Clinical findings of 40 patients with nocardiosis: A retrospective analysis in a tertiary hospital

Abstract

To the best of our knowledge, no Chinese case studies concerning Nocardia infection have been published to date. Therefore, the present study aimed to retrospectively evaluate the risk factors, clinical features, imaging results, laboratory abnormalities, treatments and outcomes of nocardiosis in a Chinese tertiary hospital. Data collected from patients with laboratory-confirmed nocardiosis were retrospectively analyzed. A total of 40 patients who had a positive culture of Nocardia were included. The median time between the onset of symptoms and diagnosis was 42 days. Underlying diseases were identified in 72.5% of the patients of which diabetes was the most common (32.5%). The most important risk factor was corticosteroid administration. Fever and cough were common clinical symptoms. The pleuropulmonary (85%) were the most frequently involved sites and the disseminated disease rate was 30.0%. Frequent chest computed tomography scans revealed the presence of airspace opacities, nodules and masses, in addition to cavitary lesions that were particularly common among the study group. Brain images revealed lesions associated with abscesses. The majority of the patients (71.1%) were treated with trimethoprim sulfamethoxazole alone or in combination with other drugs. The in-hospital mortality rate was 15.0%. Disseminated disease, immunocompromised patients, an older age, brain involvement and concomitant infections were associated with a poor prognosis. Nocardiosis is an uncommon but emerging disease. The present study reports the first case series on nocardiosis from China and provides important information on the clinical features and risk factors of nocardiosis. Early recognition of the disease and the initiation of appropriate treatment are essential for a good prognosis.

Role of FNA and Special Stains in Rapid Cytopathological Diagnosis of Pulmonary Nocardiosis

“…Immunodeficiency following renal, heart, and bone marrow transplants, AIDS, diabetes, chemotherapy, and corticosteroid treatment for rheumatoid arthritis or systemic lupus erythematosus, for example, can predispose to Nocardia infection [8, 9]. Studies by Yang et al [10] in 2014 and Hui et al [11] in 2003 have shown that bronchiectasis and other structural lung abnormalities such as COPD are also prominent risk factors. This was observed in our patient having COPD as well.…”

Nocardia spp.: A Rare Cause of Pneumonia Globally

“…5,16 Nocardiosis is more common in males. 36,79,80 Additionally, chronic lung disease, 5,11,12,16,81,82 bronchiectasis, 10 prior tuberculosis, 12 cystic fibrosis (CF), 83 diabetes mellitus, 16,17 and alcohol abuse 16 may predispose to pulmonary nocardiosis even without overt evidence for impaired immunity. Well-recognized risk factors for nocardiosis include corticosteroid (CS) use 11,21,84,85 ; IS status 2,32,86,87 ; chronic granulomatous disease (CGD) [88][89][90] ; solid organ transplant (SOT) [6][7][8]54,91,92 ; HSCT 3 ; hematological malignancies, cancer, or chemotherapy 3,93,94 ; human immunodeficiency virus (HIV) infection 11,77,[95][96][97] ; and pulmonary alveolar proteinosis.…”

Unexplained Pleural Infection in an Immunosuppressive Patient: Nocardiosis

“…Nocardiozis, sıklıkla kortikosteroid tedavi alan ya da sistemik immünsüpresif kişilerde ortaya çıkmaktadır. Örneğin; solid organ nakilleri, diyabet, otoimmün hastalıklar, kronik akciğer hastalığı, kronik granülomatöz hastalık, kronik alkolizm ve HIV infeksiyonu gibi (6). İnhale beklometazon dipropionat kullanırken infeksiyonun görüldüğü olgu da bildirilmiştir (4).…”