II. Pathophysiology
- Filamentous gram-positive Bacteria
- Causes Nodular Lymphangitis
- Nocardia brasiliensis most common etiology
III. Exposure risks
- Soil or plant debris (e.g. gardening)
- Splinters
IV. Findings: Nocardiosis (80% of presentations)
- Respiratory infection (Pneumonia, Lung Abscess)
- CNS Infection (including Brain Abscess)
- Disseminated Nocardiosis
- Systemic symptoms and focal symptoms variable based on abscess location
V. Findings: Nodular Lymphangitis (20% of presentations are primary cutaneous or Lymphocutaneous Nocardiosis)
VI. Differential Diagnosis
- See Nodular Lymphangitis
-
Pneumonia
- Actinomyces
- Tuberculosis
- Fungal Pneumonia (e.g. Histoplasmosis)
- Pneumocystis jiroveci Pneumonia
- Mycobacterium Avium Complex
- Malignancy
- Kaposi Sarcoma
- Non-Hodgkin Lymphoma
- Glioblastoma
VII. Labs
- Microscopic examination
- Weakly Gram Positive Bacteria
- Filaments are acid-fast
- Culture (slow growth may require several weeks)
- Routine fluid culture
- Culture of biopsied tissue
VIII. Management
- Treatment Duration: 3 months (6 months if Immunocompromised)
-
TMP-SMZ DS (Septra DS or Bactrim DS): preferred
- Dose: 5-10 mg/kg/day up to 2 DS tablets orally three times daily for three months
- Complete Blood Count weekly (lower dose if cytopenia)
- Alternative Antibiotics (based on sensitivity)
- Minocycline 100-200 mg orally twice dailyfor three months
- Other Antibiotics that have been used: Amikacin, CarbapenemAntibiotics, Quinolone Antibiotics, Linezolid
IX. Prognosis
- Mortality from Nocardiosis Pneumonia may be as high as 10% even in uncomplicated cases
X. Resources
- Nocardiosis (CDC)
- Nocardiosis (Stat Pearls)
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Related Studies
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 |
Russian | NOKARDII, NOCARDIA, НОКАРДИИ |
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 |
Russian | NOKARDIOZY, НОКАРДИОЗЫ |
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 |