Nocardiosis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Common Symptoms

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, seizures, or sudden onset of neurologic deficit.

Pulmonary Infection

• night sweats, fever, cough, chest pain
• Pulmonary nocardiosis is subacute in onset and refractory to standard antibiotherapy
• symptoms are more severe in immunocompromised individuals
• radiologic studies show multiple pulmonary infiltrates with tendency to central necrosis

Neurological Infection

• Headache, lethargy, confusion, seizures, sudden onset of neurological deficit
• CT scan shows cerebral abscess
• Nocardial meningitis is very rare and difficult to diagnose

Lymphocutaneous disease

• Nocardial cellulitis is akin of erysipela but is more subacute
• Nodular lymphangeitis mimics sporotrichosis with multiple nodules alongside a lymphatic pathway
• Mycetoma is a rare complication and osteitis may ensue .

Ocular disease

• Very rarely nocardiae cause keratitis
• Gennerally there is a history of ocular trauma

Disseminated nocardiosis

• Disseminated infection can occur in very immunocompromised patients
• It generally involves both lungs and brain
• Fever, moderate or very high can be seen
• Multiple cavitating pulmonary infiltrates develop
• Cerebral abscesses arise later
• Cutaneous lesions are very rarely seen
• If untreated, the prognosis is grim for this form of disease