Clinical characteristics, microbiology, and outcomes for patients with lung and disseminated nocardiosis in a tertiary hospital

Abstract

These results highlight the protean disease manifestations and antimicrobial susceptibility of Nocardia and indicate the need to address the option of combined antimicrobial therapy for lung and disseminated nocardiosis.

Disseminated nocardiosis in an immunocompetent patient

“…[9] Despite appropriate therapy, the overall mortality rate is high due to delay in diagnosis or to the debilitated state of patients with severely compromised host defences. Wang et al [3] showed that the mortality from lung nocardiosis in their cohort was 33%.…”

“…The most common species are N. asteroides and N. brasiliensis. [3,4] Transmission in humans is by direct skin inoculation or inhalation.…”

“…Sulphonamides such as co-trimoxazole have been the mainstay of treatment for nocardiosis but newer studies indicate resistance to co-trimoxazole. [3] Combination therapy of co-trimoxazole plus a carbapenem, or third-generation cephalosporins, or minocycline with or without amikacin have been the primary regimens for the treatment of pulmonary, disseminated, or brain nocardiosis especially in patients receiving immunosuppressive agents. [9] Despite appropriate therapy, the overall mortality rate is high due to delay in diagnosis or to the debilitated state of patients with severely compromised host defences.…”

CT findings of pulmonary nocardiosis: a report of 9 cases

“…High resolution CT (HRCT), which can depict lung structures and pathogenic changes with excellent details, is often used to evaluate pulmonary parenchyma and interstitial abnormalities (18)(19)(20). Comparing to conventional radiography, HRCT can detect pathologic changes of pulmonary nocardiosis at early phase and in better characteristics (5,6). In a pictorial review, Kanne et al illustrated that CT findings of pulmonary nocardiosis included lung consolidation, nodules/masses, pleural involvement and chest wall extension (9).…”

“…Because its clinical presentations are nonspecific as subacute pneumonia, pulmonary nocardiosis is difficult to diagnose. If correct diagnosis can be obtained, pulmonary nocardiosis respond favorably to high-dose sulfonamide therapy, otherwise, hematogenous dissemination to soft tissue and brain is association with high morbidity and mortality (5)(6)(7). Therefore, prompt diagnosis and treatment is essential for improving patients' outcome.…”