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Rhodococcus equi Pulmonary Infections in Patients With Cancer: Three New Cases and Review of the Literature

Vélez, Marela Z. MD*; Greene, John N. MD, FACP†‡; Vincent, Albert L. PhD*; Sandin, Ramon L. MD, MS, FCAP§∥

Infectious Diseases in Clinical Practice:
doi: 10.1097/IPC.0b013e31819fe519
Case Reports
Abstract

Rhodococcus equi is an aerobic coccobacillus that causes bronchopneumonia in livestock. Most human infections with R. equi occur among immunocompromised population, especially patients with human immunodeficiency virus infection and cancer. We looked at the unique presentation and management of R. equi infections in patients with cancer from our own experiences and from a review of the literature. Rhodococcus equi presents most commonly in immunocompromised patients as a pulmonary disease. In addition, more than 80% of immunocompromised patients develop bacteremia compared with 30% of immunocompetent patients. Because Rhodococcus is a known pathogen of livestock, it is not surprising that approximately 25% to 45% of infected patients with cancer are exposed to farm animals. Rhodococcus equi infections in patients with cancer are rare but may be life threatening if not recognized and treated promptly. Antibiotic resistance and the frequent propensity of R. equi infections to recur require the use of combination antibiotic therapy for a prolonged period.

Author Information

From the *Division of Infectious Disease and International Medicine, University of South Florida College of Medicine; †Infectious Diseases and Hospital Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, and ‡Internal Medicine & Interdisciplinary Oncology, University of South Florida College of Medicine; and §Clinical Microbiology and Virology Laboratories and Clinical Pathologist, H. Lee Moffitt Cancer Center and Research Institute, and ∥Pathology and Interdisciplinary Oncology, University of South Florida College of Medicine, Tampa, FL.

Reprints: John N. Greene, MD, FACP, Infectious Diseases and Hospital Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, 12902 Magnolia Dr, WCB-BMT, Tampa, FL 33612-9497. E-mail: john.greene@moffitt.org.

© 2009 Lippincott Williams & Wilkins, Inc.