Related Experiment Videos
[Pulmonary nocardiosis: presentation of 3 clinical cases]
J Ugedo1, A Pérez, J L Orcástegui
1Servicio de Neumología, Hospital Clínico Universitario Lozano Blesa, Zaragoza.
Introduction:
Nocardiosis is an infectious disease that frequently involves to the respiratory tract. Nocardia asteroides is the predominant human pathogen. Nocardiosis is difficult to diagnose and that's why its incidence is not well established.
Cases:
Three cases diagnosed in a Pneumology Section are reported. None of them was affected by AIDS and all of them were initially diagnosed from bronchopneumonia. Empirical antibiotherapy was initiated and because of the unsatisfactory progress, bronchoscopy was performed in all cases and in one case a transthoracic puncture was made. Nocardia spp. was then isolated and this let to began with a specific treatment. All the patients progress satisfactorily in their respiratory infection.
Discussion:
Although there are usually factors that predispose to nocardiosis, it can also occur in absence of these, as it happened in one of report patients. The clinical and radiological manifestations are not, in many cases enough to reach the diagnosis. Thus germ isolation is very important, and invasive procedures are often essential to obtain a quality samples to cultivate. Sulfonamides were considered drugs of choice, but nowadays, many authors propose trimethoprim-sulfamethoxazole. Imipenem, amikacin have also proved to be effective.
Insights
Nocardiosis, a respiratory infection caused by Nocardia asteroides, is challenging to diagnose. Invasive procedures are crucial for identifying the pathogen and initiating effective treatment, leading to satisfactory patient recovery.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Pulmonology
Background:
- Nocardiosis is an infectious disease primarily affecting the respiratory tract, with Nocardia asteroides as the main human pathogen.
- The incidence of nocardiosis remains poorly established due to diagnostic challenges.
Observation:
- Three cases of nocardiosis initially presenting as bronchopneumonia are reported in non-HIV patients.
- Initial empirical antibiotic therapy was often ineffective, necessitating further investigation.
- Bronchoscopy and transthoracic puncture were essential for isolating Nocardia species.
Findings:
- Nocardia species were successfully isolated in all reported cases, enabling targeted treatment.
- Patients showed satisfactory recovery from respiratory infections following specific antimicrobial therapy.
- Nocardiosis can occur even in the absence of typical predisposing factors.
Implications:
- Accurate diagnosis of nocardiosis often requires invasive procedures for pathogen isolation.
- Trimethoprim-sulfamethoxazole is increasingly recommended, alongside traditional sulfonamides, imipenem, and amikacin for effective treatment.
- Increased awareness and diagnostic vigilance are necessary for managing this opportunistic infection.