Pulmonary Nocardiosis: Risk Factors, Clinical Features, Diagnosis and Prognosis

Raquel Martínez; Soledad Reyes; Rosario Menéndez

Disclosures

Curr Opin Pulm Med. 2008;14(3):219-227. 

In This Article

Abstract and Introduction

Abstract

Purpose of Review: Pulmonary infection by Nocardia spp. has been recognized for the past 100 years. The number of cases of pulmonary nocardiosis reported in the literature is increasing, and in some cases, a diagnosis is reached even postmortem. This increase is partly due to the growing number of patients with depressed cellular immunity. The diagnosis of this infection, which has a high rate of mortality, is usually delayed, due to a nonspecific clinical-radiological presentation and the difficulties in cultivating the bacteria. This review analyzes the current situation, in order to better understand this infection and enhance awareness and clinical suspicion that would lead to further specific microbiological studies and treatment.
Recent Findings: The number of case series in the literature is increasing. This development may be due to an absolute increase in the number of immmunocompromised patients, but also to improvements in laboratory techniques and molecular methods to detect nocardiosis.
Summary: It is important to keep in mind, and suspect the presence of pulmonary nocardiosis in the immunodepressed patients with clinical pulmonary infection. Furthermore, the laboratory should be notified when Nocardia is suspected in a clinical specimen so that measures can be taken to optimize recognition and recovery of the organism.

Introduction

Pulmonary nocardiosis is an important cause of opportunistic infection in immunosuppressed patients, and the incidence of this infection is increasing. Pulmonary nocardiosis manifests as an acute, subacute or chronic infection with a marked tendency towards remissions and exacerbations. There is usually a delay in its diagnosis and, therefore, in specific treatment, worsening the prognosis for an illness that already has a high rate of mortality. The purpose of this article is primarily to review the risk factors, clinical features, diagnosis, treatment and prognosis of pulmonary nocardiosis.

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