Clinical profile of pulmonary nocardiosis

Pulmonary nocardiosis mimics pulmonary tuberculosis in both clinical symptoms, being chronic in nature and radiological characteristics, and it is often wrongly treated with anti-tuberculosis drugs. The present study was undertaken to determine the prevalence of pulmonary nocardial infection in patients having chronic chest symptoms and to study their clinical response to specific chemotherapeutic agents. All the patients, who had a negative sputum for AFB on direct smear examination consecutively, were investigated for nocardiosis by examining the sputum with KOH preparation and modified Ziehl-Neelsen method. This was later confirmed by fungal culture of the sputum and inoculation on McClung's broth for paraffin baiting technique. Fibreoptic bronchoscopy was performed on all the suspected cases and the bronchial aspirate was examined similarly. The confirmed cases of nocardiosis were treated with cotrimaxazole and doxycycline for a total duration of six months. The prevalence of pulmonary nocardiosis in the present study was 1.9 percent. All the patients were immunocompetent. All the patients showed a good clinical response to chemotherapy at the end of six months of treatment. No relapse has been observed on follow up.