Nocardiosis

Jump to navigation Jump to search
Nocardiosis
ICD-10 A43
ICD-9 039.9
DiseasesDB 9058
MeSH D009617

WikiDoc Resources for Nocardiosis

Articles

Most recent articles on Nocardiosis

Most cited articles on Nocardiosis

Review articles on Nocardiosis

Articles on Nocardiosis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Nocardiosis

Images of Nocardiosis

Photos of Nocardiosis

Podcasts & MP3s on Nocardiosis

Videos on Nocardiosis

Evidence Based Medicine

Cochrane Collaboration on Nocardiosis

Bandolier on Nocardiosis

TRIP on Nocardiosis

Clinical Trials

Ongoing Trials on Nocardiosis at Clinical Trials.gov

Trial results on Nocardiosis

Clinical Trials on Nocardiosis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Nocardiosis

NICE Guidance on Nocardiosis

NHS PRODIGY Guidance

FDA on Nocardiosis

CDC on Nocardiosis

Books

Books on Nocardiosis

News

Nocardiosis in the news

Be alerted to news on Nocardiosis

News trends on Nocardiosis

Commentary

Blogs on Nocardiosis

Definitions

Definitions of Nocardiosis

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

Symptoms of Nocardiosis

Causes & Risk Factors for Nocardiosis

Diagnostic studies for Nocardiosis

Treatment of Nocardiosis

Continuing Medical Education (CME)

CME Programs on Nocardiosis

International

Nocardiosis en Espanol

Nocardiosis en Francais

Business

Nocardiosis in the Marketplace

Patents on Nocardiosis

Experimental / Informatics

List of terms related to Nocardiosis

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

Overview

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

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.

Pulmonary, disseminated and CNS infections are acquired through inhalation; primary cutaneous disease is acquired through inoculation of the skin. Rarely, nosocomial postsurgical transmission occurs.

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.

Epidemiology and Demographics

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.

Risk Factors

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.

Natural History, Complications and Prognosis

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.

Diagnosis

History and 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

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

Laboratory Findings

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]

Future or Investigational Therapies

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.

Sources

http://www.cdc.gov/nczved/divisions/dfbmd/diseases/nocardiosis/technical.html#eight

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.

Template:Bacterial diseases


nl:Nocardiose


Template:WikiDoc Sources