Diagnosis and Management of Pulmonary Infection due to Rhodococcus equi.
Clin Microbiol Infect. 2018 May 16;:
Authors: Lin WV, Kruse RL, Yang K, Musher DM
BACKGROUND: Rhodococcus equi is a recognized cause of disease in humans, especially in patients who are immunocompromised. Because diphtheroids are regarded as part of normal respiratory flora, the importance of R. equi as a pulmonary pathogen may not be fully appreciated and its prevalence underestimated. Most treatment recommendations for R. equi infection were established before antiretroviral drugs became available for HIV/AIDS therapy, and therapeutic strategies may need to be updated.
AIMS: To review the role of R. equi as a cause of pulmonary infection; to highlight its importance for clinicians and microbiologists; and to challenge current approaches to treatment, whether in immunodeficient or immunocompetent patients.
SOURCES: A PubMed search using combinations of the following terms: 'Rhodococcus (automatically including Corynebacterium) equi' AND 'pneumonia' OR 'pulmonary' infection, then cross-checking references in the resulting cases, case series, and reviews.
CONTENT: We provide a review that details the challenges in the diagnosis, microbiology, and pathogenesis of pulmonary infection caused by R. equi and the options for treatment.
IMPLICATIONS: Ten to 14 days of treatment may be effective for pneumonia due to R. equi. Our review suggests that longer courses of therapy are needed for cavitary lesions and lung masses. However, recommendations for excessively prolonged treatment of all pulmonary infections arose during a time that many cases occurred in AIDS patients and before effective antiretroviral therapy was available. We suggest that the rationale for prolonged therapy with multiple antibiotics needs to be re-evaluated.
PMID: 29777923 [PubMed - as supplied by publisher]