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Pulmonary nocardiosis

Definition

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

Alternative Names

Nocardiosis - pulmonary; Mycetoma; Nocardia

Causes

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 with a weak immune system are at a high risk for nocardia infection. This includes people who have:

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

Other people at risk include those with long-term (chronic) lung problems related to smoking, emphysema, or other tuberculosis.

Symptoms

Pulmonary nocardiosis mainly affects the lungs. But, it can also spread to other organs in the body. Common symptoms may include:

ENTIRE BODY

  • Fever (comes and goes)
  • General ill feeling (malaise)
  • Night sweats

GASTROINTESTINAL SYSTEM

LUNGS AND AIRWAYS

  • Breathing difficulty
  • Chest pain not due to heart problems
  • Coughing up blood or mucus
  • Rapid breathing
  • Shortness of breath

MUSCLES AND JOINTS

NERVOUS SYSTEM

  • Change in mental state
  • Confusion
  • Dizziness
  • Headache
  • Seizures

SKIN

Exams and Tests

Your health care provider 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:

Treatment

The goal of treatment is to control the infection. Antibiotics are used, but it may take a while to get better. You're provider will tell you how long you need to take the medicines. This may be for up to a year.

Surgery may be needed to remove or drain infected areas.

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

Outlook (Prognosis)

The outcome is often good when the condition is diagnosed and treated quickly.

The outcome is poor when the infection:

  • Spreads outside the lung
  • Treatment is delayed
  • The person has a serious disease that leads to or requires long-term suppression of the immune system

Possible Complications

Complications of pulmonary nocardiosis may include:

When to Contact a Medical Professional

Call your 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 people with a weak immune system may need to take antibiotics for long periods of time to prevent the infection from returning.

References

Southwick FS. Nocardiosis. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 330.

Torres A, Menendez R, Wunderink RG. Bacterial pneumonia and lung abscess. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 33.


Review Date: 8/21/2016
Reviewed By: Denis Hadjiliadis, MD, MHS, Paul F. Harron, Jr. Associate Professor of Medicine, Pulmonary, Allergy, and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
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