{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T16:26:07Z","timestamp":1758039967166,"version":"3.44.0"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T00:00:00Z","timestamp":1757548800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:italic>Nocardia<\/jats:italic> bacteremia is a rare but life-threatening opportunistic infection associated with high mortality rates. Early diagnosis and prompt initiation of appropriate treatment are crucial for improving patient outcomes. In our study, we report a patient with diffuse large B-cell lymhoma who unfortunately had a bloodstream infection with <jats:italic>Nocardia cyriacigeorgica<\/jats:italic>. The patient presented with characteristic clinical manifestations of septic shock, including persistent high-grade fever, hypotension, and acute renal insufficiency. Despite receiving empirical treatment with imipenem for 6 days following admission, the patient remained febrile with temperatures reaching 39\u00b0C. Subsequent blood cultures identified <jats:italic>N. cyriacigeorgica<\/jats:italic>, prompting a modification of the antimicrobial regimen to a triple-drug combination of imipenem, linezolid, and trimethoprim-sulfamethoxazole (TMP-SMX). Following the initiation of therapy, the patient demonstrated significant clinical improvement and was subsequently discharged. Based on this clinical experience and the severity of nocardial infections, we recommend combination therapy with two to three antimicrobial agents for the management of <jats:italic>Nocardia<\/jats:italic> infections.<\/jats:p>","DOI":"10.3389\/fmed.2025.1595190","type":"journal-article","created":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T05:26:04Z","timestamp":1757568364000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Bloodstream infection with Nocardia cyriacigeorgica in a patient with diffuse large B-cell lymphoma"],"prefix":"10.3389","volume":"12","author":[{"given":"Ning","family":"Du","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bingqing","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongmin","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haochun","family":"Tang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianping","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Meng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"You","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/j.mayocp.2011.11.016","article-title":"Nocardiosis: updates and clinical overview.","volume":"87","author":"Wilson","year":"2012","journal-title":"Mayo Clin Proc."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1396","DOI":"10.1093\/cid\/cix124","article-title":"Outcome and treatment of nocardiosis after solid organ transplantation: new insights from a European study.","volume":"64","author":"Lebeaux","year":"2017","journal-title":"Clin Infect Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1097\/01.md.0000141100.30871.39","article-title":"A case series and focused review of nocardiosis: clinical and microbiologic aspects.","volume":"83","author":"Lederman","year":"2004","journal-title":"Medicine."},{"key":"B4","doi-asserted-by":"publisher","first-page":"213","DOI":"10.1128\/CMR.7.2.213","article-title":"Nocardia species: host-parasite relationships.","volume":"7","author":"Beaman","year":"1994","journal-title":"Clin Microbiol Rev."},{"key":"B5","doi-asserted-by":"publisher","first-page":"41","DOI":"10.2147\/IMCRJ.S59315","article-title":"Soil-acquired cutaneous nocardiosis on the forearm of a healthy male contracted in a swamp in rural eastern Virginia.","volume":"7","author":"Palmieri","year":"2014","journal-title":"Int Med Case Rep J."},{"key":"B6","doi-asserted-by":"publisher","first-page":"e12436","DOI":"10.1097\/MD.0000000000012436","article-title":"Manifestations and outcomes of nocardia infections: comparison of immunocompromised and nonimmunocompromised adult patients.","volume":"97","author":"Steinbrink","year":"2018","journal-title":"Medicine."},{"key":"B7","doi-asserted-by":"publisher","first-page":"754","DOI":"10.1093\/jac\/dkw489","article-title":"Epidemiology and susceptibility to antimicrobial agents of the main Nocardia species in Spain.","volume":"72","author":"Valdezate","year":"2017","journal-title":"J Antimicrob Chemother."},{"key":"B8","doi-asserted-by":"publisher","first-page":"338","DOI":"10.1093\/cid\/ciw241","article-title":"Nocardia infection in solid organ transplant recipients: a multicenter European case-control study.","volume":"63","author":"Coussement","year":"2016","journal-title":"Clin Infect Dis."},{"key":"B9","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1016\/j.ijid.2020.01.011","article-title":"Nocardia bacteremia: a single-center retrospective review and a systematic review of the literature.","volume":"92","author":"Williams","year":"2020","journal-title":"Int J Infect Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1080\/00365540410020929","article-title":"Port-A catheter-associated Nocardia bacteremia detected by gallium inflammation scan: a case report and literature review.","volume":"36","author":"Lai","year":"2004","journal-title":"Scand J Infect Dis."},{"key":"B11","doi-asserted-by":"publisher","first-page":"469","DOI":"10.1128\/JCM.01816-10","article-title":"Catheter-associated Nocardia higoensis bacteremia in a child with acute lymphocytic leukemia.","volume":"49","author":"Watson","year":"2011","journal-title":"J Clin Microbiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"929","DOI":"10.1099\/jmm.0.053561-0","article-title":"Bacteraemia caused by Sciscionella marina in a lymphoma patient: phenotypically mimicking Nocardia.","volume":"62","author":"Sinha","year":"2013","journal-title":"J Med Microbiol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e13509","DOI":"10.1111\/ctr.13509","article-title":"Nocardia infections in solid organ transplantation: guidelines from the infectious diseases community of practice of the American society of transplantation.","volume":"33","author":"Restrepo","year":"2019","journal-title":"Clin Transplant."},{"key":"B14","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1016\/j.cmi.2020.12.019","article-title":"How do I manage nocardiosis?","volume":"27","author":"Margalit","year":"2021","journal-title":"Clin Microbiol Infect."},{"key":"B15","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1128\/CMR.19.2.259-282.2006","article-title":"Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy.","volume":"19","author":"Brown-Elliott","year":"2006","journal-title":"Clin Microbiol Rev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"e1868","DOI":"10.1128\/AAC.01868-19","article-title":"Retrospective analysis of antimicrobial susceptibility profiles of nocardia species from a tertiary hospital and reference laboratory, 2011 to 2017.","volume":"64","author":"Hamdi","year":"2020","journal-title":"Antimicrob Agents Chemother."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e0140621","DOI":"10.1128\/msystems.01406-21","article-title":"Comprehensive analysis of the nocardia cyriacigeorgica complex reveals five species-level clades with different evolutionary and pathogenicity characteristics.","volume":"7","author":"Xu","year":"2022","journal-title":"mSystems."},{"key":"B18","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1086\/657399","article-title":"Antimicrobial-resistant nocardia isolates, United States, 1995-2004.","volume":"51","author":"Uhde","year":"2010","journal-title":"Clin Infect Dis."},{"key":"B19","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1016\/j.diagmicrobio.2018.12.007","article-title":"Clinical features, identification, antimicrobial resistance patterns of Nocardia species in China: 2009-2017.","volume":"94","author":"Huang","year":"2019","journal-title":"Diagn Microbiol Infect Dis."},{"key":"B20","doi-asserted-by":"publisher","first-page":"e8007","DOI":"10.7759\/cureus.8007","article-title":"Nocardia bloodstream infection: a retrospective clinical analysis of seven cases in a single centre.","volume":"12","author":"Liang","year":"2020","journal-title":"Cureus."},{"key":"B21","doi-asserted-by":"publisher","first-page":"160","DOI":"10.1016\/j.resinv.2013.09.004","article-title":"Pulmonary nocardiosis: a clinical analysis of 59 cases.","volume":"52","author":"Kurahara","year":"2014","journal-title":"Respir Investig."},{"key":"B22","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1167\/iovs.65.3.26","article-title":"Whole genome sequencing highlights the pathogenic profile in Nocardia Keratitis.","volume":"65","author":"Guo","year":"2024","journal-title":"Invest Ophthalmol Vis Sci."},{"key":"B23","doi-asserted-by":"publisher","first-page":"504","DOI":"10.3390\/cells13060504","article-title":"Implementing whole genome sequencing (WGS) in clinical practice: advantages, challenges, and future perspectives.","volume":"13","author":"Brlek","year":"2024","journal-title":"Cells."},{"key":"B24","doi-asserted-by":"publisher","first-page":"1872","DOI":"10.3390\/microorganisms11081872","article-title":"Machine learning of the whole genome sequence of Mycobacterium tuberculosis: a scoping PRISMA-based review.","volume":"11","author":"Perea-Jacobo","year":"2023","journal-title":"Microorganisms."},{"key":"B25","doi-asserted-by":"publisher","first-page":"9834","DOI":"10.3390\/ijms23179834","article-title":"Combination of whole genome sequencing and metagenomics for microbiological diagnostics.","volume":"23","author":"Purushothaman","year":"2022","journal-title":"Int J Mol Sci."},{"key":"B26","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1159\/000539977","article-title":"Disseminated infection caused by Nocardia cyriacigeorgica in immunocompromised patient confirmed by whole genome sequencing.","volume":"70","author":"Varda Brki\u0107","year":"2025","journal-title":"Chemotherapy."},{"key":"B27","doi-asserted-by":"publisher","first-page":"1053914","DOI":"10.3389\/fimmu.2022.1053914","article-title":"Case report: nocardia gipuzkoensis infection in an immunocompetent patient diagnosed by metagenomic next-generation sequencing and whole genome sequencing.","volume":"13","author":"Liu","year":"2022","journal-title":"Front Immunol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e0009665","DOI":"10.1371\/journal.pntd.0009665","article-title":"Whole genome sequencing reveals the genomic diversity, taxonomic classification, and evolutionary relationships of the genus Nocardia.","volume":"15","author":"Xu","year":"2021","journal-title":"PLoS Negl Trop Dis."},{"key":"B29","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1097\/MD.0000000000000012","article-title":"Nocardiosis of the central nervous system: experience from a general hospital and review of 84 cases from the literature.","volume":"93","author":"Anagnostou","year":"2014","journal-title":"Medicine."},{"key":"B30","doi-asserted-by":"publisher","first-page":"e364","DOI":"10.1128\/AAC.00364-18","article-title":"Pathogenic Nocardia cyriacigeorgica and Nocardia nova evolve to resist trimethoprim-Sulfamethoxazole by both expected and unexpected pathways.","volume":"62","author":"Mehta","year":"2018","journal-title":"Antimicrob Agents Chemother."},{"key":"B31","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.ijid.2023.02.023","article-title":"Clinical characteristics, susceptibility profiles, and treatment of nocardiosis: a multicenter retrospective study in 2015-2021.","volume":"130","author":"Yang","year":"2023","journal-title":"Int J Infect Dis."},{"key":"B32","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1016\/j.micpath.2017.11.012","article-title":"Nocardiosis from 1888 to 2017.","volume":"114","author":"Fatahi-Bafghi","year":"2018","journal-title":"Microb Pathog."},{"key":"B33","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1128\/AAC.02770-14","article-title":"Antimicrobial susceptibility among clinical Nocardia species identified by multilocus sequence analysis.","volume":"59","author":"McTaggart","year":"2015","journal-title":"Antimicrob Agents Chemother."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1595190\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T05:26:07Z","timestamp":1757568367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1595190\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,11]]},"references-count":33,"alternative-id":["10.3389\/fmed.2025.1595190"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1595190","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2025,9,11]]},"article-number":"1595190"}}