CT findings of pulmonary nocardiosis: a report of 9 cases

Liu, Baoliang; Zhang, Yuanlong; Gong, Jingshan; Shu-bing, Jiang; Huang, Yunkai; Wang, Lingwei; Xu, Junjun; Qiu, Chen

doi:10.21037/jtd.2017.09.122

Cited by 23 publications

(21 citation statements)

References 20 publications

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“…Common CT thorax ndings in Pulmonary Nocardiosis were parenchymal nodules, consolidation, mediastinal lymphadenopathy with or without cavitation present in around 70% of patients. Above CT abnormality in immunocompromised patients with high clinical suspicion may suggest the likelihood of Pulmonary Nocardiosis (11). Con rmation of diagnosis is requiring identi cation and isolation of Nocardia spp.…”

Section: Resultsmentioning

confidence: 99%

Clinical Features, Radiological Findings and Treatment Outcome in Patients with Pulmonary Nocardiosis – A Retrospective Analysis

Yadav

Meena

Kumar

et al. 2021

Preprint

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Introduction - Lack of specific clinical features makes the diagnosis difficult in Pulmonary Nocardiosis. High index of suspicion is required for diagnosis especially in cohort pre-existing risk factors. This study aimed at describing the clinical and radiological characteristics and outcome in patients with Pulmonary Nocardiosis.Methods - This was a retrospective observational study. Data of confirmed cases with Pulmonary Nocardiosis were collected from digital patient management system. Results - Total eight cases of Pulmonary Nocardiosis were included. The mean age of patients was 50 ± 14.3 years with female preponderance (62.5%). The most common co-morbidity was chronic lung disease (37.5%). The common clinical feature of pulmonary nocardiosis was cough with expectoration (50%). The mean duration of symptoms was 18 days. The common radiological (CT thorax) finding were consolidation, bronchiectasis, mediastinal lymphdenoathy and nodularity (50% each). One patient had extension of pulmonary disease in chest wall. Microbiological detection of Nocardia spp. was done in sputum samples (50%) and in BAL samples (50%). Culture was positive in two BAL samples. Intravenous empirical antibiotics in combination with oral trimethoprim sulfamethoxazole double standard (15 mg/kg trimethoprim) was started at the time of diagnosis. Ceftriaxone and amikacin were commonly used antimicrobials.Conclusion - Nocardia spp. commonly causes disease in patients with pre-exisitng lung pathological with or without defective cell mediated immunity. A high index of suspesion is required in patients with subacute to chronic respiratory symptoms, raised inflammatory markers and absence of common respiratory pathogens in evaluation.

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Section: Resultsmentioning

confidence: 99%

Clinical Features, Radiological Findings and Treatment Outcome in Patients with Pulmonary Nocardiosis – A Retrospective Analysis

Yadav

Meena

Kumar

et al. 2021

Preprint

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“…They found nodules ( n = 13, 32.5%), cavitation ( n = 12, 30.0%), consolidation ( n = 9, 22.5%), and masses ( n = 5, 12.5%) but no lymph node enlargement. Liu et al also reported nine cases of pulmonary nocardiosis, with consolidation ( n = 8, 88.9%) and mass or nodule ( n = 6, 66.7%) being the most common CT findings , but only two patients had lymph node enlargement. As both mediastinal lymph node enlargement and a mass were present on CT, it took time to determine an accurate diagnosis.…”

Section: Discussionmentioning

confidence: 97%

Pulmonary nocardiosis caused by Nocardia exalbida mimicking lung cancer

Miyaoka

Nakamoto

Shirai

et al. 2019

Respirology Case Reports

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Nocardiosis is an uncommon infection caused by Nocardia species, but it can often occur in immunocompromised patients. As computed tomography (CT) findings of pulmonary nocardiosis, consolidation, masses, and nodules are often found, but lymph node enlargement is infrequent. Nocardia exalbida was first isolated in 2006, and there are still few reports on this microorganism. We report a case of pulmonary nocardiosis caused by N. exalbida presenting as a mass and lymph node enlargement that mimicked lung cancer. A 76‐year‐old man was referred and admitted to our hospital because of persistent cough, sputum production, and chest discomfort. Chest CT showed a mass in the superior segment of the left upper lobe and mediastinal lymph node enlargement. After we performed bronchoscopies, Nocardia species was isolated in a cultured specimen and identified as N. exalbida. This case required differentiation from lung cancer and was difficult to diagnose.

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“…Our patient presented cough, purulent sputum, and occasional chest pain that did not improve despite the prophylactic use of oral voriconazole for 20 days. Radiological imaging of pulmonary Nocardia is non-specific as well and is generally focused under the pleura with occasional presence of pulmonary consolidation, pulmonary infiltration, solitary or multiple nodules, and other changes and with easy formation of voids [ 16 ]. These symptoms and radiological imaging provided poor clues to distinguish Nocardia infection from infection by other pathogens (e.g., pulmonary actinomycosis, tuberculosis, fungus), vasculitis or malignant tumors.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Nocardia infection in a child with idiopathic pulmonary hemosiderosis

et al. 2021

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Background Idiopathic pulmonary hemosiderosis (IPH) encompasses a rare and agnogenic group of diffuse alveolar capillary hemorrhagic diseases. Corticosteroid treatment is the globally preferred therapeutic strategy for IPH; however, it can cause immunodeficiency. Nocardia infection often occurs in immunocompromised patients and primarily involves the pleura and lungs. Herein, we describe a case of pediatric pulmonary Nocardia infection after the corticosteroid treatment of IPH. Case presentation A 7-year-old girl presented with chief complaints of pale complexion persisting for 1 year and a cough for 20 days. Abundant hemosiderin-laden macrophages were detected in the gastric juice, which supported the diagnosis of IPH. Uninterrupted doses of corticosteroids were administered during the last hospitalization. After nearly 2 months of corticosteroids therapy, the patient began to cough and produce a purulent sputum. Next-generation sequencing of the bronchoalveolar lavage fluid revealed Nocardia abscessus (N. abscessus) DNA. Linezolid was administered with good response, and the patient was discharged after 18 days of hospitalization. Her symptoms and pulmonary lesions had recovered, and the IPH appeared to be well-controlled with low dose of corticosteroids in follow-up. Conclusions Nocardia infection should be considered in the differential diagnoses for IPH patients receiving corticosteroid therapy, especially in patients with poor response to conventional empirical antibiotic therapy. Next-generation sequencing of bronchoalveolar lavage fluid may be used to quickly identify the Nocardia. Sulfonamides or linezolid are effective for pediatric pulmonary Nocardia infection.

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CT findings of pulmonary nocardiosis: a report of 9 cases

Cited by 23 publications

References 20 publications

Clinical Features, Radiological Findings and Treatment Outcome in Patients with Pulmonary Nocardiosis – A Retrospective Analysis

Clinical Features, Radiological Findings and Treatment Outcome in Patients with Pulmonary Nocardiosis – A Retrospective Analysis

Pulmonary nocardiosis caused by Nocardia exalbida mimicking lung cancer

Pulmonary Nocardia infection in a child with idiopathic pulmonary hemosiderosis

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