Last Updated: 2022-02-25
- Nocard, 1888
- Eppinger, 1890
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
- Pulmonary diseases
- 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.
- 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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