Nocardiosis
| Nocardiosis | |
| ICD-10 | A43 |
|---|---|
| ICD-9 | 039.9 |
| DiseasesDB | 9058 |
| eMedicine | med/1644 derm/297 ped/1610 |
| MeSH | D009617 |
|
WikiDoc Resources for Nocardiosis |
|
Articles |
|---|
|
Most recent articles on Nocardiosis Most cited articles on Nocardiosis |
|
Media |
|
Powerpoint slides on Nocardiosis |
|
Evidence Based Medicine |
|
Clinical Trials |
|
Ongoing Trials on Nocardiosis at Clinical Trials.gov Clinical Trials on Nocardiosis at Google
|
|
Guidelines / Policies / Govt |
|
US National Guidelines Clearinghouse on Nocardiosis
|
|
Books |
|
News |
|
Commentary |
|
Definitions |
|
Patient Resources / Community |
|
Patient resources on Nocardiosis Discussion groups on Nocardiosis Patient Handouts on Nocardiosis Directions to Hospitals Treating Nocardiosis Risk calculators and risk factors for Nocardiosis
|
|
Healthcare Provider Resources |
|
Causes & Risk Factors for Nocardiosis |
|
Continuing Medical Education (CME) |
|
International |
|
|
|
Business |
|
Experimental / Informatics |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Nocardiosis is an infectious disease affecting either the lungs (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.
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.[1]
Causes
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.[1] Generally, nocardial infection requires some degree of immune suppression.
Symptoms
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
[3] 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
Diagnosis
Diagnosis may be difficult. Nocardiae are weakly acid-fast organisms and can be visualized by modified Ziehl Neelsen stains like Fite-Faraco method 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.[2] Infiltration and pleural effusion are usually seen via x-ray.
Treatment
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.[1] A new combination drug therapy (sulfonamide, ceftriaxone, and amikacin) has also shown promise.[2]
References
- ↑ 1.0 1.1 1.2 "Nocardiosis (Professional Guide to Diseases (Eighth Edition)) - WrongDiagnosis.com". Retrieved 2007-07-12.
- ↑ 2.0 2.1 "Nocardiosis: DBMD - WrongDiagnosis.com". Retrieved 2007-07-12.