Nocardiosis

Last reviewed: 7 Sep 2022
Last updated: 29 Jul 2020

Summary

Definition

History and exam

Key diagnostic factors

  • cough with purulent sputum
  • fever
More key diagnostic factors

Other diagnostic factors

  • male gender
  • headache
  • nausea and vomiting
  • confusion
  • depressed consciousness
  • cutaneous ulcers or abscesses
Other diagnostic factors

Risk factors

  • solid organ and hematopoietic stem cell transplant recipients
  • HIV-positive and low CD4 T-cell count (<100 cells/mm³)
  • immunosuppression
  • structural pulmonary disease
  • malignancy and chemotherapy
  • male gender
  • agricultural work
More risk factors

Diagnostic investigations

1st investigations to order

  • Gram and acid-fast stains
  • culture
  • chest x-ray
More 1st investigations to order

Investigations to consider

  • biochemical species typing
  • thoracic CT scan
  • CT head
  • MRI head
  • 16S rRNA sequencing and other polymerase chain reaction (PCR)-based techniques
More investigations to consider

Emerging tests

  • identification and typing according to gyrB and rpoB genes
  • matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS)

Treatment algorithm

ACUTE

severe nocardiosis: disseminated disease, CNS involvement, cavitary pulmonary lesions, or immunocompromise

nonsevere nocardiosis: immunocompetent, nondisseminated, no CNS involvement, no pulmonary cavitary lesions

Contributors

Authors

Jorge Garbino, MD, MPD

Division of Infectious Disease

Geneva University Hospital

Geneva

Switzerland

Disclosures

JG declares that he has no competing interests.

Juan Ambrosioni, MD, PhD

Division of Infectious Diseases

Hospital Clinic-IDIBAPS

Barcelona

Spain

Disclosures

JA is an advisory board member of Gilead Sciences and ViiV Healthcare.

Peer reviewers

Ali Hassoun, MD, FACP, FIDSA, AAHIVS

Infectious Disease Specialist

Alabama Infectious Diseases Center

Huntsville

AL

Disclosures

AH declares that he has no competing interests.

M. Narita, MD

Associate Professor of Medicine

Division of Pulmonary and Critical Care

Harborview Medical Center

University of Washington

Seattle

WA

Disclosures

MN declares that he has no competing interests.

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