Nocardiosis
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| ICD-10 | A43 |
|---|---|
| ICD-9 | 039.9 |
Nocardiosis is an infectious disease affecting either the lungs (pulmonary nocardiosis) or the whole body (systemic nocardiosis). It is due to infection by bacterium of the genus Nocardia, most commonly Nocardia asteroides or Nocardia brasiliensis.
It is most common in men, especially those with a compromised immune system. In patients with brain infection, mortality exceeds 80%; in other forms, mortality is 50%, even with appropriate therapy.[1]
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[edit] Causes
Normally found in soil, these organisms cause occasional sporadic disease in humans and animals throughout the world. The usual mode of transmission is inhalation of organisms suspended in dust. Transmission by direct inoculation through puncture wounds or abrasions is less common.[2]
[edit] Symptoms
[edit] Diagnosis
Diagnosis may be difficult. 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.[3] Infiltration and pleural effusion are usually seen via x-ray.
[edit] Treatment
Nocardiosis requires at least 6 months of treatment, preferably with co-trimoxazole or high doses of sulfonamides. In patients who don’t respond to sulfonamide treatment, other drugs, such as ampicillin, erythromycin, or minocycline, may be added. 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. [4] A new combination drug therapy (sulfonamide, ceftriaxone, and amikacin) has also shown promise [5]
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