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==Causes==
==Causes==
also from organ transplants
 
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.
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.



Revision as of 11:53, 10 January 2009

Nocardiosis
ICD-10 A43
ICD-9 039.9
DiseasesDB 9058
eMedicine med/1644  derm/297 ped/1610
MeSH D009617

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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

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. 1.0 1.1 1.2 "Nocardiosis (Professional Guide to Diseases (Eighth Edition)) - WrongDiagnosis.com". Retrieved 2007-07-12.
  2. 2.0 2.1 "Nocardiosis: DBMD - WrongDiagnosis.com". Retrieved 2007-07-12.

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