Nocardiosis

• Nocard, 1888
• Eppinger, 1890

Nocardiosis.

Infection of multiple organ systems caused by Nocardia.

World-wide occurrence in the soil and on plants.

• Pathogen: Nocardia asteroides (most common), less common: N. farcinica, N. nova and N. brasiliensis.
• Nocardia occurs in soil and lead, mostly in immunocompromised patients, to exogenous infection by inoculation (skin nocardiosis) or inhalation (pulmonary nocardiosis)
• Transmission from person to person has not been described

• Predisposing factors
  • HIV/AIDS
  • Pulmonary diseases
  • Neoplasms
  • Collagenoses

• Lung cardiosis
  • Most commonly caused by Nocardia asteroides
  • Chronic lung infection in immunodeficiency with the typical symptoms of pneumonia and systemic symptoms. The radiological changes are non-specific.

• Sporotrichoid superficial cutaneous nocardiosis
  • Pustules develop into abscessed nodules with a chain-like (sporotrichoid) arrangement along a lymphatic drainage area. Pathogens are mostly Nocardia asteroides or Nocardia brasiliensis.

• Oculoglandular involvement
• Conjunctivitis and lymphadenopathy. The trigger is usually a smear-triggered infection with Nocardia brasiliensis.

• Clinic
• Bacterial smear
• Chest X-ray

• Not detectable in routine section
• Fine branched filaments (drusen) similar to Actinomyces, but acid-fast and Gram- and PAS-positive

• Primary cutaneous nocardiosis: good prognosis
• Systemic nocardiosis: lethality up to 50%
despite therapy
• Recurrences possible

• Rapid therapy is essential
• Operative sanitation with drainage
• Antibiotic therapy according to antibiogram
• It is important that antibiotic therapy, to avoid recurrence, is given for several weeks
• Ex juvantibus with:
  • Cotrimoxazole (sulfamethoxazole/trimethoprim) p.o. 800/160mg 2x daily
  • Alternatively: imipenem/cilastatin i.v. (after dilution in NaCl or glucose solution) 500/500 mg 1 g 2-4x daily. AND amikacin i.v. 15 mg/kg bw in 1-3 doses (max. total 15 g)
  • Alternatively: Minocycline p.o. 100 mg 2x daily.

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