Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- tosse com escarro purulento
- febre
Other diagnostic factors
- cefaleia
- náuseas e vômitos
- confusão
- consciência deprimida
- úlceras ou abscessos cutâneos
Risk factors
- receptores de transplante de órgão sólido e de células-tronco hematopoéticas
- positivo ao vírus da imunodeficiência humana (HIV-positivo) e baixa celularidade de células T CD4 (<100 células/mm³)
- imunossupressão
- doença pulmonar estrutural
- malignidade e quimioterapia
- trabalho agrícola
Diagnostic tests
1st tests to order
- Colorações de Gram e álcool-ácido resistente
- cultura
- tecnologia de ionização-dessorção a laser assistida por matriz acoplada a espetrometria de massa por tempo de voo (MALDI-TOF MS)
- tipagem bioquímica da espécie
- técnicas baseadas em reação em cadeia da polimerase
- radiografia torácica
- tomografia computadorizada (TC) do crânio
Tests to consider
- tomografia computadorizada (TC) do tórax
- ressonância nuclear magnética (RNM) de crânio
Emerging tests
- sequenciamento de última geração
Treatment algorithm
nocardiose grave: doença disseminada, envolvimento do sistema nervoso central (SNC), lesões pulmonares cavitárias ou imunocomprometimento
nocardiose não grave: imunocompetente, não disseminada, sem envolvimento do sistema nervoso central (SNC), sem lesões pulmonares cavitárias
Contributors
Authors
Timothy Sullivan, MD
Associate Professor
Division of Infectious Diseases
Icahn School of Medicine at Mount Sinai
New York
NY
Disclosures
TS declares that he has no competing interests.
Acknowledgements
Dr Timothy Sullivan would like to gratefully acknowledge Dr Jorge Garbino and Dr Juan Ambrosioni, previous contributors to this topic.
Disclosures
JG declares that he has no competing interests. JA is an advisory board member of Gilead Sciences and ViiV Healthcare.
Peer reviewers
Senu Apewokin, MD
Associate Professor of Medicine
Director, Transplant Infectious Diseases
University of Cincinnati
Cincinnati
OH
Disclosures
SA declares that she has no competing interests.
Rebecca N. Kumar, MD, MS
Assistant Professor of Medicine
Georgetown University Medical Center
Washington
DC
Disclosures
RNK has received research grants from Regeneron and Gilead, which have been paid to Georgetown University.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Brown-Elliott BA, Brown JM, Conville PS, et al. Clinical and laboratory features of the Nocardia spp. based on current molecular taxonomy. Clin Microbiol Rev. 2006 Apr;19(2):259-82.Full text Abstract
Hamdi AM, Fida M, Deml SM, et al. Retrospective analysis of antimicrobial susceptibility profiles of Nocardia species from a tertiary hospital and reference laboratory, 2011 to 2017. Antimicrob Agents Chemother. 2020 Feb 21;64(3):e01868-19.Full text Abstract
Corti ME, Villafane-Fioti MF. Nocardiosis: a review. Int J Infect Dis. 2003 Dec;7(4):243-50.Full text Abstract
Margalit I, Lebeaux D, Tishler O, et al. How do I manage nocardiosis? Clin Microbiol Infect. 2021 Apr;27(4):550-8.Full text Abstract
Restrepo A, Clark NM, Infectious Diseases Community of Practice of the American Society of Transplantation. Nocardia infections in solid organ transplantation: guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation. Clin Transplant. 2019 Sep;33(9):e13509. Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Tuberculose
- Actinomicose
- Abscesso pulmonar
More DifferentialsGuidelines
- Nocardia infections in solid organ transplantation
More Guidelines
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