BMJ Case Reports 2013; doi:10.1136/bcr-2013-009069

Emergence of co-trimoxazole resistant Nocardia brasiliensis causing fatal pneumonia

  1. Deepak Kumar2
  1. 1Department of Microbiology, Hind Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  2. 2Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
  3. 3Department of Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
  1. Correspondence to Dr Himanshu D, dr.himanshu.reddy{at}


An 85-year-old man was admitted to the medical intensive care unit with a 10-day history of severe breathlessness, fever and cough. The patient was known to have chronic obstructive pulmonary disease and had been receiving corticosteroids in the preceding 18 months. He had been treated for tuberculosis 2.5 years previously. On examination he was febrile, tachycardic with a respiratory rate of 46/min. Auscultation revealed bilateral crepitation's and wheeze. Chest radiograph revealed patchy infiltrates on right lung. The patient developed respiratory depression and was mechanically ventilated. His sputum and endotracheal aspirates revealed Nocardia brasiliensis on culture which was found to be co-trimoxazole resistant. Once this became known imipenem was substituted for co-trimoxazole but unfortunately condition of the patient did not improve and he died following a cardiac arrest.

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