Last reviewed: 23 Aug 2023
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.
Differentials
- Tuberculosis
- Actinomycosis
- Lung abscess
More DifferentialsGuidelines
- Nocardia infections in solid organ transplantation
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