2026· Medicina· Vol 86 4, pp.
1037-1039
· 0 citations
Medicine
TL;DR
The case of a 48-year-old patient recently diagnosed with HIV and a CD4 lymphocyte count of less than 50 cells/ uL, who consulted for prolonged fever without apparent focus, highlights the importance of considering nocardiosis in the differential diagnosis of prolonged fever with multiple deep lesions in immunocompromised patients.
Pulmonary nocardiosis is an uncommon but potentially life-threatening opportunistic infection caused by aerobic actinomycetes of the genus Nocardia. Owing to its nonspecific clinical and radiological manifestations, it frequently mimics pulmonary tuberculosis, bacterial pneumonia, and fungal infections, often resulting in delayed diagnosis and treatment. We report the case of a 52-year-old immunocompetent female with a history of successfully treated pulmonary tuberculosis who presented with cough with expectoration, fever, chest pain, and loss of appetite. Clinical examination revealed bilateral decreased breath sounds with occasional wheeze. Laboratory investigations demonstrated neutrophilic leukocytosis, while conventional acid-fast bacilli staining was negative. Computed tomography of the chest showed bilateral upper lobe cavitary consolidations with multiple centrilobular nodules and a tree-in-bud appearance, initially raising suspicion of recurrent pulmonary tuberculosis. However, modified acid-fast staining of sputum demonstrated thin, branching filamentous organisms consistent with Nocardia species, establishing the diagnosis of pulmonary nocardiosis. Bronchoalveolar lavage culture was negative, likely due to prior antibiotic exposure. The patient was treated with weight-adjusted double-strength trimethoprim-sulfamethoxazole, resulting in marked clinical improvement and significant radiological resolution on follow-up. This case emphasizes the importance of maintaining a high index of suspicion for pulmonary nocardiosis in patients with post-tuberculous structural lung disease who present with persistent respiratory symptoms and cavitary pulmonary lesions despite negative acid-fast bacilli results. Early microbiological confirmation using modified acid-fast staining and prompt initiation of appropriate antimicrobial therapy are crucial to prevent dissemination and improve clinical outcomes, particularly in tuberculosis-endemic regions where nocardiosis remains an underrecognized differential diagnosis.
A. A., S. K., E. Abraham et al.· PAIN, JOINTS, SPINE· 0 citations
ABSTRACT
Pulmonary nocardiosis is an uncommon but potentially serious infection caused by aerobic actinomycetes of the genus Nocardia. It predominantly affects individuals with impaired immunity or underlying structural lung disease, but can also occur in apparently immunocompetent hosts. The clinical and radiological features often overlap with tuberculosis and fungal infections, particularly in endemic regions, leading to frequent misdiagnosis and delay in appropriate therapy. We present a series of three patients with microbiologically confirmed pulmonary nocardiosis, each representing different clinical backgrounds. The first case involved a middle-aged male with poorly controlled diabetes mellitus presenting with chronic cough and bilateral pulmonary infiltrates. Imaging revealed patchy peribronchial opacities, and bronchoalveolar lavage (BAL) demonstrated filamentous, weakly acid-fast organisms on modified acid-fast staining. The second case was an elderly female with underlying bronchiectasis who presented with increased cough and expectoration; imaging showed bronchiectatic changes with superimposed infiltrates, and BAL confirmed Nocardia infection. The third case involved an elderly male with recent immunosuppressive therapy who presented with acute respiratory symptoms and radiological evidence of multifocal consolidation; microbiological evaluation confirmed nocardiosis. All patients were treated with appropriate antimicrobial therapy, including trimethoprim-sulfamethoxazole as the backbone, with additional agents such as imipenem or linezolid in selected cases. Clinical improvement was observed in patients who adhered to therapy, with symptomatic relief and partial radiological resolution on follow-up. This case series underscores the varied clinical presentation and imaging spectrum of pulmonary nocardiosis. Diabetes mellitus, structural lung disease, and immunosuppressive therapy emerged as key predisposing factors. The condition often mimics tuberculosis or bacterial pneumonia, making microbiological confirmation using modified acid-fast staining crucial. Early diagnosis and prompt initiation of appropriate therapy significantly influence patient outcomes. Pulmonary nocardiosis should be considered in patients with nonresolving pulmonary infiltrates, especially in the presence of risk factors such as diabetes, bronchiectasis, or immunosuppression. A high index of suspicion, combined with timely microbiological diagnosis and appropriate antimicrobial therapy, is essential to improve prognosis and reduce morbidity.
N. Raja, V. Jereen, A. Arthi et al.· Annals of African medicine· 0 citations
Nocardia mainly affects immunocompromised individuals. We report a case of immunocompetent male, with neurological complaints for the past eight months. Contrast-enhanced MRI (CE-MRI) revealed space-occupying lesion with frontal lobe abscess. The patient underwent craniotomy, and pus was sent for microbiological diagnosis. Direct KOH-calcofluor mount, and modified Ziehl-Neelsen (ZN) staining demonstrated thin, branching filamentous structures suggestive of Nocardia spp. Nocardia brasiliensis was confirmed through 16S rRNA sequencing. The patient received targeted antimicrobial therapy. Direct fluorescent microscopy is an important initial investigation in the diagnostic workup. Early diagnosis and appropriate management is key to favourable clinical outcomes in cerebral nocardiosis.
K. P. Angitha, H. Jain, M. Sinha et al.· Indian Journal of Medical Mi...· 0 citations
Background Nocardiosis is an opportunistic infection caused by aerobic, Gram-positive actinomycetes of the genus Nocardia that most often affects patients with impaired cell-mediated immunity, including those receiving corticosteroids or other immunosuppressive therapies. Disseminated disease frequently involves the central nervous system, where a systematic review reported an overall case fatality rate of 22.8%, and Nocardia farcinica is the most commonly identified species. We report a case of disseminated Nocardia farcinica with multiple cerebral abscesses in a patient receiving induction immunosuppressive therapy for autoimmune hepatitis. Case report A 55-year-old man with a history of autoimmune hepatitis and occupational soil exposure presented with 4–5 week history of progressive cognitive impairment, dysarthria, and right upper extremity weakness. Two months earlier, he had been treated with high-dose corticosteroids and azathioprine and prescribed trimethoprim-sulfamethoxazole (TMP-SMX) prophylaxis, which had been interrupted for an estimated 2–4 weeks before presentation during ongoing corticosteroid therapy. Upon admission, laboratory tests demonstrated neutrophil-predominant leukocytosis with lymphopenia, and liver function tests showed substantial improvement compared to his initial presentation of autoimmune hepatitis. Neuroimaging revealed multiple ring-enhancing intracerebral lesions with surrounding vasogenic edema. Stereotactic aspiration of a cerebral abscess and drainage of a concurrent retroperitoneal collection grew Nocardia farcinica, confirming disseminated nocardiosis. Antimicrobial therapy was transitioned to imipenem-cilastatin and TMP-SMX based on susceptibility testing. During infection management, azathioprine was paused, and prednisone was continued at a dose of 25 mg/day, followed by a biochemical autoimmune hepatitis flare requiring hepatology-guided monitoring. The patient demonstrated gradual neurologic improvement and was discharged to inpatient rehabilitation after an 18-day hospitalization. Conclusion Disseminated nocardiosis should be considered for immunosuppressed patients with autoimmune hepatitis presenting with subacute neurological decline and ring-enhancing brain lesions, particularly during outpatient immunosuppression transitions when antimicrobial prophylaxis may be interrupted or incompletely reconciled. The patient demonstrated progressive neurological improvement and radiographic abscess reduction after 3 months of susceptibility-guided combination therapy, reinforcing the importance of early tissue diagnosis and neurosurgical intervention in this population.
Akram Alnounou, D. Bahariev, John Brown et al.· Frontiers in Medicine· 0 citations
The diagnosis and treatment of Mycobacterium abscessus infections present significant challenges, especially in the rare cases of extrapulmonary involvement in pediatric patients. These cases are characterized by diagnostic difficulties, limited therapeutic options, scarce clinical experience, and a lack of evidence-based treatment guidelines. This article reports on a 6-year-old child who experienced fever and abdominal pain. Metagenomic next-generation sequencing (mNGS) facilitated the rapid and accurate identification of Mycobacterium abscessus as the causative pathogen. Under a standardized full-course protocol, an individualized therapy regimen (that includes Imipenem, Azithromycin, and Linezolid) led to favorable clinical outcomes. Through the analysis of this successfully treated case, we aim to derive clinical insights and identify potential limitations, with the goal of exploring effective diagnostic and therapeutic approaches for pediatric patients with non-tuberculous mycobacterial (NTM) infections in the future.
Linlin Zhang, Dixi Huang, Jie Song et al.· Frontiers in Pediatrics· 0 citations
Nocardiosis is a rare, serious infection caused by
Nocardia
species, primarily affecting immunocompromised individuals. It commonly presents as pulmonary disease, often mimicking tuberculosis or bacterial pneumonia.
Nocardia farcinica
, although less common than
Nocardia asteroides
, is notably aggressive, multidrug-resistant, and linked to disseminated disease and high morbidity. We report necrotizing pneumonia caused by
N. farcinica
in a 74-year-old woman without major immunosuppression, with only controlled diabetes and hypertension as comorbidities. She presented with a 20-day history of fever and productive cough, progressing to moderate obtundation (GCS 9 to 12). Diagnosis was established through endotracheal aspirate culture with Matrix-Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) identification after 6 to 7 days of admission. Targeted combination therapy with intravenous imipenem-cilastatin, intravenous amikacin, and oral trimethoprim-sulfamethoxazole (TMP-SMX) led to complete clinical, neurological, and radiological resolution at 6 months.