Rhodococcus equi Infection Treatment & Management

Updated: Dec 03, 2018
  • Author: Indira Kedlaya, MD; Chief Editor: Thomas E Herchline, MD  more...
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Treatment

Medical Care

The mainstay of medical care is treatment of the underlying infection with antibiotics and surgical therapy, as described below. Other aspects of medical care include the following:

  • Providing good supportive care, including adequate oxygenation with ventilatory support, if necessary

  • Maximizing nutritional status

  • Diagnosing and treating underlying immunosuppression

  • Spontaneous resolution of an R equi pulmonary nodule has been reported in a patient who underwent transplantation.

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Surgical Care

Surgical therapy has a definite role in certain R equi infections. Local surgical resection or debridement is recommended in cases of R equi endophthalmitis, osteomyelitis, subcutaneous abscess, paravertebral abscess, and pericardial effusion.

In R equi pneumonia , surgical treatment has no obvious benefit. Some authors recommend surgical treatment such as lobectomy or partial lung resection when the infection has evolved into a large abscess or when the infection is overwhelming. Consideration of surgical resection also seems prudent when an infection fails to respond to antibiotics alone.

Torres-Tortosa (2003) reported that 16.4% of their series of HIV-infected patients required surgical intervention. [8]

In a review by Capdevila et al (1997), 11 of 78 patients infected with HIV who had R equi pneumonia underwent surgery. [9] Four of the 11 patients died, 3 cases resolved, the course was unknown in 3 patients, and, in 1 patient, the infection was chronic.

A 1991 review by Harvey and Sunstrum included patients with and without immunocompromised conditions. [7] The overall rate of survival was 75% when surgical resection was combined with antibiotic therapy. Among patients receiving antibiotics alone, the survival rate was 61.1%. Two of 4 patients infected with HIV who received surgical treatment in addition to antibiotics died, while the remaining 2 improved. Also notable is that this study included a few patients with localized extrapulmonary infections.

In a review of R equi infection in patients who underwent transplantation, 3 patients with pneumonia were treated with surgical resection. One of them was cured despite receiving no antibiotics. Of the remaining 2 patients who received additional antibiotic treatment, 1 died (death was due to other causes) and the other had a relapse. In another study involving renal transplants, approximately half of the reported cases required surgical intervention. [12]

Two immunocompetent patients with R equi pneumonia underwent surgical resection even before a definitive diagnosis was made. One of them died, while the other was cured.

In R equi pneumonia, other surgical therapy, such as drainage of empyema, may be used.

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Consultations

Consultation with an infectious disease specialist is helpful, not only in providing recommendations regarding the diagnosis and management of suspected R equi infection, but also with regards to the management of any underlying immunocompromised condition (eg, HIV/AIDS).

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Diet

No dietary modifications modify the disease course.

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Activity

No activity modifications are required.

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Prevention

Patients, especially those who are immunocompromised, should exercise caution in contact with farm animals. This especially is true on dry windy days.

Implement good hygienic measures when eating fresh farm vegetables.

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Long-Term Monitoring

Ensure compliance with antibiotics.

Monitor for resolution. Antibiotics can be discontinued after complete resolution is achieved.

Watch for relapse, especially in patients infected with HIV.

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Further Inpatient Care

Patients with R equi infection should be monitored for clinical improvement following treatment. Repeat imaging may be necessary. Any pleural effusion that develops may require drainage.

Provide follow-up care for adverse effects of antibiotics and drug interactions, especially in patients infected with HIV who are on antiretroviral medications.

Provide good supportive care.

Consider outpatient management once improvement with antibiotics is observed.

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