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Rhodococcus equi--an emerging human pathogen in immunocompromized hosts: a report of four cases from Malaysia

Puthucheary SD, Sangkar V, Hafeez A, Karunakaran R, Raja NS, Hassan HH

Southeast Asian J. Trop. Med. Public Health, 2006 Jan;37(1):157-61.
PMID: 16771229

Rhodococcus equi, a recognized pathogen in horses, is emerging as a human opportunistic pathogen, especially in immunocompromized hosts. We describe four immunocompromized patients who had serious R. equi infections with an overall mortality of 75%. The natural habitat of R. equi is soil, particularly soil contaminated with animal manure. Necrotizing pneumonia is the commonest form of infection but extrapulmonary infections, such as wound infections and subcutaneous abscess, have also been described in humans. R. equi is cultured easily in ordinary non-selective media. Large, smooth, irregular colonies appear within 48 hours. It is a facultative, intracellular, nonmotile, non-spore forming, gram-positive coccobacillus, which is weakly acid-fast staining and bears a similarity to diphtheroids. It forms a salmon-colored pigment usually after 48 hours incubation. A particular characteristic of this organism is that it undergoes synergistic hemolysis with some bacteria on sheep blood agar. R. equi may be misidentified as diphtheroids, Mycobacterium species, or Nocardia. In vitro R. equi is usually susceptible to erythromycin, ciprofloxacin, vancomycin, aminoglycosides, rifampin, imipenem and meropenem. The organism can be difficult to eradicate, making treatment challenging. Increased awareness of the infection may help with early diagnosis and timely treatment.

Matched MeSH terms: Rhodococcus equi*
Fulltext Clinicopathological and radiographic features in 40 cats diagnosed with pulmonary and cutaneous Rhodococcus equi infection (2012-2018)

Aslam MW, Lau SF, Chin CSL, Ahmad NI, Rahman NA, Kuppusamy K, et al.

J Feline Med Surg, 2020 Aug;22(8):774-790.
PMID: 32400257 DOI: 10.1177/1098612X19886395

OBJECTIVES: This retrospective study aimed to describe clinical manifestations, diagnostic options, radiological features, therapeutic plans and outcomes for cats infected with Rhodococcus equi.
METHODS: Forty cats aged between 2 months and 11 years old (median 6 months) that were definitively diagnosed with rhodococcosis between 2012 and 2018 were recruited in this study. Medical records were reviewed for information on signalment, history, clinical presentation, diagnostic testing, treatment plans and clinical outcomes.
RESULTS: Of the 40 cats, 36 showed the pulmonary form of the disease, with 35 (87.5%) presenting with dyspnoea, while four cats presented with only cutaneous lesions. Mean body temperature was 38.7 ± 0.2°C. Dyspnoea was noted in 87.5% of the cats. Leukocytosis (58.3%) with band neutrophilia (83.3%), monocytosis (58.3%) and thrombocytopenia (55.5%) were prominent findings in the haematology reports. Hyperproteinaemia (61.1%) with hypoalbuminaemia (22.2%) and hyperglobulinaemia (63.8%) with a low albumin:globulin ratio (38.9%) were prominent features of blood biochemistry reports. An alveolar-interstitial pattern was noted in 75% of pre-thoracocentesis radiographs. Pleural effusion, hepatomegaly, thoracic lymphadenopathy and atelectasis of any lung lobe were seen in 88.9%, 75%, 41.7% and 36.1% of cats, respectively. Overall, the mortality rate was 67.5% in both forms.
CONCLUSIONS AND RELEVANCE: Clinicians should be aware that feline rhodococcosis manifests as a pulmonary disease at a much higher rate than previously reported. Further studies are required to address the epidemiology, pathophysiology, disease management and prognosis of feline rhodococcosis. The role of immunosuppression as a predisposing factor in feline rhodococcosis requires further investigation.

Matched MeSH terms: Rhodococcus equi/physiology*
Fulltext A review on rhodococcus equi: horse, cat and human

Aslam, M.W.

Jurnal Veterinar Malaysia, 2019;31(2):1-12.
MyJurnal

In recent years, Rhodococcus equi has emerged as pathogen of importance in respiratory and non-respiratory infectious diseases of animals and humans. Its distribution is worldwide and incidence of disease is increasing in nonequine species like cats and humans. Sporadic infection in human and cat is hypothesized to infect immunocompromised cases largely. While predominantly in foals, infection is quite endemic/epidemic in nature depending on virulence of strain, and incidence is 10 – 20% since birth till weaning. Mode of acquisition is quite variable in humans, cats and foals and depends on the route of exposure. Pathogenesis is well understood in natural host but in cats and humans it is still in its infancy because of the manifestation of unusual cases with low to no exposure to contaminated elements. Clinical signs depend on the site of infection but respiratory manifestations are quite common in foals and human cases. In cats extra-pulmonary disorders are hypothesized as more common presentation. Definitive diagnosis is based on the microbiological culture and cytology from tracheobronchial aspirate for respiratory cases and site of sample for non-respiratory lesions. White blood cells and fibrinogen have some correlation in degree of diagnosis in foals but not in cats and humans. Macrolides especially clarithromycin along with rifampin are considered best combination at the moment and recently resistance is being reported against erythromycin and rifampin. In foals, consensus statements by ACVIM published detailed control and preventions but in humans and cats so far hygiene and isolation of infected patients are for the time being the methods to control nosocomial spread.

Matched MeSH terms: Rhodococcus equi

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