Last Updated: 2022-02-25

Author(s): Anzengruber F., Navarini A.

ICD11: 1C1B.Z

  • 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
    • 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

  1. Babilas P, Scherer K, Landthaler M, Ehrenstein B, Szeimies RM. Nokardioseinfektion einer Gefäßendoprothese. Hautarzt 2007;58:335-7.
  2. Fergie JE, Purcell K. Nocardiosis in South Texas children. The Pediatric Infectious Disease Journal 2001;20:711-4.
  3. Jimenez-Galanes Marchan S, Meneu Díaz JC, Caso Maestro O, et al. Disseminated Nocardiosis: A Rare Infectious Complication Following Non–Heart-Beating Donor Liver Transplantation. Transplantation Proceedings 2009;41:2495-7.
  4. Lederman ER, Crum NF. A Case Series and Focused Review of Nocardiosis. Medicine 2004;83:300-13.
  5. Lerner PI. Nocardiosis. Clinical Infectious Diseases 1996;22:891-905.
  6. Warren NG. ACTINOMYCOSIS, NOCARDIOSIS, AND ACTINOMYCETOMA. Dermatologic Clinics 1996;14:85-95.
  7. Masumoto A, Hirama T, Kawana H, et al. [Case report; a case of lung and skin nocardiosis in a non-immunocompromised patient]. Nihon Naika Gakkai Zasshi 2013;102:2679-81.
  8. Akasaka E, Ikoma N, Mabuchi T, et al. A novel case of nocardiosis with skin lesion due to Nocardia araoensis. J Dermatol 2011;38:702-6.
  9. Takahara M, Imafuku S, Matsuda T, et al. Concurrent double infections of the skin: phaeohyphomycosis and nocardiosis in a patient with idiopathic thrombocytopenic purpura. J Am Acad Dermatol 2005;53:S277-80.
  10. Yu CT, Tsai YH, Leu HS, Shieh WB. [Pulmonary nocardiosis with skin and subcutaneous dissemination. An imitator mimicking tuberculosis]. Changgeng Yi Xue Za Zhi 1992;15:54-8.
  11. Risemberg A, Esteso SC, Fernandez MD. [Nocardiosis. Presentation of a case with primary lung involvement and 2 skin metastases]. Rev Fac Cienc Med Cordoba 1968;26:337-45.
  12. Bakos L, Sugar J. [Inflammatio cutis racemosa in the region of skin cancer based on nocardiosis after irradiation]. Dermatol Wochenschr 1959;139:191-5.
  13. Bakos L, Sugar J. [Inflammatio cutis racemosa in the vicinity of irradiated skin cancer developed from nocardiosis]. Borgyogy Venerol Sz 1958;12:80-4.