Nocardiosis, case series and literature review

Abstract

Nocardiosis is caused by a branched Gram-positive bacillus that affects mostly immunosuppressed patients. The involvement can be localized or disseminated and the treatment depends on the affected organs, the severity and the susceptibility profile.
Nocardiosis is a differential diagnosis of localized or disseminated abscesses in immunosuppressed patients. Clinical suspicion would allow the start of empirical treatment, microbiological search and positive impact on survival.
A series of 14 patients from different health institutions in Bogotá is presented, between January 2.008 and November 2.023 with infection by Nocardia spp.; The information was obtained from databases of the clinical microbiology laboratory; demographic, clinical and laboratory variables were searched.
Fourteen patients were analyzed, with an average age of 49,8 years (30 to 72 years), 69,2% men, nine had a diagnosis involving immunosuppression: six (42,8%) with a diagnosis of cancer and three with other underlying immunosuppression. Among the comorbidities, diabetes and hypertension were present. The presentation was chronic in 69,3%, the organs involved were the brain and lung in 53,9%. The species was established in five patients; one of the patients presented infection with Cryptococcus spp. The treatment was prolonged and included trimetoprim-sulfametoxazol in 84,7%, died 28,6%.
Infection by Nocardia spp. It is essentially opportunistic, presents unique clinical and microbiological aspects, and is a differential diagnosis of localized or systemic abscesses in immunosuppressed patients. Clinical suspicion allows a careful approach in terms of diagnosis and the initiation of empiric antibiotic treatment that remains diverse can have a positive impact on survival.