Rhodococcus equi Treatment & Management

Updated: Apr 13, 2015
  • Author: Indira Kedlaya, MD; Chief Editor: Burke A Cunha, 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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