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Pulmonary Nocardiosis.

Gio J. Baracco1, Gordon M. Dickinson

  • 1Infectious Disease Section (111), Miami Veterans Affairs Medical Center, 1201 NW 16th Street, Miami, FL 33125, USA. Gio.Baracco@med.va.gov

Current Infectious Disease Reports
|June 1, 2001
PubMed
Summary

Pulmonary nocardiosis, a serious infection caused by Nocardia, affects immunosuppressed individuals. Sulfonamides like trimethoprim-sulfamethoxazole are the most effective treatments, though susceptibility testing is challenging.

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Area of Science:

  • Medical Microbiology
  • Infectious Diseases
  • Pulmonology

Background:

  • Pulmonary nocardiosis is an uncommon, serious infection.
  • It primarily affects immunosuppressed individuals, including transplant recipients and those with AIDS.
  • Nocardia species, found in soil, cause infection via inhalation or inoculation.

Purpose of the Study:

  • To review the clinical presentation, diagnosis, and treatment of pulmonary nocardiosis.
  • To highlight the challenges in identifying Nocardia species and determining antimicrobial susceptibility.
  • To emphasize the importance of accurate diagnosis for effective treatment in immunocompromised patients.

Main Methods:

  • Review of existing literature on pulmonary nocardiosis.
  • Analysis of clinical presentations and diagnostic challenges.
  • Evaluation of antimicrobial efficacy and treatment guidelines.

Main Results:

  • Pulmonary nocardiosis often presents as necrotizing pneumonia with potential for metastatic infections (brain, subcutaneous).
  • Isolation of Nocardia is feasible in most labs, but speciation and susceptibility testing are difficult due to slow growth.
  • Sulfonamides, particularly trimethoprim-sulfamethoxazole, are the most reliable treatments.

Conclusions:

  • Accurate species identification and susceptibility testing are crucial for managing pulmonary nocardiosis, especially in immunosuppressed patients.
  • Sulfonamides remain the cornerstone of therapy.
  • Limited clinical data exist for alternative antimicrobial agents, despite in vitro activity.

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