Nocardia infection

  • Definition
    • Nocardia infection is a disorder that affecs the lungs, brain, or skin. It occurs mainly in people with weakened immune systems.

  • Alternative Names
    • Nocardiosis

  • Causes
    • Nocardia infection is an infection caused by a bacterium. It usually starts in the lungs. It may spread to other organs, most often the brain and the skin. It may also involve the kidneys, joints, heart, eyes, and bones.

      Nocardia bacteria are found in soil around the world. You can get the disease by breathing in dust that has the bacteria. You can also get the diseaseor if soil containing nocardia bacteria gets into an open wound.

      You are more likely to get this infection if you have chronic lung disease or a weakened immune system, which can occur with transplants, cancer, HIV/AIDs, and long-term use of steroids.

  • Symptoms
    • Symptoms vary and depend on the organs involved.

      If in the lungs, symptoms may include:

      • Chest pain when breathing (may occur suddenly or slowly)
      • Coughing up blood
      • Fevers
      • Night sweats
      • Weight loss

      If in the brain, symptoms may include:

      • Fever
      • Headache
      • Seizures

      If the skin is affected, symptoms may include:

      • Skin breakdown
      • Skin breakdown and abnormal passage or draining tract (fistula)
      • Ulcers or nodules with infection sometimes spreading along lymph nodes

      Some people with nocardia infection have no symptoms.

  • Exams and Tests
    • The health care provider will examine you and ask about your symptoms.

      Nocardiosis is diagnosed using tests that identify the bacteria. Depending on the part of the body infected, testing may involve taking a tissue sample by:

      • Brain biopsy
      • Bronchoscopy
      • Lung biopsy
      • Skin biopsy
      • Sputum culture
  • Treatment
    • You will need to take antibiotics for 6 months to a year or longer. You may need more than one antibiotic.

      Surgery may be done to drain pus that has collected in the skin or tissues (abscess).

  • Outlook (Prognosis)
    • How well a person does depends on your overall health and the parts of the body involved. Infection that affects many areas of the body are hard to treat, and some persons may not be able to recover.

  • Possible Complications
    • Complications of nocardial infections depend on how much of the body is involved.

      • Certain lung infections may lead to scarring and chronic shortness of breath.
      • Skin infections may lead to scarring or disfigurement.
      • Brain abscesses may lead to loss of neurological function.
  • When to Contact a Medical Professional
    • Call your provider if you have any symptoms of this infection. They are nonspecific symptoms that can have many other causes.

  • References
    • Sorrell TC, Mitchell DH, Iredell JR, Chen SC-A. Nocardia species. In: Bennett JE, Dolin R, Blaser MJ, eds. Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2015:chap 255.

      Southwick FS. Nocardiosis. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 24th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 338.