II. Pathophysiology

  1. Filamentous gram-positive Bacteria
  2. Causes Nodular Lymphangitis
    1. Nocardia brasiliensis most common etiology

III. Exposure risks

  1. Soil or plant debris (e.g. gardening)
  2. Splinters

IV. Findings: Nocardiosis (80% of presentations)

  1. Respiratory infection (Pneumonia, Lung Abscess)
    1. Fever
    2. Cough
    3. Chest Pain
  2. CNS Infection (including Brain Abscess)
    1. Headache
    2. Seizures
    3. Confusion
    4. Lethargy
    5. Focal neurologic deficit
  3. Disseminated Nocardiosis
    1. Systemic symptoms and focal symptoms variable based on abscess location

V. Findings: Nodular Lymphangitis (20% of presentations are primary cutaneous or Lymphocutaneous Nocardiosis)

  1. Primary lesion follows one to six week incubation
    1. Tender nodular lesion develops at inoculation site
  2. Secondary lesions
    1. Erythematous Papules, Nodules develop up lymph chain
    2. Lesions ulcerate and drain purulent fluid
    3. Sinus tracts may form
  3. Other findings
    1. Fever
    2. Tender regional adenopathy occur

VII. Labs

  1. Microscopic examination
    1. Weakly Gram Positive Bacteria
    2. Filaments are acid-fast
  2. Culture (slow growth may require several weeks)
    1. Routine fluid culture
    2. Culture of biopsied tissue

VIII. Management

  1. Treatment Duration: 3 months (6 months if Immunocompromised)
  2. TMP-SMZ DS (Septra DS or Bactrim DS): preferred
    1. Dose: 5-10 mg/kg/day up to 2 DS tablets orally three times daily for three months
    2. Complete Blood Count weekly (lower dose if cytopenia)
  3. Alternative antibiotics (based on sensitivity)
    1. Minocycline 100-200 mg orally twice dailyfor three months
    2. Other antibiotics that have been used: Amikacin, Carbapenem antibiotics, Quinolone antibiotics, Linezolid

IX. Prognosis

  1. Mortality from Nocardiosis Pneumonia may be as high as 10% even in uncomplicated cases

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Related Studies

Ontology: Nocardia (C0028240)

Definition (MSH) A genus of gram-positive, aerobic bacteria whose species are widely distributed and are abundant in soil. Some strains are pathogenic opportunists for humans and animals.
Definition (NCI_CDISC) Any bacteria that is not assigned to the species level but can be assigned to the Nocardia genus level.
Definition (NCI) A genus of Gram-positive, catalase-positive, rod-shaped bacteria in the phylum Actinobacteria.
Concepts Bacterium (T007)
MSH D009615
SnomedCT 59674005
Swedish Nocardia
Czech nokardie, Nocardia
Spanish género Nocardia, Nocardia (organismo), Nocardia, género Nocardia (organismo)
Finnish Nokardiat
English Nocardia, nocardia, Nocardia Trevisan 1889, NOCARDIA, Nocardia, NOS, Nocardia (organism), Genus Nocardia (organism), Genus Nocardia
Polish Nocardia, Nokardia
Norwegian Nocardia
French Nocardia
German Nocardia
Italian Nocardia
Dutch Nocardia
Portuguese Nocardia

Ontology: Nocardia Infections (C0028242)

Definition (CSP) gram positive bacterial infection with bacteria of the genus Nocardia.
Definition (MSH) Infections with bacteria of the genus NOCARDIA.
Concepts Disease or Syndrome (T047)
MSH D009617
ICD10 A43 , A43.9
SnomedCT 186404005, 187337003, 29227009
English Infection, Nocardia, Infections, Nocardia, Nocardia Infection, Nocardia Infections, Nocardiosis, unspecified, [X]Nocardiosis, unspecified, INFECT NOCARDIA, NOCARDIA INFECT, nocardiosis (diagnosis), nocardiosis, Nocardia infections, Nocardia Infections [Disease/Finding], nocardia infections, nocardia infection, Nocardiosis, Nocardioses, Nocardiosis NOS (disorder), [X]Nocardiosis, unspecified (disorder), Nocardia infection, Nocardiosis (disorder), Nocardia; infection, infection; Nocardia, Nocardiosis, NOS, Nocardiosis NOS
Italian Nocardiosi, Infezione da Nocardia, Infezioni da Nocardia
French Infection à Nocardia, Nocardiose, Infections à Nocardia, Infections à nocardies, Nocardioses
German Infektion mit Nocardia, Nokardiose, nicht naeher bezeichnet, Nokardiose, Nocardia-Infektionen, Nocardiainfektionen
Portuguese Infecção por nocardia, Infecções a Nocardia, Nocardiose
Spanish Infección por Nocardia, [X]nocardiosis, no especificada, nocardiosis, SAI (trastorno), [X]nocardiosis, no especificada (trastorno), nocardiosis, SAI, nocardiosis (trastorno), nocardiosis, Infecciones por nocardia, Nocardiosis
Japanese ノカルジア感染, ノカルジアカンセン, ノカルジアショウ, ノカルジア感染症, ノカルジア症
Swedish Nocardiainfektioner
Czech Nocardia - infekce, Nokardiové infekce, Nokardióza, Infekce nokardie
Finnish Nokardioosit
Korean 노카르디아증, 상세불명의 노카르디아증
Croatian Not Translated[Nocardia Infections]
Polish Nokardiozy
Hungarian Nocardia fertőzések, nocardiosis, Nocardia fertőzés
Norwegian Nocardiainfeksjoner
Dutch Nocardia; infectie, infectie; Nocardia, Nocardiose, niet gespecificeerd, nocardiosis, Infectie, nocardia-, Infecties, nocardia-, Nocardia-infectie, Nocardia-infecties, Nocardiose

Ontology: Cutaneous nocardiosis (C0275584)

Concepts Disease or Syndrome (T047)
ICD10 A43.1
SnomedCT 186401002, 311541000009101, 64650008
German Nokardiose der Haut
Korean 피부 노카르디아증
English nocardiosis cutaneous (diagnosis), nocardiosis cutaneous, Pyogranulomatous dermatitis (disorder), Cutaneous nocardiosis, Pyogranulomatous dermatitis, Cutaneous nocardiosis (disorder), cutaneous; nocardiosis, nocardiosis; cutaneous
Dutch cutaan; nocardiose, nocardiose; cutaan, Cutane nocardiose
Spanish dermatitis piogranulomatosa, nocardiosis cutánea (trastorno), nocardiosis cutánea

Ontology: Nocardia brasiliensis (C0317896)

Definition (NCI) A species of aerobic, Gram-positive, rod shaped bacteria assigned to the phylum Actinobacteria. This species is nonmotile, catalase and urease positive, acid-fast, oxidase negative, hydrolyzes casein, elastin, esculin, hypoxanthine, testosterone, and tyrosine, but not xanthine, produces acid phosphatase, and reduces nitrate. N. brasiliensis is naturally found in soil and is one of the main causative agents of nocardiosis.
Definition (NCI_CDISC) Any bacterial organism that can be assigned to the species Nocardia brasiliensis.
Concepts Bacterium (T007)
SnomedCT 58970008
English Nocardia brasiliensis (Lindenberg 1909) Pinoy 1913, Actinomyces violaceus subsp. brasiliensis, Discomyces brasiliensis, Nocardia brasilensis, Oospora brasiliensis, Streptothrix brasiliensis, NOCARDIA BRASILIENSIS, Actinomyces brasiliensis, Nocardia brasiliensis, Nocardia brasiliensis (organism)
Spanish Nocardia brasiliensis (organismo), Nocardia brasiliensis