Pulmonary nocardiosis

Pulmonary nocardiosis

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Respiratory system

Definition

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

Alternative Names

Nocardiosis - pulmonary

Causes, incidence, and risk factors

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 at highest risk for nocardia infection are those with a weakened immune system. This includes people who have:

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

Other people at risk include those with chronic lung problems related to smoking, emphysema, or other infections such as tuberculosis.

Symptoms

• 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
  • Cough with 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

Signs and tests

Your doctor or nurse 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
• 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 must keep taking the medications for at least 3 months.

Surgery may be needed to remove or drain infected areas.

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

Expectations (prognosis)

The outcome is often good when diagnosed and treated quickly.,

The outcome is poor when the infection spreads outside the lung, treatment is delayed, or the patient has serious underlying diseases.

Complications

• Brain abscesses
• Skin infections

Calling your health care provider

Call your health care 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 patients with an impaired immune system may need to take antibiotics for long periods of time to prevent the infection from returning.

References

Torres A. Pyogenic bacterial pneumonia and lung abscess. In: Mason RJ, Broaddus CV, Martin TR, et al. Murray & Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 32.

Limper AH. Overview of pneumonia. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 97.

Review Date: 8/30/2012

Reviewed by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Denis Hadjiliadis, MD, Assistant Professor of Medicine, Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.