Nocardiosis

Last Updated: 2022-01-21

Author(s): Anzengruber, Navarini

  • 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
  • Lungnocardiosis
    • 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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