Rhodococcus equi

#idboardreview 50 M hx of renal transplant, lives on 🐎 farm presents with fever, cough, fatigue & wt loss. Diagnosis? #medEd #idmedEd

#Rhodococcus equi (formerly Corynebacterium equi) is a gram+ nonmotile, non–spore-forming, aerobic microorganism. It may appear as coccobacillus initially & later as bacillus, depending on growth conditions and is sometimes partially acid-fast

Soil organism widespread in the environment, from which it infects domesticated, grazing animals. Occasionally R. equi causes human infection via inhalation, oral ingestion or inoculation into a wound or mucous membrane. R.f. Contact w/ animals or manure (<50% recall exposure

Generally affects pts w/ impaired cellular immunity (HIV, SOT, chemo) occasionally 10%-15% immunocompetent hosts. Others: DM, alcohol use, sarcoidosis, CKD

80% pulmonary dz and half may be bacteremic. Transplant pts: half of pts gave extra pulmonary dz brain/paravertebral abscesses, pericarditis, SQ nodules, femur OM

R equi usually S to Vanc, erythro, FQ, rifampin, CM, AG, linezolid

R Equi variable S to clinda, tetracycline, chloramphenicol & cephalosporins

R Equi usually R to penicillin (mechanism PBP & beta lactamase)

Monotherapy ineffective. 2-3 drug combo are used. Macrolide, rifampin, FQ. Immunocompromised host w/ severe infection: combo should include Vanc or CM or aminoglycoside. Iv abx 2-3 wks until improvement & then switch to po 2-8 wks. 2-6 no for immunosuppressed pts

https://www.jwatch.org/id200402020000003/2004/02/02/rhodococcus-equi-infection-animal-and-human

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30400-2/pdf

Originally tweeted by Indiana University Infectious Diseases Fellowship (@IUIDfellowship) on 15 August, 2020.

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