Clinical Features, Radiological Findings, and Treatment Outcomes in Patients with Pulmonary Nocardiosis: A Retrospective Analysis

Abstract

IntroductionLack of specific clinical features makes the diagnosis of pulmonary nocardiosis difficult. A high index of suspicion is required for diagnosis especially in cohorts with pre-existing risk factors. This study aimed to study the clinical and radiological characteristics and outcomes in patients with pulmonary nocardiosis. MethodsThis was a retrospective observational study. Data of confirmed cases with pulmonary nocardiosis were collected from a digital patient management system. ResultsA total of eight cases of pulmonary nocardiosis were included. The mean age of patients was 50 ± 14.3 years with a female preponderance (62.5%). The most common co-morbidity was chronic lung disease (37.5%). The common clinical feature of pulmonary nocardiosis was cough with expectoration (50%) and the mean duration of symptoms was 18 days. The common radiological (CT thorax) findings were consolidation, bronchiectasis, mediastinal lymphadenopathy, and nodularity (50% each). One patient had an extension of pulmonary disease in the chest wall. Microbiological detection of Nocardia spp. was done in sputum samples (50%) and in bronchoalveolar lavage (BAL) samples (50%). Culture was positive in two BAL samples. Intravenous empirical antibiotics in combination with oral trimethoprim-sulfamethoxazole double standard (15 mg/kg trimethoprim) were started at the time of diagnosis. Ceftriaxone and amikacin were commonly used antimicrobials. ConclusionNocardia spp. commonly causes disease in patients with pre-existing chronic disease. A high index of suspicion is required in patients with subacute to chronic respiratory symptoms, raised inflammatory markers, and the absence of common respiratory pathogens in evaluation.

Clinical Features of Pulmonary Nocardiosis in Patients with Different Underlying Diseases: A Case Series Study

“…The most common imaging manifestations of PN were nodules, consolidation, and mediastinal lymph node enlargement, with or without cavity. 16 This study also found that the tree-in-bud pattern on the basis of bronchiectasis can be a manifestation of PN. However, lung CT manifestations of pulmonary nocardiosis patients were not specific, and were difficult to differentiate from other infectious diseases.…”

Large mediastinal mass diagnosed as Nocardia infection by endobronchial ultrasound-guided transbronchial needle aspiration in a ceramic worker: A case report

“…Although Nocardia more frequently causes invasive infections in immunocompromised patients, it can also occur in immunocompetent patients. Pulmonary Nocardia could manifest pulmonary airspace consolidation, pulmonary nodules, pulmonary infiltrates, cavitation, and pleural effusion (5). Herein, we report an immunocompetent patient who had a large mediastinal mass and presented with a fever.…”

Nocardiosis: a single-center experience and literature review

“…The association of idiopathic CD4 lymphocytopenia and nocardiosis is less studied but was already described. 16 Moreover, in a recent retrospective multicenter cohort study who aimed to identify the factors associated with Nocardia spp . dissemination, lymphopenia was an independent risk factor for DN and correlates with a worst prognosis.…”