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| {{Infobox_Disease | | | {{Nocardiosis}} |
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| | {{About1|Nocardia}} |
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| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| DiseasesDB = 9058 |
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| ICD10 = {{ICD10|A|43||a|30}} |
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| ICD9 = {{ICD9|039.9}} |
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| ICDO = |
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| OMIM = |
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| MeshID = D009617 |
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| {{SI}}
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| {{CMG}} | | {{CMG}} |
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| ==Overview== | | {{SK}} Nocardia infection |
| '''Nocardiosis''' is an [[infectious disease]] affecting either the [[lung]]s (''pulmonary nocardiosis'') or the whole body (''systemic nocardiosis''). It is due to infection by bacterium of the genus [[Nocardia]], most commonly ''Nocardia asteroides'' or ''Nocardia brasiliensis''.
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| | ==[[Nocardiosis overview|Overview]]== |
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| | ==[[Nocardiosis pathophysiology|Pathophysiology]]== |
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| | ==[[Nocardiosis differential diagnosis|Differentiating Nocardiosis from other Diseases]]== |
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| | ==[[Nocardiosis epidemiology and demographics|Epidemiology and Demographics]]== |
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| It is most common in men, especially those with a compromised immune system. In patients with brain infection, mortality exceeds 80%; in other forms, mortality is 50%, even with appropriate therapy.<ref name="wdbd7a">{{cite web |url=http://www.wrongdiagnosis.com/n/nocardiosis/book-diseases-7a.htm |title=Nocardiosis (Professional Guide to Diseases (Eighth Edition)) - WrongDiagnosis.com |accessdate=2007-07-12 |format= |work=}}</ref>
| | ==[[Nocardiosis risk factors|Risk Factors]]== |
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| ==Causes== | | ==[[Nocardiosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| The majority of cases are caused by the Nocardia asteroides complex (at least 50% of invasive infections). The N. asteroides complex is comprised of N. abscessus, N. cyriacigeorgica, N. farcinica, and N. nova. Other known pathogenic species of Nocardia include N. transvalensis complex, N. brasiliensis, and N. pseudobrasiliensis.
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| Pulmonary, disseminated and CNS infections are acquired through inhalation; primary cutaneous disease is acquired through inoculation of the skin. Rarely, nosocomial postsurgical transmission occurs.
| | ==[[Nocardia|Causes]]== |
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| Normally found in soil, these organisms cause occasional sporadic disease in humans and animals throughout the world. The usual mode of transmission is inhalation of organisms suspended in dust. Transmission by direct inoculation through puncture wounds or abrasions is less common.<ref name="wdbd7a"> </ref> Generally, nocardial infection requires some degree of immune suppression.
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| ==Epidemiology and Demographics==
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| In the United States, it has been estimated that 500-1,000 new cases of Nocardia infection occur annually. Approximately 60% of nocardiosis cases are associated with pre-existing immune compromise. Although incidence data are extremely limited, the number of cases is likely rising as a result of the increase in the number of severely immunocompromised persons.
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| ==Risk Factors==
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| Severely immunocompromised persons are at greatest risk for nocardiosis. These include persons with [[connective tissue]] disorders, [[malignancy]], [[HIV infection]], [[pulmonary alveolar proteinosis]], alcoholism, or high-dose [[corticosteroid]] use.
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| ==Natural History, Complications and Prognosis==
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| Approximately 10% of cases with uncomplicated [[pneumonia]] are fatal. The [[case-fatality rate]] increases with overwhelming infection, disseminated disease, or brain [[abscess]]. Surgical drainage may be indicated and may improve patient outcome.
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| ==Diagnosis== | | ==Diagnosis== |
| ===History and Symptoms===
| | [[Nocardiosis history and symptoms|History and Symptoms]] | [[Nocardiosis physical examination|Physical Examination]] | [[Nocardiosis laboratory findings|Laboratory Findings]] | [[Nocardiosis x ray|X Ray]] | [[Nocardiosis CT|CT]] | [[Nocardiosis MRI|MRI]] | [[Nocardiosis other diagnostic studies|Other Diagnostic Studies]] |
| Overall, 80% of nocardiosis cases present as invasive [[pulmonary]] [[infection]], disseminated infection, or [[brain abscess]]; 20% present as [[cellulitis]]. Pulmonary infection commonly presents with [[fever]], [[cough]], or chest pain. [[Central nervous system]] (CNS) symptoms include headache, [[lethargy]], [[confusion]], [[seizure]]s, or sudden onset of neurologic deficit.
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| Pulmonary Infection
| | ==Treatment== |
| * night [[sweat]]s, [[fever]], [[cough]], chest pain
| | [[Nocardiosis medical therapy|Medical Therapy]] | [[Nocardiosis surgery|Surgery]] | [[Nocardiosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Nocardiosis future or investigational therapies|Future or Investigational Therapies]] |
| * Pulmonary nocardiosis is subacute in onset and refractory to standard antibiotherapy
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| * symptoms are more severe in [[immunodeficiency|immunocompromised]] individuals
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| * radiologic studies show multiple pulmonary infiltrates with tendency to central necrosis
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| Neurological Infection
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| *[[Headache]], [[lethargy]], [[confusion]], [[seizure]]s, sudden onset of neurological deficit
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| * [[CT scan]] shows cerebral abscess
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| * Nocardial meningitis is very rare and difficult to diagnose
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| Lymphocutaneous disease
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| * [[Nocardial cellulitis]] is akin of [[erysipela]] but is more subacute
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| * [[Nodular lymphangeitis]] mimics sporotrichosis with multiple nodules alongside a lymphatic pathway
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| * [[Mycetoma]] is a rare complication and osteitis may ensue .
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| Ocular disease
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| * Very rarely nocardiae cause [[keratitis]]
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| * Gennerally there is a history of ocular trauma
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| Disseminated nocardiosis
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| * Disseminated infection can occur in very immunocompromised patients
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| *It generally involves both lungs and brain
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| *[[Fever]], moderate or very high can be seen
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| *Multiple cavitating pulmonary infiltrates develop
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| *[[Cerebral abscesses]] arise later
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| *Cutaneous lesions are very rarely seen
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| * If untreated, the prognosis is grim for this form of disease
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| ===Laboratory Findings=== | | ==Case Studies== |
| Diagnosis may be difficult.
| | [[Nocardiosis case study one|Case #1]] |
| Nocardiae are weakly acid-fast organisms and can be visualized by modified Ziehl Neelsen stains like Fite-Faraco method
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| In the clinical laboratory, routine cultures may be held for insufficient time to grow nocardiae, and referral to a reference laboratory may be needed for species identification.<ref name="wddbmd">{{cite web |url=http://www.wrongdiagnosis.com/artic/nocardiosis_dbmd.htm |title=Nocardiosis: DBMD - WrongDiagnosis.com |accessdate=2007-07-12 |format= |work=}}</ref>
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| Infiltration and [[pleural effusion]] are usually seen via [[x-ray]].
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| ==Treatment==
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| Nocardiosis requires at least 6 months of treatment, preferably with co-trimoxazole or high doses of sulfonamides. In patients who don’t respond to sulfonamide treatment, other drugs, such as ampicillin, erythromycin, or minocycline, may be added. Treatment also includes surgical drainage of abscesses and excision of necrotic tissue. The acute phase requires complete bed rest; as the patient improves, activity can increase.<ref name="wdbd7a"> </ref> A new combination drug therapy (sulfonamide, ceftriaxone, and amikacin) has also shown promise.<ref name="wddbmd"> </ref>
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| ==Future or Investigational Therapies==
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| Although incidence data are extremely limited, the number of cases is likely rising as a result of the increase in the number of severely immunocompromised persons.
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| ==Sources== | | ==Sources== |
| http://www.cdc.gov/nczved/divisions/dfbmd/diseases/nocardiosis/technical.html#eight | | http://www.cdc.gov/nczved/divisions/dfbmd/diseases/nocardiosis/technical.html#eight |
| ==References== | | |
| <references/>
| | ==Related Chapters== |
| | *[[Nocardia]] |
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| {{Bacterial diseases}} | | {{Bacterial diseases}} |
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| [[nl:Nocardiose]] | | [[nl:Nocardiose]] |
| | [[Category:Disease]] |
| | [[Category:Bacterial diseases]] |
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| [[Category:Parasitic diseases]]
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| [[Category:Infectious disease]]
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