About nocardiosis

What is nocardiosis?

Nocardiosis is an infectious pulmonary disease characterized by abscesses in the lungs. These abscesses may extend through the chest wall. The infection is spread through the body via the bloodstream by a microorganism called Nocardia asteroids.

What are the symptoms for nocardiosis?

Most cases of nocardiosis begin as pulmonary infections that develop into lung abscesses. Symptoms may include chest pain, cough, bloody sputum, sweats, chills, weakness, lack of appetite, Weight loss and difficult or labored breathing. Nocardiosis symptoms are similar to those of pneumonia and tuberculosis.

The infection may spread through the bloodstream resulting in abscesses in the brain, where they are very serious indeed, or less frequently and less seriously, in the kidney, intestines or other organs. Approximately one-third of reported cases develop brain abscesses if left untreated or if treatment is delayed. Symptoms associated with brain abscesses may include severe Headache and focal, sensory and motor disturbances.

Skin abscesses occur in approximately one-third of all cases of nocardiosis, and are usually found scattered across the hand, chest wall and buttocks. In patients whose immune system is suppressed due to HIV infection or to corticosteroid or cytotoxic drugs, ulcerative colitis, malignancy of the lymph system or a variety of other diseases, progression of the disease can be very rapid.

Nocardiosis may last from several months to years. It is essential that the infection be diagnosed and differentiated from tuberculosis and pneumonia.

What are the causes for nocardiosis?

Nocardiosis is caused by Nocardia asteroides, a bacterium that is carried up into the air from the ground and may be inhaled. Other species of the same family of bacteria such as Nocardia brasiliensis, Nocardia caviae, and Nocardia farcinica, are also known to cause disease. The organism usually enters the body through the lungs or, more rarely, through the gastrointestinal tract or the skin.

People whose immune systems are not functioning properly (immunocompromised) are at risk for nocardial infections. People whose immune systems are functioning properly but who are taking immunosuppressive drugs as part of the routine for organ transplantation are at greater than normal risk as well.

What are the treatments for nocardiosis?

Nocardia organisms are usually resistant to penicillin. Sulfonamide drugs may be prescribed. However, since most cases respond slowly, treatment with sulfonamide drugs must be continued for several months. Trimethoprim-sulfamethoxazole is often prescribed for immunosuppressed patients. Recurrent infection is common.

Other drugs sometimes prescribed are Imipenem and cilastatin (Primaxin), Meropenem (Merrem IV), Cefotaxime (Claforan), Ceftriaxone (Rocephin) ampicillin, minocycline, and amikacin. Without treatment the disease can be fatal, so proper and prompt diagnosis is essential.

If infection occurs and spreads, surgery may be needed to remove and/or drain the infected areas.

What are the risk factors for nocardiosis?

Nocardiosis is a disease caused by bacteria in soil and water.

  • It most frequently affects those who have compromised immune systems and have trouble fighting off infections, such as cancer patients or those on specific drugs like steroids.
  • The risk factor for nocardiosis is more in people/patients whose immunity is compromised, mainly those with defects which are cell-mediated. Examples of such diseases / immunocompromised instances include Diabetes, Cancer, and HIV/AIDS.
  • Alcoholism or any similar addiction can also lead to this disease.
  • A pre-existing immunological deficit is linked to nocardiosis in about 60% of cases.
  • Men also have a higher risk of contracting the virus than women do; for every female who develops nocardiosis, roughly 3 men do as well.
  • Advanced chronic obstructive lung diseases are other risk factors for Nocardia infections.
  • Specific risk factors include corticosteroid treatment and immunosuppressive therapy.

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