Clinical features, diagnosis, therapy, and prevention of Rhodococcus equi infections
- Camille N Kotton, MD
Camille N Kotton, MD
- Associate Professor
- Harvard Medical School
The first case of infection caused by Rhodococcus equi was reported in 1967 , and only 12 additional cases were recorded in the next 15 years . While still not commonplace, a dramatic increase occurred early in the HIV pandemic and R. equi has increasingly been appreciated, especially as an opportunistic pathogen. Increasing recognition of R. equi as a pathogen has subsequently led to improved laboratory identification of infections in both immunocompromised and normal humans.
The clinical manifestations, diagnosis, treatment, and prevention of R. equi infections will be reviewed here. The microbiology, epidemiology, and pathogenesis of R. equi infections are discussed separately. (See "Microbiology, epidemiology, and pathogenesis of Rhodococcus equi infections".)
R. equi has increasingly been appreciated as a cause of infection in patients with immune system dysfunction [3-12]. The majority of R. equi infections occur in adults, but infection in children and infants (including preterm infants) has also been reported .
Pulmonary infections are the most common form of human disease caused by R. equi. Extrapulmonary disease, with or without a concurrent pulmonary infection, can also occur. In one large review of 72 cases, pneumonia occurred in 76 percent of patients, and the lung was the sole site of infection in 82 percent . Pneumonia was accompanied by extrapulmonary infection in 18 percent of cases, while infection at extrapulmonary sites occurred without evidence of pulmonary involvement in 24 percent.
Pulmonary infection — Most published cases of pneumonia have occurred in immunocompromised hosts, including transplant recipients [14,15]. In such patients, infection is typically subacute in onset but results in high fever, cough (which may or may not be productive), and prominent fatigue [3-11]. Chest pain and weight loss are also common . Hemoptysis can occur, and is sometimes severe enough to require multiple transfusions and even pneumonectomy. In a series of 67 HIV-infected patients with R. equi infection, cough, sputum production, and hemoptysis were present in 88, 85, and 31 percent, respectively; chest radiography was abnormal in 65 (97 percent) .
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- CLINICAL FEATURES
- Immunocompromised hosts
- - Pulmonary infection
- - Extrapulmonary infection
- With concurrent pulmonary infection
- Patients without pulmonary infection
- Immunocompetent hosts
- DIFFERENTIAL DIAGNOSIS
- ANTIMICROBIAL THERAPY
- Treatment of immunocompromised hosts
- - Preferred agents
- - Alternative agents
- - Duration
- Treatment of immunocompetent hosts
- ADJUNCTIVE TREATMENT INTERVENTIONS
- Improving immune function
- Extrapulmonary disease
- Primary prevention
- Secondary prevention
- SUMMARY AND RECOMMENDATIONS