Shorter vs. standard-duration antibiotic therapy for nocardiosis: a multi-center retrospective cohort study

Clinical profile and outcomes of pulmonary nocardiosis in India: a systematic review of individual cases

Introduction

Nocardiosis is a common cause of pneumonia in immunocompromised individuals. Limited data regarding its epidemiology, clinical presentations, and outcomes in India are available. This systematic review analysed the clinical profile and outcomes of pulmonary nocardiosis in India.

Methods

We systematically reviewed individual cases of culture-confirmed pulmonary nocardiosis from India published between January 1960 and May 2024 using the PubMed, Embase, and Web of Science databases. Studies lacking microbiological confirmation or detailed clinical data were excluded. Descriptive statistics were used to summarise demographic, clinical, and microbiological data, while chi-square and t-tests assessed differences between mortality and survival groups.

Results

The review included 109 cases from 67 studies. Male predominance (74.1%) was observed, with a mean age of 49.6 ± 16.9 years. Diabetes (26.6%), steroid use (51.4%), and chronic lung disease (37.8%) were key risk factors. Nocardia otitidiscaviarum (38.4%) was the most common species identified. Mortality was noted in 26% of the patients. Cotrimoxazole resistance and lack of cotrimoxazole use for treatment were associated with mortality.

Conclusions

Pulmonary nocardiosis presents diagnostic and therapeutic challenges in India, with high resistance rates and significant mortality. Improved diagnostic methods and region-specific treatment strategies are essential.

Primary Cutaneous Nocardiosis (Lymphangitic Type) in an Immunocompetent Patient: A Case Report

Cutaneous nocardiosis is an uncommon bacterial infection caused by Nocardia spp.; Nocardia brasiliensis is the agent involved in most cases. This infection is acquired through the direct traumatic inoculation of soil, plants, or other substrates where the bacteria are found. Clinically, it usually manifests as an erythematous ulcerated nodule. In one-third of cases, nodules or gummas are distributed over the lymphatic pathways that resemble lymphocutaneous sporotrichosis. Its manifestations vary and can present acutely or more frequently with a latent clinical picture over time. Diagnosis is established mainly by Gram staining, biopsy, exudate culture, and molecular biology. Nocardia infections can recur, implying that antimicrobial therapy must be prolonged (between 6 and 12 months) and involve monitoring patients for at least 6 months after the end of treatment. Early diagnosis and targeted treatment may reduce patient mortality rates. We report the case of an 82-year-old woman who presented with four nodules with a lymphangitic spread on her left hand and forearm, one week after the trauma. Molecular identification was performed using 16S rDNA gene sequencing, and Nocardia brasiliensis was identified.