Pulmonary nocardiosis re-visited: experience of 35 patients at diagnosis

Abstract

Pulmonary infection by Nocardia is an uncommon opportunistic infection in humans. Thirty-five patients with pulmonary nocardiosis were identified in two tertiary referral hospitals. A retrospective review of the patient characteristics, clinical and laboratory features including antimicrobial susceptibility at diagnosis was carried out. Radiological features derived from chest radiographs and CT scans were also documented. In our population, the predominant risk factors were immuno-compromised state, corticosteroid therapy, and underlying pulmonary pathology. The presenting features were similar to those previously described but disseminated infection was not common. The radiological changes were diverse and non-specific. Nocardia asteroides was the commonest species. Most Nocardia isolates were susceptible to imipenem, ceftriaxone, amikacin, and cotrimoxazole. Co-existing microbial agents are common and reflect the underlying complex disorders.

Disseminated Cerebral and Intradural Extramedullary Spinal Nocardiosis in an Immunocompetent Patient

“…Nocardia often presents as an opportunistic infection in immunocompromised patients. The predisposed population includes post-organ transplantation patients on immunosuppression therapy, patients with acquired immune deficiency syndrome (AIDS) and patients on chronic steroid therapy [1][2][3][4][5][6] . Cerebral nocardia infection is rare and accounts for only 1-2% of all cerebral abscesses.…”

“…Central nervous system (CNS) nocardia infection is notoriously difficult to diagnose as presenting symptoms are non-specific and dependent on the anatomical location of the lesion. Previously reported symptoms include headaches, visual disturbances, ataxia, seizures, focal neurological deficits and myelopathy [5,6] . Only through biopsy of the lesion and culture can early identification of the organism be made and proper antimicrobial therapy instituted.…”

The Elusive SIRS Diagnosis

“…3 Nocardia is a soil dweller and readily aerosolizes. Its common portal of entry is through the lungs, 9 and it is associated with chronic lung disease, especially bronchiectasis. 10 It can cause endocarditis and frequently disseminates to the central nervous system, as it did in this patient.…”

Multiple Cavitary Nodules Accompanied by Pulmonary Nocardiosis in a Patient with Systemic Lupus Erythematosus

“…[1] Immunosuppression is a well-established risk factor for nocardiosis. It is primarily an opportunistic infection.…”