Pulmonary nocardiosis

Definition

Pulmonary nocardiosis is an infection of the lung that is caused by the fungus-like bacteria Nocardia asteroides.

Alternative Names

Causes, incidence, and risk factors

Nocardia infection develops when you breathe in (inhale) the bacteria. The infection causes pneumonia-like symptoms but the infection can spread to any part of the body. Brain and skin infections are the most common complications.

In the United States, there are 500 to1,000 new cases of nocardia infection diagnosed each year.

People at highest risk for nocardia infection are those with weakened immune systems. This including persons with HIV, those who have had an organ transplant, or people taking l steroid medicines for a long time. People who have chronic lung problems related to smoking, emphysema, or other infections such as tuberculosis are also at increased risk.

Symptoms

• Lungs and airways
  • Chest pain not due to heart problems
  • Shortness of breath
  • Rapid breathing
  • Coughing up blood
  • Cough with mucous
  • Breathing gets harder and harder (pulmonary insufficiency)
• Gastrointestinal system
  • Nausea
  • Vomiting
  • Unintentional weight loss
  • Swollen liver and spleen (hepatosplenomegaly)
• Muscles and joints
  • Joint pain
• Nervous system
  • Headache
  • Change in mental state (occurs with brain lesions)
  • Confusion
  • Dizziness
  • Seizures
• Skin
  • Skin rashes or lumps
  • Skin sores (abscesses)
  • Swollen lymph nodes
• Entire body
  • Fever (comes and goes)
  • Night sweats, excessive sweating at night
  • General ill feeling (malaise)

Signs and tests

• Decreased breath sounds in the lung
• Crackles (rales) in the infected lung detected by stethoscope
• Chest x-ray
• CT scan
• Sputum stain and culture
• Bronchial alveolar lavage - fluid is sent for stain and culture
• Pleural fluid culture and stain
• Bronchoscopy

Treatment

The objective of treatment is to control the infection. Antibiotics are used, but the response to treatment may be slow and the medications must be continued for at least 3 months. Patients who have medication allergies will need to take alternative antibiotics.

Surgery may be needed to remove or drain infected areas.

Expectations (prognosis)

The probable outcome is generally good when diagnosis and treatment are prompt. Outcome is poor when the infection is widespread and treatment has been delayed.

Complications

• Invasion by lesions into the ribs
• Brain abscesses
• Infections of the skin

Calling your health care provider

Call your health care provider if symptoms of this disorder develop. Early diagnosis and treatment may possibly improve the chance of a good outcome.

Prevention

Caution when using corticosteroids may be helpful - these drugs should be used sparingly and in the lowest effective doses and for the shortest periods of time possible when they are needed.

Some patients with impaired immune systems may need to take antibiotics for long periods of time to prevent the infection from recurring.