Which conditions increase the risk for pulmonary and disseminated nocardiosis?

Updated: Jul 24, 2018
  • Author: George Kurdgelashvili, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Pulmonary and disseminated nocardiosis are clearly associated with immunocompromising conditions, with approximately 60% of cases of nocardiosis other than mycetoma occurring in individuals with some compromise of host defense systems. Conditions associated with an increased risk of pulmonary and disseminated nocardiosis include the following:

  • Chronic pulmonary disease: Although pulmonary nocardiosis has been described in association with various chronic pulmonary diseases, patients with pulmonary alveolar proteinosis are at particular risk.

  • Alcoholism

  • Lymphoreticular malignancy

  • Solid-organ transplantation [22]

  • Bone marrow or stem cell transplantation, particularly allogeneic transplantation with subsequent graft versus host disease

  • Long-term corticosteroid use or Cushing syndrome

  • Systemic lupus erythematosus

  • Systemic vasculitis

  • Sarcoidosis

  • Renal failure

  • Treatment with anti–tumor necrosis factor antibody

  • HIV infection and AIDS: Nocardiosis in individuals with advanced HIV disease usually presents as a relentlessly progressive infiltrative pulmonary infection. The median CD4 count in patients infected with HIV who develop nocardiosis is approximately 50 cells/µL. [15]


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