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[Current aspects of pulmonary nocardiosis]
T Desfemmes-Baleyte1, C Mayaud, J Cadranel
1Service de pneumologie, Hôpital Saint-Antoine, Paris.
Abstract:
The nocardioses are most often due to Nocardia asteroides. Other types of Nocardia may be implicated. These infections may occur in immunocompetent patients and in that situation are most often cutaneous. They occur most frequently in patients whose immunity is depressed by cytotoxic therapy or in the group with AIDS (SIDA). The clinical presentation in these two latter groups are most often pulmonary. Haematological or lymphatic dissemination is seen in approximately one case out of two with preferential involvement of the central nervous system. Currently a recrudescence of these infections is noted. It is important to emphasise that these infections are curable with antibiotic therapy and that the prognosis depends on the rapidity of the diagnosis and the earliness of treatment.
Insights
Nocardioses, often caused by Nocardia asteroides, present as skin infections in immunocompetent individuals but frequently manifest as pulmonary disease in immunocompromised patients. Early diagnosis and antibiotic treatment are crucial for a favorable prognosis of these increasingly common infections.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Immunology
Context:
- Nocardioses are bacterial infections primarily caused by Nocardia species.
- These infections can affect both immunocompetent and immunocompromised individuals.
- A recent increase in nocardioses cases has been observed.
Purpose:
- To describe the epidemiology and clinical manifestations of nocardioses.
- To highlight the distinct presentations in immunocompetent versus immunocompromised patients.
- To emphasize the importance of timely diagnosis and treatment.
Summary:
- Nocardia asteroides is the most common causative agent, though other Nocardia species can be involved.
- In immunocompetent hosts, nocardioses typically present as cutaneous infections.
- In contrast, immunocompromised patients (e.g., those with AIDS or on cytotoxic therapy) often develop pulmonary nocardioses.
- Disseminated disease, particularly affecting the central nervous system, occurs in about half of immunocompromised cases.
- Nocardioses are treatable with antibiotics, with outcomes dependent on prompt diagnosis and intervention.
Impact:
- Informs clinicians about the varied presentations of nocardioses.
- Underscores the need for vigilance in diagnosing and treating these infections, especially in at-risk populations.
- Highlights the curable nature of nocardioses with appropriate antibiotic therapy.