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Nocardia

Etiology: - associated conditions a) pulmonary alveolar proteinosis b) malignancy - especially lymphoma, lymphocytic leukemia c) immunocompromised hosts - AIDS - corticosteroids - organ transplantation - renal transplantation Epidemiology: - saprophytic, found in soil Pathology: - skin infection - pulmonary infection - nodules & cavitation - CNS infection - bacteremia is rare [3] Laboratory: - Nocardia serology - Nocardia identified in isolate - gram stain: gram-positive filamentous bacillus [3] - weakly acid-fast staining positive - aerobic, non-spore formings - Nocardia identified by culture - slow-growing in culture, 8 weeks Special laboratory: - bronchoscopy with bronchoalveolar lavage Radiology: - chest X-ray - nodular densities in upper & lower lung field Complications: - most common site of dissemination from the lungs is the CNS leading to focal neurologic deficits - skin, bone & muscle are the next most common sites of dissemination - pericarditis can occur - endocarditis is rare - cardiac murmur, retinal hemorrhages, splenomegaly Management: 1) sulfisoxazole 2) Bactrim 3) minocycline 4) imipenem (synergism with cefotaxime) 5) cefotaxime (synergism with imipenem) 6) amikacin * if symptoms recur after treatment (within months) consider pulmomary alveolar proteinosis

Related

nocardiosis pulmonary alveolar phospholipoproteinosis; alveolar proteinosis; pulmonary surfactant metabolism dysfunction; inborn error of pulmonary surfactant metabolism

Specific

Nocardia asteroides Nocardia brasiliensis Nocardia caviae

General

Nocardiaceae

Properties

KINGDOM: monera DIVISION: SCHIZOMYCETES

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 809
  2. ARUP Consult: Actinomyces and Nocardia Species deprecated reference
  3. Medical Knowledge Self Assessment Program (MKSAP) 16, 18. American College of Physicians, Philadelphia 2012, 2018
  4. NEJM Knowledge+ - Coussement J, Lebeaux D, Rouzaud C, Lortholary O. Nocardia infections in solid organ and hematopoietic stem cell transplant recipients. Curr Opin Infect Dis. 2017 Dec;30(6):545-551. PMID: 28922286 Review. - Martinez R, Reyes S, Menendez R. Pulmonary nocardiosis: risk factors, clinical features, diagnosis and prognosis. Curr Opin Pulm Med. 2008 May;14(3):219-27. PMID: 18427245 Review.