Presentation
CONCLUSION: The CT presentation of PN is heterogeneous. Airspace disease appeared most frequently (in 64% of the cases), and nodules were present in 57% of the cases. [ncbi.nlm.nih.gov]
Immune System
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Mediastinal Lymphadenopathy
Mediastinal lymphadenopathy was present in 8 (15%) patients. Fifteen patients (28%) had pleural effusions; the effusions were unilateral in 10 patients. [ncbi.nlm.nih.gov]
Entire Body System
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Fever
He presented with recurrent high-grade fever of a few days' duration prior to his initial visit, which subsequently led to his admission. [ncbi.nlm.nih.gov]
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Weight Loss
Mice infected with highly purified unicellular preparations of NbGFP did not develop granulomas despite showing weight loss. Finally, intranasal delivery of nocardial microcolonies was enough for mice to develop granulomas with minimal weight loss. [ncbi.nlm.nih.gov]
[…] chest pain The symptoms of fever, chills, and weight loss often result in pulmonary nocardiosis being mistaken for tuberculosis ! [amboss.com]
loss skin infection, rashes, lumps, abscesses Some with nocardiosis never experience any symptoms. [healthblurbs.com]
Night sweats, fatigue and weakness, lack of appetite and weight loss may also be experienced. In up to 30% of cases the infection enters the bloodstream and spreads to other organs (most commonly the brain) where it causes abscesses. [southerncross.co.nz]
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Chills
Fever and chills appeared. The patient did not have a headache, chest pain, cough, or other pulmonary symptoms. Reexamination revealed a 3-cm erythematous, nonfluctuant soft-tissue mass on the back in addition to the scalp lesions and adenopathy. [nejm.org]
[…] features Pulmonary nocardiosis Onset: acute, subacute, or chronic Constitutional symptoms : fever, weight loss, anorexia, night sweats Respiratory symptoms (recurrent pneumonia ): productive cough, dyspnea, pleuritic chest pain The symptoms of fever, chills [amboss.com]
Pulmonary nocardiosis is the most common, and its symptoms are a lot like ones you might have with pneumonia or tuberculosis : Chest pain Coughing Sweating Chills Feeling weak Lack of appetite Unexplained weight loss Shortness of breath or a hard time [webmd.com]
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. [rarediseases.org]
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Malaise
The clinical presentations ranged from malaise to respiratory failure. The radiological manifestations varied from a solitary nodule to extensive cavitary bronchopneumonia with distant dissemination. [ncbi.nlm.nih.gov]
Common symptoms may include: ENTIRE BODY Fever (comes and goes) General ill feeling ( malaise ) Night sweats GASTROINTESTINAL SYSTEM Nausea Liver and spleen swelling ( hepatosplenomegaly ) Loss of appetite Unintentional weight loss Vomiting LUNGS AND [medlineplus.gov]
Fever, malaise and anorexia. Night sweats. Weight loss. Haemoptysis, chest pain and difficulty in breathing - may also be present but are usually less prominent. [patient.info]
Pulmonary nocardiosis typically presents features made of dyspnoea, cough, chest pain, with no specific symptoms of fever, malaise and anorexia [ 13 ]. [omicsonline.org]
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Hodgkin Lymphoma
We describe a case of pulmonary infection with Nocardia asteroides in a non-Hodgkin's lymphoma patient. [ncbi.nlm.nih.gov]
lymphoma, glioblastoma multiforme [if ocular involvement]); (9) Kaposi's sarcoma; (10) yaws The differential for pulmonary or disseminated nocardiosis includes: (1) Mycobacterium tuberculosis; (2) deep fungal infections; (3) actinomycosis; (4) viral, [dermatologyadvisor.com]
Respiratoric
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Cough
We describe a case report of a patient with culture positive Nocardia asteroides who presented with complaints of cough and expectoration with episodes of haemoptysis and dyspnoea. [ncbi.nlm.nih.gov]
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Dyspnea
We reported a case of 36 year old immunocompetent non-smoker female patient with no premorbid illness who presented with fever, cough with scanty sputum, hemoptysis, left sided chest pain and exertional dyspnea for two weeks. [ncbi.nlm.nih.gov]
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Hemoptysis
Pulmonary nocardiosis should be considered in the differential diagnosis of hemoptysis, even in immunocompetent patients. [ncbi.nlm.nih.gov]
An 18-year-old male presented with cough and expectoration with episodes of hemoptysis for 1-year. Frequency and volume of hemoptysis has increased since last 7 days. [atmph.org]
The broad range of other symptoms caused by nocardia infection are: seizures hepatitis arthralgia dizziness confusion headache hemoptysis night sweats swollen spleen abdominal pain nausea, vomiting fever may undulate shortness of breath swollen lymph [healthblurbs.com]
Case Presentation History of Present Illness: A 65 year-old male with a history of metastatic neuroendocrine tumor of the pancreas, was admitted to the hospital with a one-week history of hemoptysis, cough, and dyspnea. [swjpcc.com]
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Productive Cough
Diagnosis of pulmonary nocardiosis in cases who presented with a short duration of fever and productive cough was often delayed because they were considered to have acute bacterial pneumonia. [ncbi.nlm.nih.gov]
As in any other type of pneumonia, productive cough, pleuritic chest pain, and fever are the dominant symptoms, making it difficult to differentiate from other lung infections. [amboss.com]
He reports that two days ago he developed a productive cough with associated shortness of breath. He also endorses drenching sweats for the last several nights. [medbullets.com]
The clinical manifestations in our and reported patients were, respectively, productive cough (n 6, 85.7%; n 10, 30.3%), pyrexia (n 6, 85.7%; n 12, 36.4%), sputum (n 0, 0%; n 4, 12.1%), and dyspnea (n 3, 42.9%; n 3, 9%). [jtd.amegroups.com]
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Chronic Cough
She presented to the hospital with an exacerbated chronic cough that had lasted several months and chronic fever, with no weight loss. Prior to admission, amoxicillin followed by spiramycin therapy was not effective. [err.ersjournals.com]
The most common symptoms at presentation are chronic cough, chest pain, dyspnoea and haemoptysis. [4] Thus pulmonary nocardiosis can mimic tuberculosis. [jpgmonline.com]
Skin
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Chronic Dermatitis
Hyperimmunoglobulin E syndrome (HIE) is a rare condition characterised by marked elevation of serum IgE level, chronic dermatitis, intense pruritus, and recurrent serious infection. The major organism is usually S aureus. [ncbi.nlm.nih.gov]
Neurologic
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Neglect
Pulmonary nocardiosis is an opportunistic infection in an immunocompromised patient; however, often neglected in the immunocompetent patient from the diagnosis considerations. [ncbi.nlm.nih.gov]
And Wenzel et al. suggested Candida albicans as a causative agent of nearly 60% nosocomial infection so their presence could not be neglected as normal flora. [biopublisher.ca]
Nocadiosis: A neglected chronic lung disease in Africa? Thorax 1988; 43:905-910. 5. Gaude GS, Hemashettar BM, Bagga AS, Chatterji R. Clinical profile of pulmonary nocardiosis. Indian J Chest Dis Allied Sci 1999; 41:153-157. 6. [jpgmonline.com]
Workup
X-Ray
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Cavitary Lesion
Computed tomography findings of pulmonary nocardiosis after lung transplantation consist predominantly of nodules and cavitary lesions without any significant zonal or anatomic distribution. [ncbi.nlm.nih.gov]
This patient showed multiple cavitary lesions on chest X-rays. [archivesofrheumatology.org]
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Left Pleural Effusion
Small left pleural effusion ( arrow ) is present. View larger version (126K) Fig. 1B — 26-year-old male allogeneic blood stem cell transplant recipient with graft-versus-host disease and pulmonary nocardiosis. [ajronline.org]
Serum
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Lymphocytopenia
Immunosuppressant therapy, lymphocytopenia, particularly low CD4 T-lymphocyte counts, and low serum albumin levels may be disease susceptibility factors. [ncbi.nlm.nih.gov]
Strikingly, none of our patients had an hematological malignancy, neutropenia, lymphocytopenia, or cytomegalovirus infection. [lungindia.com]
Microbiology
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Nocardia Asteroides
We describe a case report of a patient with culture positive Nocardia asteroides who presented with complaints of cough and expectoration with episodes of haemoptysis and dyspnoea. [ncbi.nlm.nih.gov]
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Nocardia Brasiliensis
Keywords: Immunocompetent, Nocardia brasiliensis, pulmonary How to cite this article: Amatya R, Koirala R, Khanal B, Dhakal S S. Nocardia brasiliensis primary pulmonary nocardiosis with subcutaneous involvement in an immunocompetent patient. [ijmm.org]
BALB/c mice infected intranasally with two different doses of GFP-expressing Nocardia brasiliensis ATCC700358 (NbGFP), develop weight loss and pulmonary granulomas. [ncbi.nlm.nih.gov]
Conclusion Nocardia brasiliensis is a rare cause of chronic wounds that can have deadly consequences without appropriate treatment. It is associated with traumatic inoculation of contaminated soil. [woundsresearch.com]
Figure 1 Rough chalky-white colonies of Nocardia brasiliensis grown on Columbia blood agar Table 1 Physiological characteristics and biochemical reactions of our Nocardia brasiliensis isolate Decomposition of: Adenine - Casein Tyrosine Xanthine - API [ann-clinmicrob.biomedcentral.com]
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Gram-Positive Rods
Gram-stained smears of sputum and pus from the abscess showing branched gram-positive rods led to a diagnosis of pulmonary nocardiosis with dissemination to the lungs and subcutaneous tissues. [ncbi.nlm.nih.gov]
Gram staining was performed in 29 patients, and a characteristic Gram-positive rod was detected in 28 patients (96.6%). Thirty-one strains of Nocardia were isolated and identified. [jstage.jst.go.jp]
A sample of bronchial lavage fluid obtained by bronchofiberscopy showed filamentous branching gram-positive rods and acid-fast filamentous branching rods, and a colony of suspected Nocardia was cultured. [jmmcr.microbiologyresearch.org]
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Nocardia Otitidis Caviarum
Pulmonary Nocardia otitidis-caviarum infection in a patient with bronchiectasia. Nihon Naika Gakkai Zasshi 2002;91:3037-9. Morita H, Torii M, Yokoyama T, et al. A case of pulmonary nocardiosis with a polypoid lesion in a bronchus. [jtd.amegroups.com]
Treatment
The patients' characteristics, clinical findings, radiological features, and treatment history were not different between the two groups. [ncbi.nlm.nih.gov]
Prognosis
Nocardiosis is an opportunistic infection with unfavourable prognosis and is predominantly seen in immunocompromised patients. [ncbi.nlm.nih.gov]
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. [10] Prognosis [ edit ] The prognosis of nocardiosis is highly [en.wikipedia.org]
The prognosis can vary with those with disseminated nocardiosis having mortality rates up to 40%. Subtherapeutic levels of antibiotics can result in flare-ups while patients are on treatments. [radiopaedia.org]
Etiology
Each part surveys individual infections caused not only by well-known etiologic agents, but also by new and emerging species often taxonomically closely related to a major disea- producing microorganism and until recently not considered to be human pathogens [books.google.com]
Etiology Pathogen Nocardia species : ubiquitous in soil worldwide Transmission : inhalation (most common), ingestion, and inoculation through a skin wound or injury Risk factors Immunocompromise ; ( HIV infection, organ transplant, glucocorticoid therapy [amboss.com]
The presence of sulfur granules and filamentous, gram-positive bacteria can point to this etiology. Final diagnosis is made by standard aerobic culture and sensitivity for a total of 5 days. [woundsresearch.com]
(Etiology) Pulmonary Nocardiosis is caused by inhalation of the bacteria Nocardia asteroids. [dovemed.com]
Epidemiology
The objectives of this study were to better understand the epidemiologic, demographic, clinical, and laboratory information in patients with pulmonary nocardiosis in southern Taiwan. [ncbi.nlm.nih.gov]
Epidemiology References: [1] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
"Dermatologic Manifestations of Nocardiosis: Background, Pathophysiology, Epidemiology". 2016-09-27. 12. External links [ edit ] [en.wikipedia.org]
Gutierrez-Galhardo MC, Freitas DFS, do Valle ACF, Almeida-Paes R, de Oliveira MME, Zancopé-Oliveira RM: Epidemiological aspects of sporotrichosis epidemic in Brazil. Curr Fungal Infect Rep 2015; 9:238–245. [karger.com]
We review the epidemiology and microbiology of the major medically important aerobic actinomycetes. [scienceopen.com]
Pathophysiology
"Dermatologic Manifestations of Nocardiosis: Background, Pathophysiology, Epidemiology". 2016-09-27. 12. External links [ edit ] [en.wikipedia.org]
The previously described pathophysiology of nocardiosis cannot be confirmed. Antibiotic susceptibility of N. cyriacigeorgica showed the usual in vitro effectiveness of cotrimoxazole, imipenem, amikacin and linezolid, but also minocycline [ 3 ]. [err.ersjournals.com]
As new and more powerful immunosuppressive drugs became available, 6 the epidemiological, pathophysiological, and clinical characteristics of opportunistic infections might have changed. [journals.lww.com]
Pathophysiology Nocardia species are facultative intracellular pathogens that gain virulence through evading the host's immune responses. [dermatologyadvisor.com]
Prevention
Infection developed at a time when efforts were being made with moderate dosages of immunosuppressive drugs to prevent rejection of the transplant. The subsequent nocardemia lasted for one week. [ncbi.nlm.nih.gov]
References Centre for Disease Control and Prevention (2013) Nocardiosis. Division of Bacterial and Mycotic Diseases; Centre for Disease Control and Prevention, Atlanta, GA. New Zealand Dermatological Society Inc. (2013) Nocardiosis. In DermNet NZ. [southerncross.co.nz]
Preventive measures for Pulmonary Nocardiosis include: Drugs, such as corticosteroids should be used cautiously, at a minimum dose and for a minimum possible period of time Individuals with weak immune systems may require antibiotics to prevent this disease [dovemed.com]