A FATAL PULMONARY INFECTION BY NOCARDIA BRASILIENSIS

Clinical Features, Radiological Findings, and Treatment Outcomes in Patients with Pulmonary Nocardiosis: A Retrospective Analysis

Introduction Lack of specific clinical features makes the diagnosis of pulmonary nocardiosis difficult. A high index of suspicion is required for diagnosis especially in cohorts with pre-existing risk factors. This study aimed to study the clinical and radiological characteristics and outcomes in patients with pulmonary nocardiosis. Methods This was a retrospective observational study. Data of confirmed cases with pulmonary nocardiosis were collected from a digital patient management system. Results A total of eight cases of pulmonary nocardiosis were included. The mean age of patients was 50 ± 14.3 years with a female preponderance (62.5%). The most common co-morbidity was chronic lung disease (37.5%). The common clinical feature of pulmonary nocardiosis was cough with expectoration (50%) and the mean duration of symptoms was 18 days. The common radiological (CT thorax) findings were consolidation, bronchiectasis, mediastinal lymphadenopathy, and nodularity (50% each). One patient had an extension of pulmonary disease in the chest wall. Microbiological detection of Nocardia spp. was done in sputum samples (50%) and in bronchoalveolar lavage (BAL) samples (50%). Culture was positive in two BAL samples. Intravenous empirical antibiotics in combination with oral trimethoprim-sulfamethoxazole double standard (15 mg/kg trimethoprim) were started at the time of diagnosis. Ceftriaxone and amikacin were commonly used antimicrobials. Conclusion Nocardia spp. commonly causes disease in patients with pre-existing chronic disease. A high index of suspicion is required in patients with subacute to chronic respiratory symptoms, raised inflammatory markers, and the absence of common respiratory pathogens in evaluation.

Pulmonary Nocardiosis: Unusual Presentation in Intensive Care Unit

Pulmonary nocardiosis is a rare disease, which mainly affects immunocompromised hosts such as uncontrolled diabetics; HIV patients; and patients on immunosuppressive therapies such as anticancer drugs, systemic steroids, and transplant recipients. The diagnosis is often missed and delayed, resulting in inappropriate treatment and thus higher mortality. We are reporting a case of pulmonary nocardiosis with acute presentation in an immune-competent host, who presented with community-acquired pneumonia to the Intensive Care Unit. Clinical expertise with multiple high-end and interventional investigations timely confirmed the case as pulmonary nocardiosis. Conservative management with medications led to her complete recovery.

A life-threatening case of disseminated nocardiosis due to Nocardia brasiliensis

Nocardiosis is a rare disease caused by infection with Nocardia species, aerobic actinomycetes with a worldwide distribution. A rare life-threatening disseminated Nocardia brasiliensis infection is described in an elderly, immunocompromised patient. Microorganism was recovered from bronchial secretions and dermal lesions, and was identified using molecular assays. Prompt, timely diagnosis and appropriate treatment ensured a favorable outcome.