Nocardiosis

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Nocardiosis
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Nocardiosis is an infectious disease affecting either the lungs (pulmonary nocardiosis) or the whole body (systemic nocardiosis). It is due to infection by a bacterium of the genus Nocardia , most commonly Nocardia asteroides or Nocardia brasiliensis .

Contents

It is most common in adult males, especially those with a weakened immune system. In patients with brain nocardia infection, mortality exceeds 80%; in other forms, mortality is 50%, even with appropriate therapy. [1]

It is one of several conditions that have been called "the great imitator". [2] Cutaneous nocardiosis commonly occurs in immunocompetent hosts and is caused in 80% of cases by Nocardia brasiliensis. [3] [4]

Signs and symptoms

Pulmonary infection

Neurological infection

Cardiac conditions

Lymphocutaneous disease

Ocular disease

Disseminated nocardiosis

Causes

Normally found in soil, these organisms cause occasional sporadic disease in humans and animals throughout the world. Another well publicized find is that of Nocardia as part of the oral microflora. Nocardia spp. have been reported in the normal gingivae and periodontal pockets along with other species such as Actinomyces , Arthromyces and Streptomyces spp. [8]

The usual mode of transmission is inhalation of organisms suspended in dust. Another very common method is by traumatic introduction, especially in the jaw. This leads to the entrance of Nocardia into the blood stream and the propagation of its pathogenic effects. Transmission by direct inoculation through puncture wounds or abrasions is less common. [1] Generally, nocardial infection requires some degree of immune suppression.[ citation needed ]

A weakened immune system is a general indicator of a person who is more susceptible to nocardiosis, such as someone who already has a disease that weakens their immune system. Additionally, those with low T-cell counts or other complications involving T-cells can expect to have a higher chance of becoming infected. Besides those with weak immune systems, a local traumatic inoculation can cause nocardiosis, specifically the cutaneous, lymphocutaneous, and subcutaneous forms of the disease. [9] [10] There is no racial pattern in the risk of becoming infected with Nocardiosis.[ citation needed ]

Diagnosis

Diagnosis of nocardiosis can be made by a doctor using various techniques. These techniques include, but are not limited to: a chest x-ray to analyze the lungs, a bronchoscopy, a brain/lung/skin biopsy, or a sputum culture. However, diagnosis may be difficult. Nocardiae are gram positive, weakly acid-fast, branching rod-shaped bacteria and can be visualized by a modified Ziehl–Neelsen stain such as the Fite-Faraco method. In the clinical laboratory, routine cultures may be held for insufficient time to grow nocardiae, and referral to a reference laboratory may be needed for species identification. [11] Pulmonary infiltration and pleural effusion are usually detected via x-ray.[ citation needed ]

Treatment

Nocardiosis requires at least 6 months of treatment, preferably with trimethoprim/sulfamethoxazole or high doses of sulfonamides. In patients who do not respond to sulfonamide treatment, other drugs, such as ampicillin, erythromycin, or minocycline, may be added.[ citation needed ]

Treatment also includes surgical drainage of abscesses and excision of necrotic tissue. The acute phase requires complete bed rest; as the patient improves, activity can increase. [1]

A new combination drug therapy (sulfonamide, ceftriaxone, and amikacin) has also shown promise. [11]

Prognosis

The prognosis of nocardiosis is highly variable. The state of the host's health, site, duration, and severity of the infection all play parts in determining the prognosis. Currently, skin and soft tissue infections have a 100% cure rate, and pleuropulmonary infections have a 90% cure rate with appropriate therapy. The cure rate falls to 63% with those infected with disseminated nocardiosis, with only half of patients surviving infections that cause brain abscess. Additionally, 44% of people who are infected in the central nervous system (CNS) die, increasing to 85% if that person has an already weakened immune system. There are no preventative treatments for nocardiosis. The only recommendation is to protect open wounds to limit entrance of the bacterium.[ citation needed ]

Epidemiology

Although there are no international data available on worldwide infection rates per year, there are roughly 500–1000 documented cases of nocardiosis per year in the US. Most of these cases occur in men, as there is a 3:1 ratio of male of female cases annually; however, this difference may be due to exposure frequency rather than susceptibility differences. From an age perspective, it is not highly more prevalent in one age group than another. [9] Cutaneous nocardiosis is slightly more common in middle aged men, but as a whole, all age groups are susceptible. [12] There is no racial pattern in the risk of becoming infected with nocardiosis.[ citation needed ]

Related Research Articles

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Coccidioidomycosis Fungal infection

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Sarcoidosis Medical condition

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Histoplasmosis Human disease

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Infective endocarditis Medical condition

Infective endocarditis is an infection of the inner surface of the heart, usually the valves. Signs and symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count. Complications may include backward blood flow in the heart, heart failure – the heart struggling to pump a sufficient amount of blood to meet the body's needs, abnormal electrical conduction in the heart, stroke, and kidney failure.

Cellulitis Bacterial infection of the skin

Cellulitis is a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days. The borders of the area of redness are generally not sharp and the skin may be swollen. While the redness often turns white when pressure is applied, this is not always the case. The area of infection is usually painful. Lymphatic vessels may occasionally be involved, and the person may have a fever and feel tired.

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Boil Medical condition

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Actinomycosis Medical condition

Actinomycosis is a rare infectious bacterial disease caused by Actinomyces species. The name refers to ray-like appearance of the organisms in the granules. About 70% of infections are due to either Actinomyces israelii or A. gerencseriae. Infection can also be caused by Streptomyces somaliensis and Propionibacterium propionicus. The condition is likely to be a polymicrobial anaerobic infection.

Miliary tuberculosis Medical condition

Miliary tuberculosis is a form of tuberculosis that is characterized by a wide dissemination into the human body and by the tiny size of the lesions (1–5 mm). Its name comes from a distinctive pattern seen on a chest radiograph of many tiny spots distributed throughout the lung fields with the appearance similar to millet seeds—thus the term "miliary" tuberculosis. Miliary TB may infect any number of organs, including the lungs, liver, and spleen. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and accounts for up to 20% of all extra-pulmonary tuberculosis cases.

Staphylococcal scalded skin syndrome Medical condition

Staphylococcal scalded skin syndrome (SSSS) is a dermatological condition caused by Staphylococcus aureus.

<i>Nocardia</i> Genus of bacteria

Nocardia is a genus of weakly staining Gram-positive, catalase-positive, rod-shaped bacteria. It forms partially acid-fast beaded branching filaments. It contains a total of 85 species. Some species are nonpathogenic, while others are responsible for nocardiosis. Nocardia species are found worldwide in soil rich in organic matter. In addition, they are oral microflora found in healthy gingiva, as well as periodontal pockets. Most Nocardia infections are acquired by inhalation of the bacteria or through traumatic introduction.

Lung abscess Medical condition

Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities containing necrotic debris or fluid caused by microbial infection.

Sporotrichosis Medical condition

Sporotrichosis, also known as rose handler's disease, is a fungal infection that affects skin, lungs, bone and joint, and can be widespread. It presents with firm painless nodules that later ulcerate. It can be localized or widespread. The disease progresses over a week to several months after the initial exposure to the fungus. Serious complications can also develop in people who have a weakened immune system.

Fever of unknown origin (FUO) refers to a condition in which the patient has an elevated temperature (fever) but, despite investigations by a physician, no explanation has been found.

Mixed connective tissue disease, commonly abbreviated as MCTD, is an autoimmune disease characterized by the presence of elevated blood levels of a specific autoantibody, now called anti-U1 ribonucleoprotein (RNP) together with a mix of symptoms of systemic lupus erythematosus (SLE), scleroderma, and polymyositis. The idea behind the "mixed" disease is that this specific autoantibody is also present in other autoimmune diseases such as systemic lupus erythematosus, polymyositis, scleroderma, etc. MCTD was characterized as an individual disease in 1972 by Sharp et al., and the term was introduced by Leroy in 1980.

<i>Mycobacterium fortuitum</i> Species of bacterium

Mycobacterium fortuitum is a nontuberculous species of the phylum Actinomycetota, belonging to the genus Mycobacterium.

Geotrichosis Medical condition

Geotrichosis is a mycosis caused by Geotrichum candidum.

Lung cavity Medical condition

A lung cavity or pulmonary cavity is an abnormal, thick-walled, air-filled space within the lung. Cavities in the lung can be caused by infections, cancer, autoimmune conditions, trauma, congenital defects, or pulmonary embolism. The most common cause of a single lung cavity is lung cancer. Bacterial, mycobacterial, and fungal infections are common causes of lung cavities. Globally, tuberculosis is likely the most common infectious cause of lung cavities. Less commonly, parasitic infections can cause cavities. Viral infections almost never cause cavities. The terms cavity and cyst are frequently used interchangeably; however, a cavity is thick walled, while a cyst is thin walled. The distinction is important because cystic lesions are unlikely to be cancer, while cavitary lesions are often caused by cancer.

References

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  3. Rapini RP, Bolognia JL, Jorizzo JL (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. ISBN   978-1-4160-2999-1.
  4. Lovecchio A, Bazzacco G, Di Bella S, Di Meo N, Luzzati R (2022-06-06). "Uncommon lymphocutaneous cellulitis after insect bite: a case report of primary cutaneous nocardiosis and literature review". Le Infezioni in Medicina. 30 (2): 285–292. doi:10.53854/liim-3002-15. PMC   9177186 . PMID   35693062.
  5. Lazo Torres AM, Gálvez Contreras C, Collado Romacho A, Gamir Ruiz FJ, Yélamos Rodríguez F, López Martínez G (August 2004). "[Nocardia endocarditis in a native mitral valve]". Revista Espanola de Cardiologia (in Spanish). 57 (8): 787–8. doi:10.1016/S0300-8932(04)77191-2. PMID   15282069.
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  9. 1 2 Mazumder SA, Gibbs RE (2016-07-25). Talavera F, King JW (eds.). "Nocardiosis: Background, Pathophysiology, Epidemiology". MedScape.
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Webmd article on Nocardiosis