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| {{Infobox_Disease |
| | __NOTOC__ |
| Name = {{PAGENAME}} |
| | {{Nocardiosis}} |
| Image = |
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| Caption = |
| | {{About1|Nocardia}} |
| DiseasesDB = 9058 |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| 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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| MedlinePlus = |
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| eMedicineSubj = med|
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| eMedicineTopic = 1644 |
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| eMedicine_mult = {{eMedicine2|derm|297}} {{eMedicine2|ped|1610}} |
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| MeshID = D009617 |
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| }}
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| {{SI}}
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| {{CMG}} | | {{CMG}} |
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| {{EH}} | | {{SK}} Nocardia infection |
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| | ==[[Nocardiosis overview|Overview]]== |
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| '''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''.
| | ==[[Nocardiosis pathophysiology|Pathophysiology]]== |
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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 differential diagnosis|Differentiating Nocardiosis from other Diseases]]== |
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| ==Causes== | | ==[[Nocardiosis epidemiology and demographics|Epidemiology and Demographics]]== |
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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.
| | ==[[Nocardiosis risk factors|Risk Factors]]== |
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| ==Symptoms== | | ==[[Nocardiosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Pulmonary Infection
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| * night [[sweat]]s, [[fever]], [[cough]], chest pain
| | ==[[Nocardia|Causes]]== |
| * 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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| [http://www.cdc.gov/ncidod/dbmd/diseaseinfo/nocardiosis_t.htm]
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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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| ==Diagnosis== | | ==Diagnosis== |
| Diagnosis may be difficult.
| | [[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]] |
| 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== | | ==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.<ref name="wdbd7a"> </ref> A new combination drug therapy (sulfonamide, ceftriaxone, and amikacin) has also shown promise.<ref name="wddbmd"> </ref> | | [[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]] |
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| ==References== | | ==Case Studies== |
| <references/>
| | [[Nocardiosis case study one|Case #1]] |
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| | ==Sources== |
| | http://www.cdc.gov/nczved/divisions/dfbmd/diseases/nocardiosis/technical.html#eight |
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| | ==Related Chapters== |
| | *[[Nocardia]] |
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| {{Bacterial diseases}} | | {{Bacterial diseases}} |
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| {{SIB}}
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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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