In 80% (16/20), FDG-PET/CT contributed to the management of nocardiosis similar to our study. In addition, in most of the literature cases, FDG-PET/CT guided the diagnostic biopsy.

Conclusion: FDG-PET/CT is valuable in the diagnosis and management of individuals with nocardiosis. The contribution of incorporating FDG-PET/CT to the management of individuals with nocardiosis and its role in monitoring treatment response and shortening treatment duration should be evaluated in prospective studies.

Citing Articles

Shorter vs. standard-duration antibiotic therapy for nocardiosis: a multi-center retrospective cohort study.

Attias N, Schlaeffer-Yosef T, Zahavi I, Hasson N, Ari Y, Darawsha B Infection. 2024; .

PMID: 39589427 DOI: 10.1007/s15010-024-02445-0.

Nocardia masquerading as pulmonary malignancy in a patient with adult-onset immunodeficiency on F-FDG PET/CT.

Dharamdasani Detaram H, Nguyen P, Wong V, Loh H, Mansberg R Radiol Case Rep. 2024; 19(10):4517-4521.

PMID: 39188623 PMC: 11345279. DOI: 10.1016/j.radcr.2024.07.058.

Nocardia Infections in the Immunocompromised Host: A Case Series and Literature Review.

Palomba E, Liparoti A, Tonizzo A, Castelli V, Alagna L, Bozzi G Microorganisms. 2022; 10(6).

PMID: 35744638 PMC: 9229660. DOI: 10.3390/microorganisms10061120.

Antibiotics in the pipeline: a literature review (2017-2020).

Al-Tawfiq J, Momattin H, Al-Ali A, Eljaaly K, Tirupathi R, Haradwala M Infection. 2021; 50(3):553-564.

PMID: 34606056 PMC: 8488069. DOI: 10.1007/s15010-021-01709-3.

References

Canoui E, Blanc K, Loubinoux J, Valade S, Hamard C, Lefebvre A . The value of molecular techniques to diagnose Ureaplasma urealyticum and Nocardia farcinica pleuropneumonia in a patient with diffuse large B-cell lymphoma. Int J Infect Dis. 2017; 64:93-95. DOI: 10.1016/j.ijid.2017.09.015. View

Righi E, Carnelutti A, Muser D, Di Gregorio F, Cadeo B, Melchioretto G . Incremental value of FDG-PET/CT to monitor treatment response in infectious spondylodiscitis. Skeletal Radiol. 2020; 49(6):903-912. DOI: 10.1007/s00256-019-03328-4. View

Chen W, Kim J, Molchanova-Cook O, Dilsizian V . The potential of FDG PET/CT for early diagnosis of cardiac device and prosthetic valve infection before morphologic damages ensue. Curr Cardiol Rep. 2014; 16(3):459. DOI: 10.1007/s11886-013-0459-y. View

Minero M, Marin M, Cercenado E, Rabadan P, Bouza E, Munoz P . Nocardiosis at the turn of the century. Medicine (Baltimore). 2009; 88(4):250-261. DOI: 10.1097/MD.0b013e3181afa1c8. View

Mascarenhas N, Lam D, Lynch G, Fisher R . PET imaging of cerebral and pulmonary Nocardia infection. Clin Nucl Med. 2006; 31(3):131-3. DOI: 10.1097/01.rlu.0000200597.42832.39. View

Garcia-Bellmunt L, Sibila O, Solanes I, Sanchez-Reus F, Plaza V . Pulmonary nocardiosis in patients with COPD: characteristics and prognostic factors. Arch Bronconeumol. 2012; 48(8):280-5. DOI: 10.1016/j.arbres.2012.04.009. View

Crozier J, Andhavarapu S, Brumble L, Sher T . First report of Nocardia beijingensis infection in an immunocompetent host in the United States. J Clin Microbiol. 2014; 52(7):2730-2. PMC: 4097741. DOI: 10.1128/JCM.00588-14. View

Iannotti C, Hall G, Procop G, Tuohy M, Staugaitis S, Weil R . Solitary Nocardia farcinica brain abscess in an immunocompetent adult mimicking metastatic brain tumor: rapid diagnosis by pyrosequencing and successful treatment. Surg Neurol. 2008; 72(1):74-9. DOI: 10.1016/j.surneu.2008.02.025. View

Davies J, Davies D . Origins and evolution of antibiotic resistance. Microbiol Mol Biol Rev. 2010; 74(3):417-33. PMC: 2937522. DOI: 10.1128/MMBR.00016-10. View

10.

Darwiche K, Totzeck B, Gatermann S, Bollow M, Ewig S . [Nocardiosis as a differential diagnosis of a PET-positive pulmonary nodule]. Pneumologie. 2007; 61(3):176-80. DOI: 10.1055/s-2006-954990. View

11.

Li S, Song X, Zhao Y, Xu K, Bi Y, Huang H . Clinical Analysis of Pulmonary Nocardiosis in Patients With Autoimmune Disease. Medicine (Baltimore). 2015; 94(39):e1561. PMC: 4616823. DOI: 10.1097/MD.0000000000001561. View

12.

Sukahri S, Zainudin L, Hadi M, Mohd Firdaus M, Abdul Hafidz M . Recurrent Empyema Thoracic Secondary to Pulmonary Nocardiosis in Immunocompetent Patients. Case Rep Pulmonol. 2020; 2020:8840920. PMC: 7609154. DOI: 10.1155/2020/8840920. View

13.

Parikh S, Bhusal Y, Faderl S, Wierda W, OBrien S, Kantarjian H . The great imitator: systemic nocardiosis mimicking Richter's transformation in relapsed chronic lymphocytic leukemia. J Clin Oncol. 2010; 28(35):e732-4. DOI: 10.1200/JCO.2010.29.9792. View

14.

Leroy-Freschini B, Treglia G, Argemi X, Bund C, Kessler R, Herbrecht R . 18F-FDG PET/CT for invasive fungal infection in immunocompromised patients. QJM. 2018; 111(9):613-622. DOI: 10.1093/qjmed/hcy128. View

15.

Biswas Roy S, Ross M, Patil P, Trepeta R, Bremner R, Panchabhai T . Primary Infection Causing a Fluorodeoxyglucose-Avid Right Renal Mass in a Redo Lung Transplant Recipient. Case Rep Transplant. 2018; 2018:9752860. PMC: 5820550. DOI: 10.1155/2018/9752860. View

16.

Tramer L, Mertz K, Huegli R, Hinic V, Jost L, Burkhalter F . Intra-Abdominal Nocardiosis-Case Report and Review of the Literature. J Clin Med. 2020; 9(7). PMC: 7408857. DOI: 10.3390/jcm9072141. View

17.

Erba P, Lancellotti P, Vilacosta I, Gaemperli O, Rouzet F, Hacker M . Recommendations on nuclear and multimodality imaging in IE and CIED infections. Eur J Nucl Med Mol Imaging. 2018; 45(10):1795-1815. DOI: 10.1007/s00259-018-4025-0. View

18.

Lebeaux D, Freund R, Van Delden C, Guillot H, Marbus S, Matignon M . Outcome and Treatment of Nocardiosis After Solid Organ Transplantation: New Insights From a European Study. Clin Infect Dis. 2017; 64(10):1396-1405. PMC: 10941331. DOI: 10.1093/cid/cix124. View

19.

Tsunezuka Y, Furusawa T, Fujimori H, Kurumaya H . Pulmonary nocardiosis with a tumor-like solitary nodule caused by Nocardia beijingenesis: first report of human surgical infection. Surg Infect (Larchmt). 2012; 13(6):418-9. DOI: 10.1089/sur.2011.130. View

20.

Restrepo A, Clark N . Nocardia infections in solid organ transplantation: Guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation. Clin Transplant. 2019; 33(9):e13509. DOI: 10.1111/ctr.13509. View