Pulmonary abscess caused by <i>Rhodococcus equi</i> : a case report and literature review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Neng , TANG Congchen ,  WANG Lichun

Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANG Lichun, Email: mindywang0218@163.com

Keywords：

Rhodococcus equi; Kidney transplantation; Lung abscess; Antimicrobial agents; Treatment

DOI：

10.7507/1671-6205.202107035

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Objective To examine the characteristics of Rhodococcus equi (R. equi) infection for better awareness of this disease.Methods The clinical data of a patient with pulmonary abscess caused by R. equi after renal transplantation were reported. We also reviewed the reports of infections caused by R. equi.Results The clinical manifestations and laboratory examination of the patient were consistent with the characteristics of R. equi infection. The growth of R. equi was found in sputum and blood culture. The follow-up data showed that the treatment was effective. Literature search identified 23 similar patients. In all the 24 patients (containing this one), the time of infection after renal transplantation ranged from 4 months to 11 years. There were 21 patients with cumulative pulmonary infection, and 10 patients had a clear epidemiological history of direct or indirect contact with horses. Eighteen patients improved after regular antibacterial treatment or surgical treatment.Conclusions Opportunistic infections caused by R. equi mainly affect transplant recipients and other patients with lower immunity. Infections caused by R. equi may affect many organ systems with various manifestations. The optimal therapy is not established due to the rarity of this infection. Clinicians should select antibiotic agents rationally based on antimicrobial susceptibility testing and treatment response of patients.

Citation： WANG Neng, TANG Congchen, WANG Lichun. Pulmonary abscess caused by Rhodococcus equi : a case report and literature review. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(8): 558-563. doi: 10.7507/1671-6205.202107035 Copy

1.	汪红, 帅丽华, 孙晓红, 等. 马红球菌致颈部脓肿 1 例. 中国感染与化疗杂志, 2018, 18(4): 424-425.
2.	Herath S, Lewis C, Nisbet M. Increasing awareness of Rhodococcus equi pulmonary infection in the immunocompetent adult: a rare infection with poor prognosis. N Z Med J, 2013, 126(1387): 165-174.
3.	Williams GD, Flanigan WJ, Campbell GS. Surgical management of localized thoracic infections in immunosuppressed patients. Ann Thorac Surg, 1971, 12(5): 471-482.
4.	Savdie E, Pigott P, Jennis F. Lung abscess due to Corynebacterium equi in a renal transplant recipient. Med J Aust, 1977, 1(22): 817-819.
5.	Ellis-Pegler RB, Parr DH, Orchard VA. Recurrent skin infection with Rhodococcus in an immunosuppressed patient. J Infect, 1983, 6(1): 39-41.
6.	Van Etta LL, Filice GA, Ferguson RM, et al. Corynebacterium equi: a review of 12 cases of human infection. Rev Infect Dis, 1983, 5(6): 1012-1018.
7.	Novak RM, Polisky EL, Janda WM, et al. Osteomyelitis caused by Rhodococcus equi in a renal transplant recipient. Infection, 1988, 16(3): 186-188.
8.	Arrieta Lezama J, García-Arenzana JM, Idígoras Viedma P, et al. [Pulmonary infection caused by Rhodococcus equi in a renal transplant recipient]. Med Clin (Barc), 1992, 99(4): 143-144.
9.	Scott MA, Graham BS, Verrall R, et al. Rhodococcus equi--an increasingly recognized opportunistic pathogen. Report of 12 cases and review of 65 cases in the literature. American journal of clinical pathology, 1995, 103(5): 649-655.
10.	Lee-Chiong T, Sadigh M, Simms M, et al. Case reports: pericarditis and lymphadenitis due to Rhodococcus equi. Am J Med Sci, 1995, 310(1): 31-33.
11.	Barsotti M, Cupisti A, Morelli E, et al. Sepsis from Rhodococcus equi successfully treated in a kidney transplant recipient. Nephrol Dial Transplant, 1997, 12(9): 2002-2004.
12.	La Rocca E, Gesu G, Caldara R, et al. Pulmonary infection caused by Rhodococcus equi in a kidney and pancreas transplant recipient: a case report. Transplantation, 1998, 65(11): 1524-1525.
13.	Gallen F, Kernaonet E, Foulet A, et al. [Pulmonary infection from Rhodococcus equi after renal transplantation. Review of the literature]. Nephrologie, 1999, 20(7): 383-386.
14.	Simsir A, Oldach D, Forest G, et al. Rhodococcus equi and cytomegalovirus pneumonia in a renal transplant patient: diagnosis by fine-needle aspiration biopsy. Diagn Cytopathol, 2001, 24(2): 129-131.
15.	González-Roncero FM, Gentil MA, Rodriguez-Algarra G, et al. Medical management of pneumonia caused by Rhodococcus equi in a renal transplant recipient. Am J Kidney Dis, 2002, 39(2): E7.
16.	Stiles BM, Isaacs RB, Daniel TM, et al. Role of surgery in Rhodococcus equi pulmonary infections. J Infect, 2002, 45(1): 59-61.
17.	Arya B, Hussian S, Hariharan S. Rhodococcus equi pneumonia in a renal transplant patient: a case report and review of literature. Clin Transplant, 2004, 18(6): 748-752.
18.	Tse KC, Tang SCW, Chan TM, et al. Rhodococcus lung abscess complicating kidney transplantation: successful management by combination antibiotic therapy. Transpl Infect Dis, 2008, 10(1): 44-47.
19.	El Karoui K, Guillet C, Sekkal N, et al. Synergistic effect of carbapenem-teicoplanin combination during severe Rhodococcus equi pneumonia in a kidney transplant recipient. Transpl Infect Dis, 2009, 11(4): 359-362.
20.	Yamshchikov AV, Schuetz A, Lyon GM. Rhodococcus equi infection. Lancet Infect Dis, 2010, 10(5): 350-359.
21.	Menon V, Gottlieb T, Gallagher M, et al. Persistent Rhodococcus equi infection in a renal transplant patient: case report and review of the literature. Transpl Infect Dis, 2012, 14(6): E126-E133.
22.	Khan MY, Ali S, Baqi S. Rhodococcus equi pneumonia in a live related renal transplant recipient. J Pak Med Assoc, 2013, 63(5): 635-638.
23.	Ursales A, Klein JA, Beal SG, et al. Antibiotic failure in a renal transplant patient with Rhodococcus equi infection: an indication for surgical lobectomy. Transpl Infect Dis, 2014, 16(6): 1019-1023.
24.	Macken E, de Jonge H, Van Caesbroeck D, et al. Rhodococcus equi Sepsis in a Renal Transplant Recipient: A Case Study. Transplant Direct, 2015, 1(3): e11.
25.	Shah P, Rojas-Moreno C, Alexander J, et al. Rhodococcus equi: another great masquerader. IDCases, 2021, 24: e01144.
26.	Weinstock DM, Brown AE. Rhodococcus equi: an emerging pathogen. Clin Infect Dis, 2002, 34(10): 1379-1385.
27.	胡越凯, 卢洪渊, 翁心华. 马红球菌感染的研究进展. 国外医学(微生物学分册), 2003, 26(2): 15-17.
28.	Dawson DR, Nydam DV, Price CT, et al. Effects of opsonization of Rhodococcus equi on bacterial viability and phagocyte activation. Am J Vet Res, 2011, 72(11): 1465-1475.
29.	Dawson TRMY, Horohov DW, Meijer WG, et al. Current understanding of the equine immune response to Rhodococcus equi. An immunological review of R. equi pneumonia. Vet Immunol Immunopathol, 2010, 135(1-2): 1-11.
30.	Von Bargen K, Scraba M, Krämer I, et al. Virulence-associated protein A from Rhodococcus equi is an intercompartmental pH-neutralising virulence factor. Cell Microbiol, 2019, 21(1): e12958.
31.	Ribeiro MG, Takai S, De Vargas AC, et al. Short report: Identification of virulence-associated plasmids in Rhodococcus equi in humans with and without acquired immunodeficiency syndrome in Brazil. Am J Trop Med Hyg, 2011, 85(3): 510-513.
32.	Vergidis P, Ariza-Heredia EJ, Nellore A, et al. Rhodococcus infection in solid organ and hematopoietic stem cell transplant recipients. Emerg Infect Dis, 2017, 23(3): 510-512.
33.	Topino S, Galati V, Grilli E, et al. Rhodococcus equi infection in HIV-infected individuals: case reports and review of the literature. AIDS Patient Care STDS, 2010, 24(4): 211-222.
34.	Lin WV, Kruse RL, Yang K, et al. Diagnosis and management of pulmonary infection due to Rhodococcus equi. Clin Microbiol Infect, 2019, 25(3): 310-315.
35.	Perez MG, Vassilev T, Kemmerly SA. Rhodococcus equi infection in transplant recipients: a case of mistaken identity and review of the literature. Transpl Infect Dis, 2002, 4(1): 52-56.
36.	Kedlaya I, Ing MB, Wong SS. Rhodococcus equi infections in immunocompetent hosts: case report and review. Clin Infect Dis, 2001, 32(3): E39-E46.
37.	Jacks SS, Giguère S, Nguyen A. In vitro susceptibilities of Rhodococcus equi and other common equine pathogens to azithromycin, clarithromycin, and 20 other antimicrobials. Antimicrob Agents Chemother, 2003, 47(5): 1742-1745.
38.	Gundelly P, Suzuki Y, Ribes JA, et al. Differences in Rhodococcus equi infections based on immune status and antibiotic susceptibility of clinical isolates in a case series of 12 patients and cases in the literature. Biomed Res Int, 2016, 2016: 2737295.
39.	桑福德. 热病—桑福德抗微生物治疗指南. 46 版. 范洪伟, 王焕玲, 周宝桐, 译. 北京: 中国协和医科大学出版社, 2017, 71.
40.	Varotti G, Barabani C, Dodi F, et al. Unusual extrapulmonary rhodococcus equi infection in a kidney transplant patient. Exp Clin Transplant, 2016, 14(6): 676-678.

1. 汪红, 帅丽华, 孙晓红, 等. 马红球菌致颈部脓肿 1 例. 中国感染与化疗杂志, 2018, 18(4): 424-425.
2. Herath S, Lewis C, Nisbet M. Increasing awareness of Rhodococcus equi pulmonary infection in the immunocompetent adult: a rare infection with poor prognosis. N Z Med J, 2013, 126(1387): 165-174.
3. Williams GD, Flanigan WJ, Campbell GS. Surgical management of localized thoracic infections in immunosuppressed patients. Ann Thorac Surg, 1971, 12(5): 471-482.
4. Savdie E, Pigott P, Jennis F. Lung abscess due to Corynebacterium equi in a renal transplant recipient. Med J Aust, 1977, 1(22): 817-819.
5. Ellis-Pegler RB, Parr DH, Orchard VA. Recurrent skin infection with Rhodococcus in an immunosuppressed patient. J Infect, 1983, 6(1): 39-41.
6. Van Etta LL, Filice GA, Ferguson RM, et al. Corynebacterium equi: a review of 12 cases of human infection. Rev Infect Dis, 1983, 5(6): 1012-1018.
7. Novak RM, Polisky EL, Janda WM, et al. Osteomyelitis caused by Rhodococcus equi in a renal transplant recipient. Infection, 1988, 16(3): 186-188.
8. Arrieta Lezama J, García-Arenzana JM, Idígoras Viedma P, et al. [Pulmonary infection caused by Rhodococcus equi in a renal transplant recipient]. Med Clin (Barc), 1992, 99(4): 143-144.
9. Scott MA, Graham BS, Verrall R, et al. Rhodococcus equi--an increasingly recognized opportunistic pathogen. Report of 12 cases and review of 65 cases in the literature. American journal of clinical pathology, 1995, 103(5): 649-655.
10. Lee-Chiong T, Sadigh M, Simms M, et al. Case reports: pericarditis and lymphadenitis due to Rhodococcus equi. Am J Med Sci, 1995, 310(1): 31-33.
11. Barsotti M, Cupisti A, Morelli E, et al. Sepsis from Rhodococcus equi successfully treated in a kidney transplant recipient. Nephrol Dial Transplant, 1997, 12(9): 2002-2004.
12. La Rocca E, Gesu G, Caldara R, et al. Pulmonary infection caused by Rhodococcus equi in a kidney and pancreas transplant recipient: a case report. Transplantation, 1998, 65(11): 1524-1525.
13. Gallen F, Kernaonet E, Foulet A, et al. [Pulmonary infection from Rhodococcus equi after renal transplantation. Review of the literature]. Nephrologie, 1999, 20(7): 383-386.
14. Simsir A, Oldach D, Forest G, et al. Rhodococcus equi and cytomegalovirus pneumonia in a renal transplant patient: diagnosis by fine-needle aspiration biopsy. Diagn Cytopathol, 2001, 24(2): 129-131.
15. González-Roncero FM, Gentil MA, Rodriguez-Algarra G, et al. Medical management of pneumonia caused by Rhodococcus equi in a renal transplant recipient. Am J Kidney Dis, 2002, 39(2): E7.
16. Stiles BM, Isaacs RB, Daniel TM, et al. Role of surgery in Rhodococcus equi pulmonary infections. J Infect, 2002, 45(1): 59-61.
17. Arya B, Hussian S, Hariharan S. Rhodococcus equi pneumonia in a renal transplant patient: a case report and review of literature. Clin Transplant, 2004, 18(6): 748-752.
18. Tse KC, Tang SCW, Chan TM, et al. Rhodococcus lung abscess complicating kidney transplantation: successful management by combination antibiotic therapy. Transpl Infect Dis, 2008, 10(1): 44-47.
19. El Karoui K, Guillet C, Sekkal N, et al. Synergistic effect of carbapenem-teicoplanin combination during severe Rhodococcus equi pneumonia in a kidney transplant recipient. Transpl Infect Dis, 2009, 11(4): 359-362.
20. Yamshchikov AV, Schuetz A, Lyon GM. Rhodococcus equi infection. Lancet Infect Dis, 2010, 10(5): 350-359.
21. Menon V, Gottlieb T, Gallagher M, et al. Persistent Rhodococcus equi infection in a renal transplant patient: case report and review of the literature. Transpl Infect Dis, 2012, 14(6): E126-E133.
22. Khan MY, Ali S, Baqi S. Rhodococcus equi pneumonia in a live related renal transplant recipient. J Pak Med Assoc, 2013, 63(5): 635-638.
23. Ursales A, Klein JA, Beal SG, et al. Antibiotic failure in a renal transplant patient with Rhodococcus equi infection: an indication for surgical lobectomy. Transpl Infect Dis, 2014, 16(6): 1019-1023.
24. Macken E, de Jonge H, Van Caesbroeck D, et al. Rhodococcus equi Sepsis in a Renal Transplant Recipient: A Case Study. Transplant Direct, 2015, 1(3): e11.
25. Shah P, Rojas-Moreno C, Alexander J, et al. Rhodococcus equi: another great masquerader. IDCases, 2021, 24: e01144.
26. Weinstock DM, Brown AE. Rhodococcus equi: an emerging pathogen. Clin Infect Dis, 2002, 34(10): 1379-1385.
27. 胡越凯, 卢洪渊, 翁心华. 马红球菌感染的研究进展. 国外医学(微生物学分册), 2003, 26(2): 15-17.
28. Dawson DR, Nydam DV, Price CT, et al. Effects of opsonization of Rhodococcus equi on bacterial viability and phagocyte activation. Am J Vet Res, 2011, 72(11): 1465-1475.
29. Dawson TRMY, Horohov DW, Meijer WG, et al. Current understanding of the equine immune response to Rhodococcus equi. An immunological review of R. equi pneumonia. Vet Immunol Immunopathol, 2010, 135(1-2): 1-11.
30. Von Bargen K, Scraba M, Krämer I, et al. Virulence-associated protein A from Rhodococcus equi is an intercompartmental pH-neutralising virulence factor. Cell Microbiol, 2019, 21(1): e12958.
31. Ribeiro MG, Takai S, De Vargas AC, et al. Short report: Identification of virulence-associated plasmids in Rhodococcus equi in humans with and without acquired immunodeficiency syndrome in Brazil. Am J Trop Med Hyg, 2011, 85(3): 510-513.
32. Vergidis P, Ariza-Heredia EJ, Nellore A, et al. Rhodococcus infection in solid organ and hematopoietic stem cell transplant recipients. Emerg Infect Dis, 2017, 23(3): 510-512.
33. Topino S, Galati V, Grilli E, et al. Rhodococcus equi infection in HIV-infected individuals: case reports and review of the literature. AIDS Patient Care STDS, 2010, 24(4): 211-222.
34. Lin WV, Kruse RL, Yang K, et al. Diagnosis and management of pulmonary infection due to Rhodococcus equi. Clin Microbiol Infect, 2019, 25(3): 310-315.
35. Perez MG, Vassilev T, Kemmerly SA. Rhodococcus equi infection in transplant recipients: a case of mistaken identity and review of the literature. Transpl Infect Dis, 2002, 4(1): 52-56.
36. Kedlaya I, Ing MB, Wong SS. Rhodococcus equi infections in immunocompetent hosts: case report and review. Clin Infect Dis, 2001, 32(3): E39-E46.
37. Jacks SS, Giguère S, Nguyen A. In vitro susceptibilities of Rhodococcus equi and other common equine pathogens to azithromycin, clarithromycin, and 20 other antimicrobials. Antimicrob Agents Chemother, 2003, 47(5): 1742-1745.
38. Gundelly P, Suzuki Y, Ribes JA, et al. Differences in Rhodococcus equi infections based on immune status and antibiotic susceptibility of clinical isolates in a case series of 12 patients and cases in the literature. Biomed Res Int, 2016, 2016: 2737295.
39. 桑福德. 热病—桑福德抗微生物治疗指南. 46 版. 范洪伟, 王焕玲, 周宝桐, 译. 北京: 中国协和医科大学出版社, 2017, 71.
40. Varotti G, Barabani C, Dodi F, et al. Unusual extrapulmonary rhodococcus equi infection in a kidney transplant patient. Exp Clin Transplant, 2016, 14(6): 676-678.

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