The Role of 18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (FDG-PET/CT) in Management of Nocardiosis: A Retrospective Study and Review of the Literature

Ili Margalit, Anat Yahav, Yaara Ben Ari, Haim Ben-Zvi, Avivit Shoham, Elad Goldberg, Michal Weiler-Sagie, Noam Tau, Khitam Muhsen, Jihad Bishara, Mical Paul, Hanna Bernstine, Dafna Yahav

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Introduction: 18-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is a well-established tool for managing metastatic infections. Nocardiosis, a primarily pulmonary infection, disseminates at high rates. Routine imaging includes chest CT and brain imaging. We examined the use of FDG-PET/CT in nocardiosis and assessed its contribution to diagnosis and management. Methods: A retrospective study in two tertiary medical centers during 2011–2020. Individuals with nocardiosis for whom FDG-PET/CT was implemented for any reason were included and their medical records were reviewed. A board-certified nuclear medicine physician independently reviewed all scans. Additionally, a systematic review was conducted according to the PRISMA guidelines, to extract data from publications reporting FDG-PET/CT use for the management of nocardiosis. Results: FDG-PET/CT contributed to the management of all seven patients who met inclusion criteria. It assisted in ruling out an underlying malignancy (29%, 2/7); establishing a wide infection extent (57%, 4/7); and affecting decisions regarding treatment (57%, 4/7), including drug regimen, oral step-down, and duration of therapy. We identified 20 published case reports on this topic. In 80% (16/20), FDG-PET/CT contributed to the management of nocardiosis similar to our study. In addition, in most of the literature cases, FDG-PET/CT guided the diagnostic biopsy. Conclusion: FDG-PET/CT is valuable in the diagnosis and management of individuals with nocardiosis. The contribution of incorporating FDG-PET/CT to the management of individuals with nocardiosis and its role in monitoring treatment response and shortening treatment duration should be evaluated in prospective studies.

Original languageEnglish
Pages (from-to)2227-2246
Number of pages20
JournalInfectious Diseases and Therapy
Volume10
Issue number4
DOIs
StatePublished - Dec 2021
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2021, The Author(s).

Funding

No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published. I.M. and D.Y. conceived the study idea; I.M., E.G., J.B., and D.Y. designed the study and planned the systematic review; I.M., A.Y., Y.B.A., H.B.Z., and A.S. collected the data; I.M., M.W.S., N.T., K.M., J.B., M.P., H.B., and D.Y. drafted the manuscript; All authors contributed to manuscript revision, read and approved the submitted version. Ili Margalit, Anat Yahav, Yaara Ben Ari, Haim Ben-Zvi, Avivit Shoham, Elad Goldberg, Michal Weiler-Sagie, Noam Tau, Khitam Muhsen, Jihad Bishara, Mical Paul, Hanna Bernstine, and Dafna Yahav have nothing to disclose. The ethics committees of Rabin Medical Center and Rambam Health Care Campus approved the study protocol. An exemption from informed consent was given by the ethics committees because of the retrospective design of the study. All methods were performed in accordance with the Helsinki Declaration of 1964 and its later amendments.

Keywords

  • Imaging
  • Nocardia infections
  • Opportunistic infections

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