Nocardiosis: Updated Clinical Review and Experience at a Tertiary Center

Abstract

Nocardiosis is a rare opportunistic disease that affects mainly patients with deficient cell-mediated immunity, such as those with acquired immunodeficiency syndrome (AIDS) or transplant recipients. Pulmonary disease is the most common presentation in immunosuppressed patients and approximately one-third have a disseminated disease. Primary cutaneous nocardiosis is more frequently observed in immunocompetent patients with direct inoculation of the organism through professional exposure. The diagnosis can be challenging, as signs and symptoms are not specific and a high index of clinical of suspicion is necessary. Although gram stain, modified acid-fast stain, and cultures remain as the standard diagnostic tools, novel molecular techniques have changed the taxonomy of these organisms and, in some instances, have facilitated their identification. The disease has a marked tendency to recur and a high morbidity and mortality rate in immunosuppressed patients. Treatment is usually prolonged and an associated antibiotic treatment is preferred for severe disease. Although sulfonamides in combination with other antibiotics are still the treatment of choice, other associations such as imipenem plus amikacin are preferred in some centers. Linezolid is a useful alternative therapeutic agent due to its oral availability and activity against most of the isolates studied. Twenty-eight cases of nocardiosis were diagnosed at our center between January 1989 and April 2009. We report the epidemiologic characteristics of Nocardia spp. observed in our institution and discuss the risk factors, clinical features, diagnosis, and management of the disease.

Diversity and frequency of Nocardia spp. in the soil of Isfahan province, Iran

“…Increase in the infections caused by these organisms, with different clinical forms of systemic and disseminated forms of nocardiosis in transplant recipients, tuberculosis, liver cirrhosis, cancer, diabetes, AIDS and patients under treatment with immunosuppressive drugs and broad spectrum antibiotics in the world, reveals more importance of isolation and identification of these agents [2,[11][12][13][14][15][16][17][18][19][20][21][22][23][24] . Various studies have shown that identification and isolation of these agents in soil of different areas help to diagnose nocardiosis [1] .…”

Disseminated Nocardia farcinica infection in a patient with systemic lupus erythematosus

“…Deepseated soft tissue infection can occur by local traumatic inoculation or by haematogenous dissemination. In general, haematogenous dissemination was characteristic of immunocompromised hosts (Ambrosioni et al, 2010). Disseminated disease was present in four of the ten patients.…”

“…(Smego et al, 1983). The duration of therapy is variable and depends on the site of the lesions and the patient's immune status (Ambrosioni et al, 2010). If the CNS is involved, therapy must last for at least 12 months (Lerner, 1996).…”

Nocardia brasiliensis Infection Mimicking Juvenile Idiopathic Arthritis in a 4-Year-Old Girl

“…3 Typically, N asteroides results in pulmonary and disseminated disease, whereas N brasiliensis is more often associated with cutaneous and soft tissue infections. 4 Arthritis is a rare presentation of Nocardia infection. Most reported cases involve immunocompromised adults with disseminated disease or previously healthy people after a penetrating injury to the affected joint.…”