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Case Report | DOI: https://doi.org/10.31579/2690-8808/268
1Department of Pulmonology at the Virgin Mary Provincial Specialist Hospital in Częstochowa, Poland.
2Mycobacterium Tuberculosis Laboratory at the Virgin Mary Provincial Specialist Hospital in Częstochowa, Poland.
3Observation-Infectious Diseases and Hepatology Unit of the Silesian Center for Infectious Diseases, Upper Silesian Medical Center in Katowice, Poland.
4Retired Professor, former Head of the Clinic of Lung Diseases and Tuberculosis at the Medical University of Silesia in Zabrze, Poland.
*Corresponding Author: Ziora Dariusz, Retired Professor, former Head of the Clinic of Lung Diseases and Tuberculosis at the Medical University of Silesia in Zabrze, Poland.
Citation: Wróbel W, Płokarz M, Jaroszewicz J, Ziora D, (2025), A Rare Case of Concurrent Nocardiosis and COVID-19 in a Patient with Severe Bronchial Asthma, J, Clinical Case Reports and Studies, 6(6); DOI:10.31579/2690-8808/268
Copyright: © 2025, Ziora Dariusz. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 16 July 2025 | Accepted: 24 July 2025 | Published: 30 July 2025
Keywords: nocardiosis; nocardia farcinica; covid-19; bronchial asthma
Nocardiosis, a rare opportunistic infection caused by Nocardia spp., primarily affects immunocompromised individuals. We present a 65-year-old male with severe bronchial asthma and type 2 diabetes mellitus, who presented with recurrent hospitalizations due to persistent fever, progressive dyspnea, and pleuritic chest pain. Despite empiric broad-spectrum antibiotic therapy, diagnostic delays occurred because clinical and radiological features overlapped with those of other pulmonary pathologies. During hospitalization for concurrent COVID-19 infection, Nocardia farcinica was identified in a subsequent bronchial aspirate via modified acid-fast staining and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS) analysis. The patient achieved clinical and radiological improvement following targeted antimicrobial therapy (Linezolid + Trimethoprim-Sulfamethoxazole + Amikacin) before discharge. This case highlights the critical importance of considering nocardiosis in patients with chronic respiratory comorbidities, particularly when overlapping infections such as COVID-19 are present, to mitigate diagnostic delays and optimize outcomes.
Nocardiosis is a rare disease caused by aerobic, Gram-positive, weakly acid-fast bacteria from the genus Nocardia [1]. In the US, the estimated annual incidence is between 500 and 1,000 cases, although this depends on the geographical region [2, 3]. The overall average annual age-adjusted hospitalization rate in Western Europe is 0.04 per 100,000 inhabitants: 0.05 per 100,000 in males and 0.03 per 100,000 in females [4]. Nocardia comprises more than 80 species that are present in soil, long-standing dust, stagnant water, and decomposing plants. Human infection can occur through inhalation of the microorganisms or through skin injuries, causing local infections and/or dissemination to other organs via the bloodstream [1, 2, 5]. Among the over 50 potentially pathogenic Nocardia species (which vary by geographic region), N. asteroides, N. brasiliensis, N. farcinica, N. cyriacigeorgica, and N. nova are the most commonly identified causative agents [3-7]. Nocardiosis is usually an opportunistic infection occurring mainly in immunocompromised persons, solid organ transplant recipients, patients with hematological malignancies, and individuals on long-term immunosuppressive therapy [4, 6, 8]. Some reports indicate that COPD, bronchiectasis, alcoholism, and bronchial asthma can also predispose individuals to nocardiosis [9-13]. Nocardia farcinica, due to its higher pathogenicity, is more likely than other Nocardia species to invade even immunocompetent hosts, causing pulmonary and/or systemic infections [14-16].
The identification of Nocardia spp. and appropriate diagnosis can be delayed due to clinicians’ unfamiliarity with nocardiosis, non-specific symptoms (e.g., cough, fever, chest pain), radiological mimics (pneumonia, tuberculosis, lung cancer) [4,5,7, 17,18], and difficulties in bacterium culture [1,2]. Mortality rates vary widely (10–60%), influenced by species, infection site (skin, lungs, central nervous system [CNS], disseminated), host immunity, treatment timeliness and appropriateness of antibiotic therapy [2,5–7].
We present a case of a patient with severe bronchial asthma presenting with recurrent fever and worsening dyspnea, requiring multiple hospitalizations prior to definitive diagnosis of N.farcinica infection.
This case report aims to:
1. Describe the diagnostic and therapeutic challenges in a patient with severe bronchial asthma and COVID-19 coinfection later diagnosed with Nocardia farcinica pneumonia.
2. Emphasize the importance of considering nocardiosis in refractory respiratory infections, particularly in patients with chronic lung diseases receiving immunomodulatory therapy.
3. Highlight the role of advanced microbiological techniques (e.g., MALDI-TOF MS) in accelerating diagnosis.
We hypothesize that:
4. Undiagnosed Nocardia farcinica colonization in patients with chronic asthma may be unmasked by COVID-19-induced immune dysregulation and corticosteroid therapy.
5. Delayed recognition of nocardiosis in such cases contributes to prolonged morbidity and necessitates tailored antimicrobial strategies.
We report a 65-year-old male with severe asthma, nasal polyps and type 2 diabetes mellitus who presented with recurrent hospitalizations over a 9-month period (March 7–December 30, 2024; total hospitalization: 156 days) due to persistent fever (38–39°C), fluctuating productive/dry cough, progressive dyspnea, pleuritic chest pain, and generalized weakness.
| Period of hospitalization and location [ ], symptoms | Abnormal laboratory parameters at the time of hospital admission. | at dis-charge | Microbiological results | Additional key laboratory and diagnostic findings | Antibiotic treatment | Additional treatment | |
07/03-21/03/2024 [1] fever 39.20C productive cough worsening dyspnea, chest pain | CRP (mg/l) Hb (g/dl) WBC (x109/l) Neu% Glucose mg/dl | 446.1 14.7 14.1 83 261 | 11.6 17.1 14.4 76 144 | Blood culture: negative Sputum culture: negative Urine culture: negative | HS Troponin <10 ng/l pH=7.37, pCO2=41 mmHg , pO2=78 mmHg echocardiography: small amount of pericardial fluid, EF=55% abdominal ultrasonography: normal | Ceftriaxone iv. plus Ciprofloxacin i.v. | ICS, LABA, inh.Ach Insulin s.c. Clexane sc Dexamethasone iv 2x4 mg theophiline |
06/05-17/05/2024 [2] Fever 39.10C Productive cough exaggerated dyspnea at rest | CRP (mg/l) Hb (g/dl) WBC (x109/l) Neu % Eo % Glucose mg/dl | 200.1 14.4 12.3 75 1.1 206 | 2.05 15.3 8.7 57 1.0 116 | Sputum culture: Haemophilusparainfluenzae | FEV1=1.29 l (41% pred.) FEV1/FVC=57% FEV1=1.82 l (59% pred.) FEV1/FVC=64%
| Amoxicillin-clavulanic acid i.v. | ICS, LABA, inhAch Insulin s.c. Clexane s.c Dexamethasone iv 2x4 mg montelukast |
18/06-02/07/2024 [2] fever 38.50C productive cough exaggerated dyspnea at rest weakness | CRP (mg/l) Hb (g/dl) WBC (x109/l) Neu % Eo % Glucose mg/dl
| 322.3 13.0 12.1 86 0.1 253
| 5.2 11.9 10.9 74 0.1 80 | anty-Borelia IgG and IgM: negative anty- Mycoplasma IgG, IgM and IgA: negative sputum culture: coagulase negative Stapylococcus, Streptococcus gamma-haemoliticus blood and urine culture: negative | Nasal polyps and sinusitis in CT FEV1=1.19 l (38% pred.) FEV1/FVC=58% pH=7.46, pCO2=32 mmHg, pO2=61 mmHg IgE=68 IU/ml, NTproBNP=93pg/ml antibodies anty-SS-A, anty-Jo-1, anty-SCl-70, anty-dsDNA-screen negative echocardiography: small amount of pericardial fluid and fibrin, EF=58%, mild mitral valvulae insufficiency | Ceftriaxone iv. plus Clarithromycin i.v.
| ICS, LABA, inhAch Insulin-Actrapid Clexane sc Dexamethasone iv montelukast |
06/08-23/08/2024 [2] fever 38.80C productive cough worsening dyspnea at rest, weakness, chest pain | CRP (mg/l) Hb (g/dl) WBC (x109/l) Neut % Eo% D-dimer (ng/ml) Glucose mg/dl | 234.0 11.8 13.5 86 0 7150 122 | 4.94 13.9 8.3 58 2.6 ND 140 | SARS-CoV-2 antigen: negative Virus influaenze A and B: negative Legionella pneumophila antygen: negative Bronchial aspirate: Myc. TB negative, Str. viridans, coagulase negative Staphylococcus Anty-CMV IgG: positive Anty-CMV IgM: negative | Fiberoptic bronchoscopy: negative FEV1=1.49 l (49% pred.) FEV1/FVC=59% FEV1=1.95 l (64% pred.) FEV1/FVC=69% pH=7.40, pCO2=40 mmHg, pO2=75 mmHg pANCA and cANCA: negative ECG: atrium fibrillation 115/min Procalcitonin:0.08 ng/ml | Ceftazidime i.v.plus Ciprofloxacin
Amoxicillin-clavulanic ccidi.v. | ICS, LABA, inhAch Insulin-Actrapid Clexane sc Dexamethasone iv 2x4 mg i.v. montelukast |
23/09-10/10/2024 [3] fever 38.60C dry cough worsening dyspnea | CRP (mg/l) Hb (g/dl) WBC (x109/l) Neu % Eo % D-dimer (ng/ml) Glucose mg/dl | 458 12.2 18.3 81 0.2
470
94 | 329 12.7 7.7 91 0.1
1022
62 | SARS-Cov-2 antigen: positive (PCR) Blood culture: negative Urine culture: negative Sputum: Candida spp, Gram-negative bacteria -single Enterobacteriaceae | angioCT: exclusion of pulmonary embolism, progression but bilateral consolidations, nodules, cavitations antyphospholipid antibody negative
Procacitonin:0.45 ng/ml | Ceftriaxone i.v + Levofloxacin; next Ceftazidime i.v. + Fluconazole i.v. + Gentamycin | Oxygen: nasal prongs 4l/min ICS, LABA, inhAch Insulin- Clexane sc Dexamethasone iv 8mg Montelucast |
10/10-29/10/2024 [2] pulmonary changes fever, dyspnea at rest
| CRP (mg/l) Hb (g/dl) WBC (x109/l) Neu % Eo % D-dimer (ng/ml) Glucose mg/dl | 342 12.7 7.39 93 0.02 933 168 | 107 11.4 21.5 86 0.1 ND 112 | Antigen Legionella spp- negative Antybodies: IgA and IgG anty- Chlamydia and IgG and IgM anty-Mycoplasma negative Blood culture- negative Culture from bronchial aspirate: Klebsiella pneumoniae Myc. Tbc negative | pH=7.47, pCO2=43 mmHg , pO2=55 mmHg NTproBNP=760 pg/ml HIV duo-negative
| Meropenem i.v. Gentamycin i.m. Fluconazole i.v. Colistin inh. TMP-SMX i.v. | Oxygen : nasal prongs 4l/min Prednisone 30 mg ICS, LABA, inhAch Insulin-Actrapid Clexane sc Montelucast |
29/10-30/10/2024 [4] diagnostic stay for lung biopsy | Multiplex-PCR from bronchial aspirate: Acinetobacter baumani compex, Enterobacter cloace complex, Haemophilus inf., Escherich coli, Klebsiella aerogenes, Klebsiella oxytoca, Klebsiella pneumoniae, Moraxella catarrhalis, Proteus spp., Pseudomonas aeruginosa, Seratia marcescens, Staphylococcus aureus, Streptococcus pneumoniae, Legionella pneumoniae, Chlamydia pneumoniae, Mycoplasma pneumoniae Human Metapneumo-virus, MERS-CoV-2, virus RSV, virus Influenza A and B: all negative | BF; Transbronchial lung biopsy: specimens taken from left lower lobe- NSIP?/ amorphic masses in alveolar spaces | As above | As above | |||
30/10-03/12/2024 [2] fever 37.8 dyspnea, cough, fatigue | CRP (mg/l) Hb (g/dl) WBC (x109/l) Neu % Eo % Glucose mg/dl | 89.9 10.2 16.0 83 0.02 105 | 92.3 10.3 18.4 70 0,2 77 | Bronchial aspirate: weak fast acid Gram-positive bacteria Nocardia farcinica positive Bronchial aspirate: Candida crusei, coagulase negative Staphylococcus SARS-Cov-2 antygen: negative | pH=7.42, pCO2=45 mmHg, pO2=61 mmHg procalcytonin=0.17 ng/ml chest CT- partial regression consolidations and pleural fluid IgA,IgM, IgG- normal levels HIV Duo Quick: negative | Combination of TMP-SMX i.v.plus Linezolidi.v. plus Amikacin i.v.
| Oxygen: nasal prongs 2l/min Prednisone 30 mg ICS, LABA, inhAch Insulin-Actrapid Clexane, prednisone, |
03/12-31/12/2024 [5] continuation of treatment and rehabilitation | CRP (mg/l) Hb (g/dl) WBC (x109/l) Neu % Eo % Glucose mg/dl | 66.8 10.4 18.5 79 0.02 79 | 22.6 9.5 9.7 69 0.03 80 | SARS-Cov-2 antygen: negative | Procalcitonin=0.04 ng/ml Antibodies anty- HCV negative | Linezolid and Amikacin gradually discontinued TMP-SMX continuation | ICS, LABA, inhAch Insulin-Actrapid Clexane |
Table 1: summarizes the dates and locations of the patient's hospitalizations, symptoms, laboratory and microbiological test results, antibiotic therapy details, and other adjunctive medications administered.
Hospitalization Location: [1]- Department of Internal Medicine at Częstochowa Municipal Integrated Hospital.
[2] Department of Pulmonology at the Virgin Mary Provincial Specialist Hospital in Częstochowa.
[3] Department of Infectious Dieseases at Virgin Mary Provincial Specialist Hospital in Częstochowa.
[4] Department of General and Oncological Pulmonology at the Medical University of Łódź.
[5] Observation-Infectious Diseases and Hepatology Unit of the Silesian Center for Infectious Diseases, Upper Silesian Medical Center in Katowice.
Figure 1: shows chest X-ray images and serial chest computed tomography (CT) scans of the lungs obtained during successive hospitalizations from 7 March to 30 December 2024.
*05.03.2024 The chest CT scan shows a small volume of fluid in the left pleura (separation < 2 cm) and a minimal amount of fluid in the pericardial sac." (arrows). The chest X-ray (P-A view) shows blunting of the costophrenic angle on the left side. 10/05/2024 The chest X-ray shows no significant pathology.19/06/2024 The computed tomography shows persistent fluid in the left pleura and in the pericardial sac (black arrows), as well as minor infiltrative changes in the left lung (indicated by open white arrows).
22.08.2024 The chest X-ray shows no significant pathology 04.10.2024 CT shows bilateral asymmetric massive consolidative and infiltrative changes, as well as nodules with necrosis, and small areas of ground-glass opacities
*20/11/2024 CT shows persistent consolidative and infiltrative changes with slightly altered localization, but there is visible regression of fluid in the left pleural cavity. 23/12/2024 – CT shows partial regression of the consolidative and infiltrative changes, along with regression of fluid in the left pleural cavity."
Figure 2: Depicts a chest X-ray image and CT scans performed after discharge in December 2024.
18/02/2025 – CT shows almost complete remission of the lesions: only residual fibrotic changes are visible at the sites of previous consolidations and infiltrates; no cavitation was found. 11/07/2025 The chest X-ray shows no significant pathology
Initial empiric therapy, including broad-spectrum antibiotics, systemic and inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), inhaled anticholinergics (inhACh), short-acting beta-agonists (SABA), and insulin, yielded transient clinical improvement (reduced dyspnea, normalized body temperature, and decreased CRP/WBC levels). Chest computed tomography (CT) on admission (March 2024) demonstrated minimal bilateral pleural and pericardial effusions, which persisted on subsequent imaging. Extensive diagnostic workup excluded connective tissue diseases (lupus, scleroderma, polymyositis), granulomatosis with polyangiitis, malignancies, mycobacterial infections, fungal pathogens, and HIV. On September 29, 2024, the patient returned with acute respiratory failure and tested positive for SARS-CoV-2 antigen (nasopharyngeal swab). Despite treatment with dexamethasone, oxygen therapy, and empiric antibiotics, chest CT revealed bilateral infiltrates, cavitating consolidations, solitary nodules, and ground-glass opacities. CT angiography excluded pulmonary embolism, and antiphospholipid antibodies were negative. Following SARS-CoV-2 clearance, he was transferred to the Pulmonary Department (October 10, 2024), where Klebsiella pneumoniae was isolated from bronchial aspirate but later deemed a colonizer. A transbronchial lung biopsy and repeated microbiological analyses (October 29, 2024) at the Medical University of Łódź were inconclusive. Escalation to meropenem, colistin, and fluconazole in the Pulmonary Department in Częstochowa provided minimal benefit. Definitive diagnosis was achieved on November 11, 2024, when Gram-positive, branching, partially acid-fast filamentous bacilli were identified in bronchial aspirate via Giemsa and modified Ziehl-Neelsen staining. Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry (MALDI-TOF MS; bioMérieux VITEK® MS) confirmed Nocardia farcinica. Metastatic screening (brain CT, abdominal/skin ultrasonography) showed no abscess formation. Antimicrobial therapy was adjusted to intravenous linezolid (600 mg twice daily), trimethoprim-sulfamethoxazole (TMP-SMX; 10 mg/kg trimethoprim component every 8 hours), and amikacin (500 mg twice daily) for synergistic coverage. Steady clinical and radiological improvement permitted sequential de-escalation: amikacin was discontinued first, followed by linezolid. The patient was discharged on December 30, 2024, with instructions to continue oral TMP-SMX (960 mg four times daily) for six months.
Follow-Up and Outcomes:
Post-discharge chest CT (February 18, 2025) revealed near-complete resolution of consolidations, replaced by minor fibrotic changes. At 6-month follow-up (July 10, 2025), the patient remained afebrile with normal inflammatory markers (CRP: 8 mg/L, WBC: 8,8 × 10³/μL) and organ function (creatinine: 0.9 mg/dL, ALT: 28 U/L, AST: 19 U/L). Arterial blood gas analysis demonstrated adequate oxygenation (pH: 7.45, PaO₂: 77 mmHg, PaCO₂: 35 mmHg), and chest X-ray showed no active disease. Spirometry, however, indicated persistent severe obstructive dysfunction (FEV₁: 1.1 L, 30% predicted; FEV₁/FVC: 56%), likely reflecting underlying severe asthma with airway remodeling.
To our knowledge, this represents the first documented case of concurrent COVID-19 and N.farcinica coinfection in a patient with severe bronchial asthma, as reported in the English-language literature. The patient’s nonspecific presentation—fever, productive cough, and dyspnea—aligns with prior studies describing pulmonary nocardiosis, where overlapping symptoms delay diagnosis in 67–89% of cases [4,6,19]. Chronic respiratory conditions, including asthma, COPD, and bronchiectasis, are well-established risk factors for nocardiosis, with a Western European cohort identifying preexisting lung disease in 58% of cases [4]. In asthma, chronic inflammation drives goblet cell hyperplasia and mucin hypersecretion, impairing broncho-ciliary clearance and fostering bacterial colonization [11]. Concurrent inhaled corticosteroid (ICS) use may further compromise mucosal immunity, as ICS suppresses local neutrophil activity and epithelial defense mechanisms [11,12]. Initial imaging revealed rare manifestations of nocardiosis: minimal pleural and pericardial effusions. Pleural involvement occurs in 10–30% of pulmonary cases [4,6,19], while pericardial effusion—though exceptionally rare—has been associated with life-threatening tamponade, even in immunocompetent hosts [20,21]. Given the scant fluid volume, thoracentesis was deferred; however, fine-needle aspiration with cytochemical staining (e.g., Giemsa, modified Ziehl-Neelsen) could expedite diagnosis in such scenarios achieving sensitivity of 78–92% [22,23]. Notably, conventional sputum or blood cultures are suboptimal for Nocardia detection due to its slow growth (4–6 weeks on aerobic media) and susceptibility to overgrowth by commensals [1,2]. In our case, repeated cultures were discarded prematurely (standard protocol: 2–3 weeks), a practice linked to 31% false-negative rates in patients pretreated with antibiotics [1,7]. Microscopic identification of branching, beaded Gram-positive bacilli warrants advanced diagnostics, such as MALDI-TOF MS, 16S rRNA sequencing, or metagenomic next-generation sequencing (mNGS) [2,24] particularly given that 23% of pulmonary nocardiosis cases involve mixed infections (e.g., Aspergillus fumigatus, cytomegalovirus, Streptococcus pneumoniae) [6]. Post-COVID-19 readmission revealed in our patient radiographic progression with consolidations, cavitations, and nodules—features present in 10–23% of nocardiosis cases [4,17,18]. While similar CT patterns may arise in bacterial (e.g., Klebsiella pneumoniae, Staphylococcus aureus) or fungal (mucormycosis, Pneumocystis jiroveci) superinfections [25], bacterial co-infections remain often underrecognized in COVID-19 affecting 11% of hospitalized and 22.5% of critically ill patients [26]. Although Nocardia coinfection with COVID-19 is exceedingly rare [27–32], SARS-CoV-2-induced immune dysregulation and corticosteroid therapy may unmask latent infection. We hypothesize that undiagnosed N. farcinica colonization can precede COVID-19 infection [27] with transient suppression by broad-spectrum antibiotics (e.g., meropenem) insufficient to eradicate the pathogen. Subsequent dexamethasone administration for COVID-19—a known risk factor for nocardiosis (OR: 4.7) [19]—likely facilitated disease progression. Diagnostic delays spanned 250 days from initial admission, assuming early effusions signaled nocardiosis onset. If COVID-19 triggered symptomatic progression, the delay aligns with reported intervals (17–42 days) [4,8]. Concurrent ICS use during hospitalization aligns with recent reports of rapid Nocardia emergence post-COVID-19 (5–50 days) [33]. Treatment challenges in our patient mirror those in prior cases of asthma-associated nocardiosis [12,13,14], which reported pulmonary consolidations and nodular changes managed with broad-spectrum antibiotics, high-dose inhaled and systemic corticosteroids, long-acting beta-agonists (LABA), short-acting beta-agonists (SABA), inhaled anticholinergics (e.g., tiotropium). Our case confirms that clinicians may initially attribute imaging findings to asthma exacerbations or routine infections, delaying targeted testing (e.g., cultures, biopsies) for Nocardia. Prolonged use of empirical antibiotics (e.g., for bacterial pneumonia) can mask symptoms while allowing nocardial infection to progress. The coinfection of COVID-19 and nocardiosis poses unique diagnostic and therapeutic challenges due to overlapping risk factors, immune dysregulation, and treatment-related complexities, which collectively may contribute to mortality in some cases [30]. Notably, N. farcinica exhibits intrinsic resistance to third-generation cephalosporins, carbapenems, and fluoroquinolones [3], rendering empiric regimens ineffective. Combination therapy with trimethoprim-sulfamethoxazole (TMP-SMX), linezolid, and amikacin—selected based on susceptibility data [3]—achieved clinical resolution, underscoring the importance of tailored prolonged (6-12 months) regimens. Despite N. farcinica’s high mortality in immunocompromised hosts (30–40%) [34,35], early appropriate therapy reduces mortality to 5–10% [35]. Six-month oral TMP-SMX maintenance, guided by comorbidities, resulted in near-complete radiological resolution, though persistent spirometric obstruction (FEV₁: 31% predicted) likely reflects irreversible asthma-related remodeling.
The patient’s prolonged course may reflect age-related immuno-senescence and metabolic dysregulation (e.g., diabetes), both linked to reduced Sirtuin 1 (SIRT1) activity—a critical regulator of inflammation and cellular stress responses [36]. While we did not assess SIRT1 levels in this case, future studies could explore its role in patients with overlapping infections.
This case underscores the imperative to consider nocardiosis in asthmatic patients on immunomodulators presenting with refractory pneumonia, particularly during COVID-19. Diagnostic delays—exacerbated by overlapping symptoms and empiric antibiotic use—can be mitigated through repeat bronchoscopic sampling and advanced diagnostics (e.g., MALDI-TOF MS). Our findings support the hypothesis that COVID-19-related immune perturbations and corticosteroid therapy may unmask latent Nocardia colonization. Heightened clinical suspicion and prolonged tailored regimens are essential to optimize outcomes in this vulnerable population.
The patient provided written informed consent for the publication of this case report. The study protocol and publication were approved by the Ethics Committee of the Virgin Mary Provincial Specialist Hospital in Częstochowa, Poland.
The authors thank the patient for consenting to the publication of this case report and acknowledge the nursing staff of the Virgin Mary Provincial Specialist Hospital in Częstochowa, Poland for their dedicated care throughout the patient’s prolonged hospitalization.
The authors declare no conflict of interest
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"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
I would like to offer my testimony in the support. I have received through the peer review process and support the editorial office where they are to support young authors like me, encourage them to publish their work in your esteemed journals, and globalize and share knowledge globally. I really appreciate your journal, peer review, and editorial office.
Dear Agrippa Hilda- Editorial Coordinator of Journal of Neuroscience and Neurological Surgery, "The peer review process was very quick and of high quality, which can also be seen in the articles in the journal. The collaboration with the editorial office was very good."
I would like to express my sincere gratitude for the support and efficiency provided by the editorial office throughout the publication process of my article, “Delayed Vulvar Metastases from Rectal Carcinoma: A Case Report.” I greatly appreciate the assistance and guidance I received from your team, which made the entire process smooth and efficient. The peer review process was thorough and constructive, contributing to the overall quality of the final article. I am very grateful for the high level of professionalism and commitment shown by the editorial staff, and I look forward to maintaining a long-term collaboration with the International Journal of Clinical Case Reports and Reviews.
To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
