• Journal of Microbiology and Biotechnology
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• v.33 no.5
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• pp.574-581
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• 2023

Nocardiosis is an uncommon opportunistic bacterial infection which becomes a significant health problem due to its increasing incidence and high mortality rate. However, many nocardiosis patients are underdiagnosed by physicians. To summarize the clinical characteristics and management of nocardiosis would help with better diagnosis and prognosis of nocardiosis. This retrospective study was conducted based on the medical records of nocardiosis patients between January 2015 and December 2021 in a tertiary hospital in China. Overall, 44 nocardiosis patients with 54 specimens were included. The patients consisted of 26 males and 18 females with a mean age of 50.4 ± 13.2 years. Among 44 patients, 26 (59.1%) were previously given immunosuppressive therapy. Connective tissue diseases (CTDs) were the most common underlying disease (16/44). The most frequent infection sites were the lungs (17/44) and skin or soft tissues (8/44). Common symptoms included cough (23/44), expectoration (18/44), fever (15/44), and subcutaneous abscesses (15/44). Forty-five out of 54 specimens (83.3%) required over 48 hours of culture time for nocardiosis detection. Thirty-six patients were cured or improved, 5 patients were discharged from the hospital due to poor prognosis, and 1 patient died. The average diagnosis time of poor prognosis cases was 19.7 days, which was significantly longer than those of improved or cured patients (7.3 days). Immunosuppressed patients comprise a large part of nocardiosis cases, which is worth attention in clinical practice. Early diagnosis, specifically through prolonged cultivation time of specimen, could help achieve better prognosis of nocardiosis patients.

• Tuberculosis and Respiratory Diseases
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• v.53 no.1
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• pp.79-84
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• 2002

Pulmonary nocardiosis is an infrequent but severe infection due to the microorganism, Nocardia spp, which may behave as both an opportunists and as a primary pathogens. Usually nocardiosis is found in patients under immunosuppressive regimens for organ transplans, chemotherapy for a malignancy and corticosteroids. The experience of pulmonary nocardiosis in the medical literature is limited to just case reports, with a few series including extrapulmonary nocardiosis. It is believed that the incidence of this infection has been increasing since 1960. The diagnosis is difficult because of the nonspecific clinical manifestations, the lack of laboratory evidence, and the non-specific radiographic findings. Here, we report a case of pulmonary nocardiasis in a 66 year-old patient with alcoholic liver cirrhosis who has suffered from acutely developed dyspnea and general edema. The nocardia species. was cultured from a specimen obtained by a percutaneous transthoracic needle biopsy.

• Tuberculosis and Respiratory Diseases
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• v.39 no.4
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• pp.355-360
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• 1992

Nocardiosis is an acute, subacute or chronic infection, which usually introduced through the respiratory tract resulting pneumonia, and may develop a disseminated infection, especially subcutaneous abscess and/or CNS infection. It is usually affects the immunocompromized host and may be fatal unless early diagnosis and adequate treatment are performed. There have been only several case reports of nocardial infection in Korea. Nocardiosis is so unfamiliar to many physicians that may be misdiagnosed as pneumonia, tuberculosis, or neoplasm. We have experienced a case of nocardiosis from a patient who had been treated as pneumonia and tuberculosis at first. The 57-year-old male patient had fever, chill, dyspnea and blood tinged purulent sputum for 20 days. Under the impression of bacterial pneumonia, broad spectrum antibiotics were administered for more than 3 weeks without clinical improvement. Although antituberculous drugs began to be administered after acid fast bacilli were found in bronchial aspirate by bronchoscopy, the nocardial infection was suspected due to no clinical response toward antituberculous therapy and the occurrence of multiple subcutaneous abscesses on scalp. The diagnosis was made by modified Ziehl-Neelson stain and culture of the sputum and pus. Nocardia asteroides was identified. After 25 days of trimethoprim-sulfamethoxazole treatment, the patient was much improved and discharged.

• Investigative Magnetic Resonance Imaging
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• v.17 no.1
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• pp.50-54
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• 2013

Nocardiosis is an uncommon Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia spp. have the ability to cause localized or systemic suppurative disease in humans and animals. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of infected patients are immunocompetent. We report a rare case of pulmonary nocardiosis and a brain abscess caused by Nocardia asteroides in an elderly woman with a history of Crohn's disease. Radiographic imaging revealed a contrast-enhancing lesion with perilesional parenchymal edema that was preoperatively thought to be a neoplasm. The patient experienced aggressive disease progression simulating a metastatic brain tumor. Early diagnosis of norcadiosis, the absence of underlying disease, and the administration of appropriate antibiotics has a positive impact on prognosis. Familiarity with the magnetic resonance and computed tomography findings associated with CNS nocardiosis, such as those presented here, is essential for making an early diagnosis.

• The Korean Journal of Cytopathology
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• v.6 no.2
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• pp.169-173
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• 1995

Nocardia, aerobic members of the order of Actinomycetaceae, produces infections in human lung. Nocardial infection is associated with underlying diseases of immuno-suppression or treatment with corticosteroid. It is difficult to detect Nocardia by sputum examination or histologic sections and it has rarely been diagnosed by fine needle aspiration of the lung. We describe a case of pulmonary nocardiosis in a 72 year-old man, diagnosed by fine needle aspiration, which was confirmed by culture of aspirates. The aspirates showed neutrophil-predominant inflammatory cells with microorganisms demonstrated by Gomori methenamine silver and Gram stain. The organisms had characteristic long blanching filamentous structures. The lesions on chest X-ray were in resolution with antimicrobial therapy.

• Journal of Microbiology and Biotechnology
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• v.25 no.3
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• pp.321-327
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• 2015

Nocardia salmonicida is one of the main pathogens of fish nocardiosis. The purpose of this study was to build a loop-mediated isothermal amplification (LAMP) method for the rapid and sensitive detection of N. salmonicida. A set of four primers were designed from the 16S-23S rRNA intergenic spacer region of N. salmonicida, and conditions for LAMP were optimized as incubating all the reagents for 60 min at 64℃. LAMP products were judged with agar gel electrophoresis as well as with the naked eye after the addition of SYBR Green I. Results showed the sensitivity of the LAMP assay was 1.68 × 10³ CFU/ml (16.8 CFU per reaction) and 10-fold higher than that of PCR. The LAMP method was also effectively applied to detect N. salmonicida in diseased fish samples, and it may potentially facilitate the surveillance and early diagnosis of fish nocardiosis.

• Tuberculosis and Respiratory Diseases
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• v.77 no.6
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• pp.271-273
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• 2014

Disease flare-up after discontinuing epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) has been considered as a critical issue in lung cancer patients who have experienced radiologic progression after showing initial durable response. This is a case of systemic nocardiosis that occurred after chronic steroid use for radionecrosis from stereotactic radiosurgery. It was initially thought as a disease flare-up after stopping EGFR-TKI.

• Tuberculosis and Respiratory Diseases
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• v.57 no.1
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• pp.61-65
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• 2004

Even though nocardiosis is one of opportunistic infections, and can occur in Cushing's syndrome, it rarely occurs in patients with Cushing's disease. Herein, a case with Cushing's disease in whom nocardiosis had manifested as a pulmonary lesion, which after percutaneous needle aspiration, empyema and a breast abscess were also noted.

• Journal of Korean Neurosurgical Society
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• v.49 no.5
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• pp.305-307
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• 2011

We describe here the first case of a concurrent brain abscess caused by Norcardia spp. and semi-invasive pulmonary aspergillosis in an immunocompetent patient. After one year of appropriate antimicrobial therapy and surgical drainage of the brain abscess, the nocardia brain abscess and pulmonary aspergillosis have resolved.

• Tuberculosis and Respiratory Diseases
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• v.79 no.2
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• pp.101-103
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• 2016

Nocardia species are aerobic, gram-positive pathogens found worldwide in soil. Nocardia is considered an opportunistic pathogen, and its infection mostly occurs in immunocompromised patients. We report a case of Nocardia farcinica induced mediastinitis and pneumonia that occurred in a 64-year-old male patient who had no significant medical history except for hypertension. He visited another hospital with a complaint of dyspnea and left chest wall pain. The symptoms arose 7 days ago without any trauma and they worsened. A mediastinal mass was found on computed tomography scan. After being transferred to our hospital for further evaluation, he was diagnosed with mediastinitis and pneumonia. As N. farcinica was found to be the causative organism by 16S rRNA sequencing, proper antibiotic therapy including trimethoprim/sulfamethoxazole was initiated immediately. After this, the patient improved and he was discharged. If an infection has a disseminating course, nocardiosis cannot be excluded even in immunocompetent patients. Once the diagnosis is established, prompt antibiotic therapy should be performed based on the severity.