Rhodococcus equi Treatment & Management

  • Author: Indira Kedlaya, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Nov 21, 2011
 

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.
    • 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.
    • 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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Contributor Information and Disclosures
Author

Indira Kedlaya, MD  Provider, Sunshine Medical Group, PLLC

Indira Kedlaya, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Michael Ing, MD  Chief, Section of Infectious Disease, JL Pettis Memorial VA Medical Center, Assistant Professor, Department of Internal Medicine, Loma Linda University School of Medicine

Michael Ing, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of HIV Medicine, American College of Physicians-American Society of Internal Medicine, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, HIV Medicine Association of America, Infectious Diseases Society of America, International AIDS Society, Royal Society of Tropical Medicine and Hygiene, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Larry I Lutwick, MD  Professor of Medicine, State University of New York Downstate Medical School; Director, Infectious Diseases, Veterans Affairs New York Harbor Health Care System, Brooklyn Campus

Larry I Lutwick, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Chest radiograph of a patient with Rhodococcus equi infection showing multiple nodular infiltrates.
Chest radiograph of a patient with Rhodococcus equi infection demonstrating cavitation of pulmonary nodules.
Chest CT scan of a patient with Rhodococcus equi infection demonstrating nodular infiltrates.
 
 
 
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