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Semin Respir Crit Care Med 2020; 41(04): 538-554
DOI: 10.1055/s-0040-1708816
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Nocardia spp.: A Rare Cause of Pneumonia Globally

Joseph P. Lynch III
1   Division of Pulmonary, Critical Care Medicine, Allergy, and Clinical Immunology, Department of Internal Medicine, The David Geffen School of Medicine at UCLA, Los Angeles, California
,
Gail Reid
2   Division of Infectious Diseases, Loyola University Medical Center, Maywood, Illinois
3   Department of Medicine and Infectious Disease & Research Immunology Institute, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
,
Nina M. Clark
2   Division of Infectious Diseases, Loyola University Medical Center, Maywood, Illinois
3   Department of Medicine and Infectious Disease & Research Immunology Institute, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
› Author Affiliations
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Publication History

Publication Date:
06 July 2020 (online)

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Abstract

Members of the Nocardia genus are ubiquitous in the environment. These aerobic, gram-positive organisms can lead to life-threatening infection, typically in immunocompromised hosts such as solid organ transplant recipients or those receiving immunosuppressive medications for other reasons. This current review discusses the microbiology of nocardiosis, risk factors for infection, clinical manifestations, methods for diagnosis, and treatment. Nocardiosis primarily affects the lung but may also cause skin and soft tissue infection, cerebral abscess, bloodstream infection, or infection involving other organs. Although rare as a cause of community-acquired pneumonia, Nocardia can have severe morbidity and mortality, particularly in patients with comorbidities or compromised immunity. Early diagnosis and timely initiation of therapy are critical to optimizing patient outcomes. Species identification is important in determining treatment, as is in vitro susceptibility testing. Sulfonamide therapy is usually indicated, although a variety of other antimicrobials may be useful, depending on the species and susceptibility testing. Prolonged therapy is usually indicated, for 6 to 12 months, and in some cases surgical debridement may be required to resolve infection.

Keywords

Nocardia - nocardiosis - immunosuppression - impaired cellular immunity
 

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