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Pulmonary nocardiosis

Nocardiosis - pulmonary; Mycetoma; Nocardia

 

Pulmonary nocardiosis is an infection of the lung with the bacteria, Nocardia asteroides.

Causes

 

Nocardia infection develops when you breathe in (inhale) the bacteria. The infection causes pneumonia-like symptoms. The infection can spread to any part of the body.

People with a weak immune system are at a high risk for nocardia infection. This includes people who have:

  • Been taking steroids or other medicines that weaken the immune system for a long time
  • Cushing disease
  • An organ transplant
  • HIV/AIDS
  • Lymphoma

Other people at risk include those with long-term (chronic) lung problems related to smoking, emphysema, or other tuberculosis.

 

Symptoms

 

Pulmonary nocardiosis mainly affects the lungs. But, it can also spread to other organs in the body. Common symptoms may include:

ENTIRE BODY

  • Fever (comes and goes)
  • General ill feeling (malaise)
  • Night sweats

GASTROINTESTINAL SYSTEM

  • Nausea
  • Liver and spleen swelling (hepatosplenomegaly)
  • Unintentional weight loss
  • Vomiting

LUNGS AND AIRWAYS

  • Breathing difficulty
  • Chest pain not due to heart problems
  • Coughing up blood or mucus
  • Rapid breathing
  • Shortness of breath

MUSCLES AND JOINTS

  • Joint pain

NERVOUS SYSTEM

  • Change in mental state
  • Confusion
  • Dizziness
  • Headache
  • Seizures

SKIN

  • Skin rashes or lumps
  • Skin sores (abscesses)
  • Swollen lymph nodes

 

Exams and Tests

 

Your health care provider will examine you and listen to your lungs using a stethoscope. You may have abnormal lung sounds, called crackles. Tests that may be done include:

  • Bronchoalveolar lavage -- fluid is sent for stain and culture, which is taken by bronchoscopy
  • Chest x-ray
  • CT scan of the chest
  • Pleural fluid culture and stain
  • Sputum stain and culture

 

Treatment

 

The goal of treatment is to control the infection. Antibiotics are used, but it may take a while to get better. You're provider will tell you how long you need to take the medicines. This may be for up to a year.

Surgery may be needed to remove or drain infected areas.

Your provider may tell you to stop taking any medicines that weaken your immune system. Never stop taking any medicine before talking to your provider first.

 

Outlook (Prognosis)

 

The outcome is often good when the condition is diagnosed and treated quickly.

The outcome is poor when the infection:

  • Spreads outside the lung
  • Treatment is delayed
  • The person has a serious disease that leads to or requires long-term suppression of the immune system

 

Possible Complications

 

Complications of pulmonary nocardiosis may include:

  • Brain abscesses
  • Skin infections

 

When to Contact a Medical Professional

 

Call your provider if you have symptoms of this disorder. Early diagnosis and treatment may improve the chance of a good outcome.

 

Prevention

 

Be careful when using corticosteroids. Use these drugs sparingly, in the lowest effective doses and for the shortest periods of time possible.

Some people with a weak immune system may need to take antibiotics for long periods of time to prevent the infection from returning.

 

 

References

Southwick FS. Nocardiosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 330.

Torres A, Menendez R, Wunderink RG. Bacterial pneumonia and lung abscess. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 33.

 
  • Respiratory system

    Respiratory system - illustration

    Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

    Respiratory system

    illustration

    • Respiratory system

      Respiratory system - illustration

      Air is breathed in through the nasal passageways, travels through the trachea and bronchi to the lungs.

      Respiratory system

      illustration

    Talking to your MD

     

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        Tests for Pulmonary nocardiosis

         

           

          Review Date: 8/21/2016

          Reviewed By: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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