Cytological diagnosis of pulmonary nocardiosis in an immunocompromised patient

Kumar, Rajiv; Chhina, Deepinder; Kaushal, Vikas; Mahajan, Ramit; Kaur, Harpreet

doi:10.4103/0255-0857.43576

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…The microbiology laboratory should be informed that Nocardia spp. is suspected as the bacteria require specific media, a long culture period and modified Ziehl-nelsen staining for direct demonstration [24, 25]. In immunosuppressed patients, a positive sputum culture is more likely to indicate disease and not colonization, and the patients must be treated.…”

Section: Discussionmentioning

confidence: 99%

Allergic Broncho Pulmonary Aspergillosis Complicated by Nocardiosis

Sharma

Ghosh

Kamble

et al. 2012

Case Reports in Pulmonology

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We describe a 70-year-old male with a history of diabetes mellitus, hypertension, and asthma who presented with increasing breathlessness for 5 months. He was diagnosed to have allergic bronchopulmonary aspergillosis (ABPA) by serological and radiographic criteria. He was treated with steroids and itraconazole. After initial improvement, he developed fever with cough and mucopurulent sputum. X-ray chest revealed multiple cavities with air fluid level. Patient was treated with antibiotics without any response. Sputum was negative for acid fast bacilli (AFB). Sputum culture for bacteria and fungus did not reveal any significant growth; however a delayed growth of Nocardia was noted on fungal plates. Modified Ziehl Nelsen stain was positive for AFB. Patient was treated with cotrimoxazole. We discuss the serological and radiological criteria of ABPA, presentation and treatment of nocardia pulmonary infection and other possible causes of necrotizing pneumonia in immunocompromised settings.

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Section: Discussionmentioning

confidence: 99%

Allergic Broncho Pulmonary Aspergillosis Complicated by Nocardiosis

Sharma

Ghosh

Kamble

et al. 2012

Case Reports in Pulmonology

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“…Nocardia has emerged as an important opportunistic pathogen in immunocompromised individuals, with pneumonia as the most common clinical presentation [1]. Impaired cellular immunity due to diabetes mellitus, acquired immunodeficiency syndrome (AIDS), malignancies, and treatment with steroids and immunosuppressants are known risk factors of this disease [2, 3].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Background: Nocardia, a gram-positive aerobic bacillus of the Actinomycetales family, is a significant opportunistic pathogen in immunocompromised individuals. Clinical and radiological features of pulmonary nocardiosis are nonspecific and can be misdiagnosed as tuberculosis, pneumocystis, staphylococcal or fungal infections, or as malignancy. Aspiration cytology with special stains is a quick and effective approach for accurate diagnosis. Materials and Methods: We present 7 cases of pulmonary nocardiosis, admitted to the pathology department in a tertiary-care hospital in Punjab. Clinical findings, immune status, laboratory tests, chest radiographs, and computed tomography scans were reviewed. Cytologically, special stains like 1% Ziehl-Neelsen (ZN), 20% ZN, periodic acid-Schiff (PAS), Grocott methenamine silver (GMS), and reticulin stains were studied along with May-Grünwald Giemsa, Papanicolaou, and hematoxylin and eosin. Results: All the patients were immunocompromised. The radiological changes were nonspecific. Cytomorphology showed acute and chronic inflammatory infiltrates with necrosis. None of the cases showed well-defined granulomas. GMS, modified 1% ZN and, Gordon and Sweet reticulin stains highlighted the delicate filamentous bacteria in all cases. PAS and 20% ZN stain for tuberculous bacilli were uniformly negative. Conclusion: FNAC can provide a quick and accurate diagnosis of nocardiosis and thereby facilitate timely medical management.

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