Nocardial Infections in the United States, 1972-1974

Abstract

A survey of members of the Infectious Diseases Society of America indicated that nocardial infections are not rare. Probably between 500 and 1,000 cases are recognized in the United States each year, of which 85% are serious pulmonary or systemic infections. Although nocardial infections are usually opportunistic infections in the compromised host, at least 15% of the infections in this series occurred in patients without a definable predisposing condition. Nocardial infections occurred in a random geographic distribution within this country, with affected males outnumbering females by 3:1. Most patients were between the ages of 21 and 50 years; however, the age range was broad. The number and variety of infections caused by Nocardia species other than Nocardia species other than Nocardia asteroides have been underestimated. Between 8.6% and 18.8% of pulmonary-systemic infections in this series were caused by species of Nocardia other than N. asteroides.

The medically important aerobic actinomycetes: epidemiology and microbiology

“…However, it was not until the retrospective analysis by Presant (434). These and other more recent reviews have suggested that nocardiosis is an increasingly recognized cause of opportunistic infection that may be associated with a variety of underlying disorders, receipt of chemotherapeutic agents, or both (41,43,124,641).…”

The Elusive SIRS Diagnosis

“…7 However, as many as 15 % of Nocardia cases do not have the above-mentioned standard risk factors. 8 In this patient, alcohol was the presumptive cause of a T cell defect. 3 Nocardia is a soil dweller and readily aerosolizes.…”

Nocardial infection of the skin

“…Although the view has been expressed that nocardia may colonize the respiratory tract particularly in those with chronic obstructive airways disease (Peabody & Seabury, 1960), this is not a common finding (Raich, Casey & Hall, 1961). By contrast, invasive pulmonary infection is the commonest clinical manifestation of systemic nocardiosis and can be caused by all three pathogenic Nocardia species (Beaman et al 1976). Although it is usually an acute or subacute respiratory disease, on rare occasions lesions may persist for many years (Kirby & McNaught, 1946).…”

“…Most appear to arise following bloodstream spread but others may result from direct extension from a pulmonary focus through the chest wall. (Beaman et al 1976) the organism was considered to be an opportunistic pathogen in 53 % of 253 cases reported. Immunosuppressive therapy, organ transplants or neoplasia were the commonest underlying factors.…”

“…While nocardiosis is generally regarded as a respiratory infection which may disseminate from the primary focus, a significant number of patients present with solitary extrapulmonary or extraneural lesions; 3900 in the survey mentioned previously (Beaman et al 1976). The usual sites of these focal lesions are the skin, subcutaneous tissue or joints.…”