Pulmonary nocardiosis in southern Taiwan

Nocardiosis mainly affects immunocompromised patients. The objectives of this study were to better understand the epidemiologic, demographic, clinical, and laboratory information in patients with pulmonary nocardiosis in southern Taiwan.

Retrospective analyzing patients aged ≥18 years with culture-proven pulmonary nocardiosis received treatment at KCGMH between January 2004 and June 2010. Nocardiae were identified by 16S rRNA gene sequence analysis. Patients with pulmonary nocardiosis caused by the mostly commonly encountered Nocardia sp. were compared with those with pulmonary nocardiosis due to other Nocardia spp.

Among the 20 patients included, cough (80%) and fever (50%) were the 2 leading symptoms/signs, while lobar consolidation (50%) and pleural effusion (40%) were the most frequent radiographic manifestations. Eighteen patients (90%) had at least one underlying disease/condition. Nocardia cyriacigeorgica was most commonly found. Compared with those whose pathogens were other Nocardia spp., patients with pulmonary nocardiosis caused by N cyriacigeorgica experienced higher clinical severity as measured by APACHE II score (19.8 ± 7.0 vs. 12.8 ± 6.7; p = 0.04) and ICU admission rate (100% vs. 25%; p < 0.01). Thirteen patients (65%) turned out to be fatal. The severity (APACHE II score, 18 ± 6 vs. 10 ± 8; p = 0.02) and the proportion of acute and subacute pulmonary nocardiosis (76% vs. 0%, p = 0.03) between fatal and survived patients differed significantly.

N cyriacigeorgica was the most common pathogen in southern Taiwan. Higher mortality rate in patients with pulmonary nocardiosis was related to disease severity and acute and subacute infection.