Abstract
Pulmonary nocardiosis (PN) is an uncommon but severe infection caused by Nocardia spp., which can behave either as opportunistic or primary pathogens. The diagnosis of PN can easily be missed. The purpose of this retrospective study is to review the predisposing factors, clinical symptoms, microbiologic, radiographic characteristics, diagnostic procedures, treatment and outcome of the patients with PN confirmed positive culture, diagnosed in a teaching hospital over the last 11 years. Twenty- six (20 men and 6 women) adult patients with a mean age at time of 49 years (range:21 to72 years) were identified with PN. Half of the patients had disseminated nocardiosis (8 with dissemination to central nervous system, 5 with soft tissue and cutaneous abscess). The predisposing conditions were treatment of steroids (88%), chronic lung diseases (31%), transplantation (19%) and malignancy (19%). Mean time to diagnosis was 31 days. In 21 patients (80%), the infection occurred outside the hospital setting. Respiratory tract sampling using noninvasive techniques had a diagnostic yield of 81%, while specimens from invasive methods had a yield of 37%. The radiological changes were diverse and non-specific. Nocardia asteroides type VI (N.cyriacigeorgica) and N.farcinica were the commonest species.Treatment was started empirically, modified according to the antimicrobial susceptibility pattern, and then continued for 6–12 months. Overall mortality was 58%, with death being caused by the Nocardia infection in 7 patients (27%).PN is a rare infection and mainly affects immunocompromised patients. Higher index of suspicion is needed for earlier diagnosis and treatment to improve prognosis.
- © 2012 ERS
