Nocardia Infections of the Face and Neck

Abstract

Involvement of the soft tissues of the face and neck by Nocardia spp. is uncommon. We review the epidemiology, clinical features, diagnosis, and management of such infections in the setting of primary cutaneous nocardiosis and disseminated disease. Although immune compromise is an important risk factor for these infections, they also occur in healthy individuals. Infection may arise through direct inoculation following injury or by hematogenous spread from a primary site, usually the lung. The rare variant of lymphocutaneous disease-cervicofacial nocardiosis-typically affects children, but can occur in adults. The diagnosis is made by conventional microscopy and culture, but radiological imaging is useful to delineate disease extent, and molecular methods are increasingly assisting the diagnosis by providing rapid detection and identification of the pathogen. Sulfonamides remain the preferred treatment for many cases and are an important component of the therapeutic armamentarium. Other therapeutic options include minocycline, the carbapenems, and linezolid.

Nocardiosis in a Patient with Acute Necrotizing Pancreatitis. aCn A Simple Microscope Specimen Save a Patient’s Life? A Case Report

“…In this case, the laboratory prepared the direct specimen treated with Gram's staining method, in accordance to the regulations [8]. Threadlike branching bacteria was present in the specimen (Figure 2), as evidenced in literature [8].…”

“…in the specimen. This species of bacteria are present in the natural environment -in the soil, water and air [8]. Hence, all human infections caused by Nocardia spp.…”

“…in the specimen, the recommended treatment of choice in nocardiosis was ordered, i.e. trimethoprim/ sulfamethoxazole [8,13]. Since Nocardia spp.…”

Cutaneous Nocardiosis

“…Lymphocutaneous nocardiosis is the most unusual form [29,30] or probably underestimated for the similarity with sporotrichosis, a more common deep fungal infection characteristically spreading along lymphatics after a skin injury. A certain predilection for children has been noted [31,32] extremities are more affected, but hands follow, especially in patients with a history of gardening or thorn injuries, preceding of several days the eruption onset ( Figure 4). Sometimes the port of entry is hardly detectable, otherwise affected with a swollen erythematous excoriation or ulcer, but the attention is attracted from the multiple erythematous painful nodules or satellite pustules linearly distributed on the main veins and lymphatics, proximally moving with lymphangitis striae towards the regional lymph nodes.…”

“…Puncture or other contaminated traumatic inoculum, such as thorn, insect or animal bite, scratch, bullet injury, intravenous drug abuse [9,19,47,48]. Occupation like farmer, shepherd, gardener, and an history of rural background or barefoot walking may help in typical pedal mycetoma, but unusual site are also to be considered, such as the face, neck, breast, back or even the scalp, after a car incident, and the vulva simulating an advanced carcinoma [31,[49][50][51][52].…”