Primary cutaneous nocardiosis of the ankle caused by N. brasiliensis: a case report

Primary cutaneous nocardiosis of the ankle caused by N. brasiliensis: a case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Primary cutaneous nocardiosis of the ankle caused by N. brasiliensis: a case report Suzan Şahin, Ebru Fidan, Serap Demir Tekol, Bülent Kaya This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4131919/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 26 Apr, 2024 Read the published version in Infection → Version 1 posted 9 You are reading this latest preprint version Abstract Nocardia is a genus of aerobic, Gram-positive bacteria known for their filamentous and branching morphology. N. brasiliensis is the most common species causing cutaneous nocardiosis. We present a 67-year-old woman who developed abscess-like lesions on the back of her right ankle after walking barefoot on soil. Cultures from the cutaneous lesions grew N. brasiliensis. Antibiotic therapy with trimethoprim-sulfamethoxazole given for a month provided near-complete resolution of her lesions. Nocardiosis Cutaneous trimethoprim-sulfamethoxazole Figures Figure 1 Figure 2 Introduction Nocardia is a genus of aerobic, Gram-positive bacteria known for their filamentous and branching morphology. Sharing characteristics of both bacteria and fungi, these actinomycetes are widely distributed in the environment, particularly in soil. Some species of Nocardia are opportunistic pathogens, capable of causing infections in humans, particularly those with compromised immune systems [ 1 ]. The mechanism of virulence is either through inhalation or via entry portals of minor skin wounds and mucous membranes that render the body vulnerable to exposure to polluted soil or water in the environment. Nocardia infections often manifest as pulmonary or cutaneous diseases, posing challenges for diagnosis and treatment due to their variable clinical presentations. N. brasiliensis is the most common species causing cutaneous nocardiosis [ 1 , 2 ]. Case report A 67-year-old woman with a 6-year history of type 2 diabetes mellitus presented with abscess-like lesions on the back of her right ankle. She reported walking barefoot on soil before the appearance of the lesions. One month before the current presentation, she sought treatment at another center, where she received one course each of oral fusidic acid followed by amoxicillin-clavulanate, without a response. At the current presentation, examination showed multiple abscesses on the back of her right ankle, measuring 1 x 2 cm in the greatest dimension (Fig. 1 a). The abscesses were drained, specimens were collected for microbiologic examination, and empirical antibiotic therapy with ceftriaxone was initiated. Laboratory studies showed a white blood cell count of 11,400 cells/mm 3 (reference, 4,000–10,000), a C-reactive protein level of 19 mg/L (reference, < 5), and an erythrocyte sedimentation rate of 59 mm/h. After 10 days of empirical antibiotic therapy, the lesions partly remitted (Fig. 1 b). Gram staining of the specimens showed leukocytes and Gram-positive filamentous bacteria (Fig. 2 a). Cultures grew Nocardia brasiliensis (Fig. 2 b, c), with discernible growth on the third day and prominent colonization on the fifth day, characterized by R-type colonies with a fluffy surface in chalky white color. Identification of the pathogenic bacteria was further confirmed by the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system. Antimicrobial sensitivity testing was not performed due to the lack of Epsilometer test strips at the time of detection of the isolates. Based on the absence of specific manifestations suggestive of other types of involvement, a diagnosis of primary cutaneous nocardiosis was made. Therapy was switched to trimethoprim-sulfamethoxazole two times daily in a combination dose of 160 mg of trimethoprim and 800 mg of sulfamethoxazole. Meanwhile, magnetic resonance imaging of the ankle showed no signs of osteomyelitis. At a 20-day follow-up visit, the patient’s lesions had largely abated (Fig. 1 c), and abnormal laboratory findings had returned to normal, with no toxic effects associated with the antibiotic therapy. At a subsequent follow-up visit 10 days later, the cutaneous lesions had almost resolved (Fig. 1 d) and the antibiotic therapy was discontinued. Discussion Primary cutaneous nocardiosis is a rare infection, most commonly caused by N. brasiliensis found in the environment, particularly in soil. It may manifest on a distal limb as superficial cellulitis or pyogenic abscess(es) that may further progress to sporotrichoid nodular lymphangitis characterized by spread along lymphatic channels or to a more destructive form, sinus tract formation [ 1 , 3 , 4 ]. Sulfonamides, in their most recent form of trimethoprim-sulfamethoxazole, have been shown to substantially improve primary cutaneous nocardiosis owing to their synergistic activity, making them the mainstay of therapy [ 1 , 5 ]. As with the presented case, resolution of lesions has been reported with trimethoprim-sulfamethoxazole in several cases [ 3 , 6 ]. Teeming with diverse microorganisms, soil can harbor bacteria, fungi, and parasites that pose health threats upon contact with broken skin or through mucous membranes. Engaging in activities such as walking barefoot or gardening without protective gloves may expose individuals to the potential risk of contracting infections. In our case, the patient contracted the infection while walking barefoot on soil. In another report of sporotrichoid nodular lymphangitis from N. brasiliensis , the patient was infected through a thorn puncture in the hand while gardening [ 3 ]. Therefore, adopting preventive measures, such as wearing shoes and gloves, becomes crucial in minimizing the chances of acquiring infections by soil-borne pathogens while enjoying outdoor activities. Declarations Conflict of interest statement: The authors declare no conflict-of-interest issue. Funding: No funding CARE Checklist The manuscript was designed and written in compliance with the CARE (Case Report Guidelines) checklist. Author contributions All authors contributed to the conception and design of the manuscript. The first draft of the manuscript was written by Suzan Şahin and all authors read and approved the final form of the manuscript. Conflict of interest The authors have no conflict-of-interest issue to disclose. Consent to participate and to publish Written informed consent was obtained from the patient reported in this case report for participation and publication. Institutional review board approval Authors of case reports are waived from applying for institutional review board approval provided that all data about the patient(s) would be de-identified. References Chen SA, Watts MR, Maddocks S, Sorrell TC. Nocardia species. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett’s principles and practice of infectious diseases. pp. 3059–70. 9 ed. Elsevier, Philadelphia, 2020. Spiliopoulou A, Kyriakou G, Georgiou S, Lekkou A, Leonidou L, Militsopoulou M, et al. Acid-fast bacteria as causative agents of skin and soft tissue infections: case presentations and literature review. Rev Inst Med Trop Sao Paulo. 2023;65:e29. Pipito L, Cascio A. Sporotrichoid nodular lymphangitis from Nocardia brasiliensis . N Engl J Med. 2023;388:1701. Vecilla DF, Radigales JR, Vivanco CA, Llanos MIG, Arco JLDTD. Lymphangitis caused by Nocardia brasiliensis after a mosquito bite. An Pediatr. 2023;99:431–2. Lao CK, Tseng MC, Chiu CH, Chen NY, Chen CH, Chung WH, et al. Clinical manifestations and antimicrobial susceptibility of Nocardia species at a tertiary hospital in Taiwan, 2011–2020. J Formos Med Assoc. 2022;121:2109–22. Wang X, Yang H, Xie Y, Xian X. Severe disseminated Nocardia brasiliensis pneumonia with normal immune function: a case report. Medicine. 2024;103:e36402. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 26 Apr, 2024 Read the published version in Infection → Version 1 posted Editorial decision: Revision requested 09 Apr, 2024 Reviews received at journal 09 Apr, 2024 Reviewers agreed at journal 04 Apr, 2024 Reviews received at journal 23 Mar, 2024 Reviewers agreed at journal 22 Mar, 2024 Reviewers invited by journal 20 Mar, 2024 Editor assigned by journal 20 Mar, 2024 Submission checks completed at journal 20 Mar, 2024 First submitted to journal 19 Mar, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4131919","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":281750324,"identity":"b89a8a12-6892-454c-b6d3-b308fa93e2e7","order_by":0,"name":"Suzan Şahin","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5UlEQVRIiWNgGAWjYDCCAzCGBGMDwwcGhgTStDDOIFELAwMzDzFa+G4ffyb5o+aOPf/s5rbHtm12efzsDYwfPubg1iJ5LsdMQuLYs8QZdw62G+e2JRdL9hxglpy5DbcWgzM8bBIGbIcTGG4ktknntjEnbriRwMbMi1cL+zOJhH+H7eVBWizb6onRwmAmcbDtMOMGkBbGtsOEtUie4TG2bOw7nLgRqEWy59zxxJk9B5vx+oXvDPvDmz++HbaXu5H+TOJHWXViP3vzwQ8f8WhBBYxsYLKBWPUg8IcUxaNgFIyCUTBSAAAfj1eYR7m0YgAAAABJRU5ErkJggg==","orcid":"","institution":"Dr. Lütfi Kırdar Kartal City Hospital","correspondingAuthor":true,"prefix":"","firstName":"Suzan","middleName":"","lastName":"Şahin","suffix":""},{"id":281750325,"identity":"4e64e826-d080-46b1-8f47-a9103b36eb57","order_by":1,"name":"Ebru Fidan","email":"","orcid":"","institution":"Dr. Lütfi Kırdar Kartal City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Ebru","middleName":"","lastName":"Fidan","suffix":""},{"id":281750326,"identity":"4b99d69a-01b4-439a-8c27-452db4fb231d","order_by":2,"name":"Serap Demir Tekol","email":"","orcid":"","institution":"Dr. Lütfi Kırdar Kartal City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Serap","middleName":"Demir","lastName":"Tekol","suffix":""},{"id":281750327,"identity":"aed31ba3-b15d-4a0a-abd5-a20f9840ebf6","order_by":3,"name":"Bülent Kaya","email":"","orcid":"","institution":"Dr. Lütfi Kırdar Kartal City Hospital","correspondingAuthor":false,"prefix":"","firstName":"Bülent","middleName":"","lastName":"Kaya","suffix":""}],"badges":[],"createdAt":"2024-03-19 16:32:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4131919/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4131919/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s15010-024-02273-2","type":"published","date":"2024-04-26T22:17:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53254901,"identity":"93bb5d01-1999-4bd1-a98b-0b770a35ce63","added_by":"auto","created_at":"2024-03-22 13:24:46","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":24313106,"visible":true,"origin":"","legend":"\u003cp\u003ePrimary cutaneous nocardiosis involving the right ankle. At presentation (A), partial remission after 10 days of empirical antibiotic therapy (B), after 20 days (C) and 30 days (D) of trimethoprim-sulfamethoxazole therapy.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4131919/v1/3f0946ba533e42073a5ea3ec.png"},{"id":53254899,"identity":"ae499e9e-9de6-4de6-8baa-e08603394320","added_by":"auto","created_at":"2024-03-22 13:24:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":849044,"visible":true,"origin":"","legend":"\u003cp\u003eGram staining of the specimen showing leukocytes and Gram-positive filamentous bacteria (A). Growth of \u003cem\u003eN. brasiliensis\u003c/em\u003e characterized by fluffy surface and chalky white color (B, C).\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-4131919/v1/33f98e2d25dda037378dd1a6.png"},{"id":55689885,"identity":"52553e3a-e658-4d7a-85c8-388c1e1046b4","added_by":"auto","created_at":"2024-05-01 22:17:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2160017,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4131919/v1/30c26ea5-9393-4224-9005-8c10dbbd8425.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Primary cutaneous nocardiosis of the ankle caused by N. brasiliensis: a case report","fulltext":[{"header":"Introduction","content":"\u003cp\u003e \u003cem\u003eNocardia\u003c/em\u003e is a genus of aerobic, Gram-positive bacteria known for their filamentous and branching morphology. Sharing characteristics of both bacteria and fungi, these actinomycetes are widely distributed in the environment, particularly in soil. Some species of \u003cem\u003eNocardia\u003c/em\u003e are opportunistic pathogens, capable of causing infections in humans, particularly those with compromised immune systems [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The mechanism of virulence is either through inhalation or via entry portals of minor skin wounds and mucous membranes that render the body vulnerable to exposure to polluted soil or water in the environment. \u003cem\u003eNocardia\u003c/em\u003e infections often manifest as pulmonary or cutaneous diseases, posing challenges for diagnosis and treatment due to their variable clinical presentations. \u003cem\u003eN. brasiliensis\u003c/em\u003e is the most common species causing cutaneous nocardiosis [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e"},{"header":"Case report","content":"\u003cp\u003eA 67-year-old woman with a 6-year history of type 2 diabetes mellitus presented with abscess-like lesions on the back of her right ankle. She reported walking barefoot on soil before the appearance of the lesions. One month before the current presentation, she sought treatment at another center, where she received one course each of oral fusidic acid followed by amoxicillin-clavulanate, without a response. At the current presentation, examination showed multiple abscesses on the back of her right ankle, measuring 1 x 2 cm in the greatest dimension (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ea). The abscesses were drained, specimens were collected for microbiologic examination, and empirical antibiotic therapy with ceftriaxone was initiated. Laboratory studies showed a white blood cell count of 11,400 cells/mm\u003csup\u003e3\u003c/sup\u003e (reference, 4,000\u0026ndash;10,000), a C-reactive protein level of 19 mg/L (reference, \u0026lt;\u0026thinsp;5), and an erythrocyte sedimentation rate of 59 mm/h. After 10 days of empirical antibiotic therapy, the lesions partly remitted (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003eb). Gram staining of the specimens showed leukocytes and Gram-positive filamentous bacteria (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003ea). Cultures grew \u003cem\u003eNocardia brasiliensis\u003c/em\u003e (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003eb, c), with discernible growth on the third day and prominent colonization on the fifth day, characterized by R-type colonies with a fluffy surface in chalky white color. Identification of the pathogenic bacteria was further confirmed by the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) system.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAntimicrobial sensitivity testing was not performed due to the lack of Epsilometer test strips at the time of detection of the isolates. Based on the absence of specific manifestations suggestive of other types of involvement, a diagnosis of primary cutaneous nocardiosis was made. Therapy was switched to trimethoprim-sulfamethoxazole two times daily in a combination dose of 160 mg of trimethoprim and 800 mg of sulfamethoxazole. Meanwhile, magnetic resonance imaging of the ankle showed no signs of osteomyelitis. At a 20-day follow-up visit, the patient\u0026rsquo;s lesions had largely abated (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ec), and abnormal laboratory findings had returned to normal, with no toxic effects associated with the antibiotic therapy. At a subsequent follow-up visit 10 days later, the cutaneous lesions had almost resolved (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003ed) and the antibiotic therapy was discontinued.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrimary cutaneous nocardiosis is a rare infection, most commonly caused by \u003cem\u003eN. brasiliensis\u003c/em\u003e found in the environment, particularly in soil. It may manifest on a distal limb as superficial cellulitis or pyogenic abscess(es) that may further progress to sporotrichoid nodular lymphangitis characterized by spread along lymphatic channels or to a more destructive form, sinus tract formation [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSulfonamides, in their most recent form of trimethoprim-sulfamethoxazole, have been shown to substantially improve primary cutaneous nocardiosis owing to their synergistic activity, making them the mainstay of therapy [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. As with the presented case, resolution of lesions has been reported with trimethoprim-sulfamethoxazole in several cases [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTeeming with diverse microorganisms, soil can harbor bacteria, fungi, and parasites that pose health threats upon contact with broken skin or through mucous membranes. Engaging in activities such as walking barefoot or gardening without protective gloves may expose individuals to the potential risk of contracting infections. In our case, the patient contracted the infection while walking barefoot on soil. In another report of sporotrichoid nodular lymphangitis from \u003cem\u003eN. brasiliensis\u003c/em\u003e, the patient was infected through a thorn puncture in the hand while gardening [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Therefore, adopting preventive measures, such as wearing shoes and gloves, becomes crucial in minimizing the chances of acquiring infections by soil-borne pathogens while enjoying outdoor activities.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of interest statement: The authors declare no conflict-of-interest issue.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding: No funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCARE Checklist\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript was designed and written in compliance with the CARE (Case Report Guidelines) checklist.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the conception and design of the manuscript. The first draft of the manuscript was written by Suzan Şahin and all authors read and approved the final form of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors have no conflict-of-interest issue to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate and to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from the patient reported in this case report for participation and publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInstitutional review board approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors of case reports are waived from applying for institutional review board approval provided that all data about the patient(s) would be de-identified.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eChen SA, Watts MR, Maddocks S, Sorrell TC. \u003cem\u003eNocardia\u003c/em\u003e species. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett\u0026rsquo;s principles and practice of infectious diseases. pp. 3059\u0026ndash;70. 9 ed. Elsevier, Philadelphia, 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpiliopoulou A, Kyriakou G, Georgiou S, Lekkou A, Leonidou L, Militsopoulou M, et al. Acid-fast bacteria as causative agents of skin and soft tissue infections: case presentations and literature review. Rev Inst Med Trop Sao Paulo. 2023;65:e29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePipito L, Cascio A. Sporotrichoid nodular lymphangitis from \u003cem\u003eNocardia brasiliensis\u003c/em\u003e. N Engl J Med. 2023;388:1701.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVecilla DF, Radigales JR, Vivanco CA, Llanos MIG, Arco JLDTD. Lymphangitis caused by \u003cem\u003eNocardia brasiliensis\u003c/em\u003e after a mosquito bite. An Pediatr. 2023;99:431\u0026ndash;2.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLao CK, Tseng MC, Chiu CH, Chen NY, Chen CH, Chung WH, et al. Clinical manifestations and antimicrobial susceptibility of \u003cem\u003eNocardia\u003c/em\u003e species at a tertiary hospital in Taiwan, 2011\u0026ndash;2020. J Formos Med Assoc. 2022;121:2109\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang X, Yang H, Xie Y, Xian X. Severe disseminated \u003cem\u003eNocardia brasiliensis\u003c/em\u003e pneumonia with normal immune function: a case report. Medicine. 2024;103:e36402.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infe","sideBox":"Learn more about [Infection](http://link.springer.com/journal/15010)","snPcode":"15010","submissionUrl":"https://submission.nature.com/new-submission/15010/3","title":"Infection","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Nocardiosis, Cutaneous, trimethoprim-sulfamethoxazole","lastPublishedDoi":"10.21203/rs.3.rs-4131919/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4131919/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e \u003cem\u003eNocardia\u003c/em\u003e is a genus of aerobic, Gram-positive bacteria known for their filamentous and branching morphology. \u003cem\u003eN. brasiliensis\u003c/em\u003e is the most common species causing cutaneous nocardiosis. We present a 67-year-old woman who developed abscess-like lesions on the back of her right ankle after walking barefoot on soil. Cultures from the cutaneous lesions grew \u003cem\u003eN. brasiliensis.\u003c/em\u003e Antibiotic therapy with trimethoprim-sulfamethoxazole given for a month provided near-complete resolution of her lesions.\u003c/p\u003e","manuscriptTitle":"Primary cutaneous nocardiosis of the ankle caused by N. brasiliensis: a case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-22 13:24:39","doi":"10.21203/rs.3.rs-4131919/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-09T20:14:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-09T19:36:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4d02fea2-a37e-4585-b4cc-fc46ad2e1a2d","date":"2024-04-04T18:18:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-03-23T06:40:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26994826-a86c-49d9-9519-a5142822af4d","date":"2024-03-22T10:25:45+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-03-20T09:57:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-03-20T09:53:32+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-03-20T07:57:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Infection","date":"2024-03-19T16:30:51+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"infection","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infe","sideBox":"Learn more about [Infection](http://link.springer.com/journal/15010)","snPcode":"15010","submissionUrl":"https://submission.nature.com/new-submission/15010/3","title":"Infection","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"cc1b08ae-72b8-4dbf-a6d7-46707cd52b2b","owner":[],"postedDate":"March 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-01T22:17:52+00:00","versionOfRecord":{"articleIdentity":"rs-4131919","link":"https://doi.org/10.1007/s15010-024-02273-2","journal":{"identity":"infection","isVorOnly":false,"title":"Infection"},"publishedOn":"2024-04-26 22:17:52","publishedOnDateReadable":"April 26th, 2024"},"versionCreatedAt":"2024-03-22 13:24:39","video":"","vorDoi":"10.1007/s15010-024-02273-2","vorDoiUrl":"https://doi.org/10.1007/s15010-024-02273-2","workflowStages":[]},"version":"v1","identity":"rs-4131919","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4131919","identity":"rs-4131919","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}