Nocardiosis

Last Updated: 2019-08-26

Author(s): Anzengruber, Navarini

Nocard 1888, Eppinger, 1890.

Nokardiosis.

Infection of multiple organ systems caused by Nokardien.

Worldwide occurrence in soil and on plants.

  • Pathogen
  • Nocardia asteroides (most common), more rarely: N. farcinica, N. nova and N. brasiliensis.
  • Nokarids occur in the soil and lead, mostly in immunosuppressed patients, to an exogenous infection due to inoculation (skin narcosis) or inhalation (pulmonary narcosis).
  • Transmission from person to person is not described.
  • Predisposing factors:
    • HIV/AIDS.
    • Lung diseases.
    • Neoplasias.
    • Collagenoses.
  • Pulmonary ocardiosis.
  • Most commonly triggered by Nocardia asteroides.
  • Chronic lung infection in immunodeficiency with the typical symptoms of pneumonia and systemic symptoms. The radiological changes are non-specific.
  • Sporotrichoids, superficial skin nocardiosis.
  • Pustules form abscessing nodes with a chain-like (sporotrichoid) arrangement along a lymph drainage area. Most pathogens are Nocardia asteroides or Nocardia brasiliensis.
  • Oculoglandular involvement.
  • Conjunctivitis and lymphadenopathy. The trigger is usually an infection with Nocardia brasiliensis caused by a smear infection.
  • Clinic.
  • Bacterial smear.
  • Thoracic x-ray.
  • Pathogen not detectable in routine section.
  • Using special staining, finely branched filaments (drusen) similar to Actinomyces visible, but acid-resistant and gram-positive as well as PAS-positive.
  • Primary cutaneous nocardiosis: good prognosis.
  • Systemic nocardiosis: lethality despite therapy up to 50%.
  • Recurrence possible.
  • Rapid therapy is essential.
  • Surgical rehabilitation with drainage.
  • Antibiotic therapy after antibiotic treatment.
  • It is important that the antibiotic therapy is carried out for several weeks to avoid recurrences.
  • Ex juvantibus with:
  • Cotrimoxazole (Sulfamethoxazole/Trimethoprim) p.o. 800/160mg 2x daily.
  • Alternative: Imipenem/Cilastatin i.v. (after dilution in NaCl or glucose gene) 500/500 mg 1 g 2-4x daily AND Amikacin intravenously 15 mg/kg bw in 1-3 doses (max. total 15 g).
  • Alternative: Minocycline p.o. 100 mg 2x daily.
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