HUMAN NOCARDIOSIS IN NORTHERN ITALY FROM 1982 TO 1992

We conducted a retrospective survey of nocardiosis in 9 city hospitals in northern Italy from 1982 to 1992. The medical records of 30 patien ts with documented nocardiosis were reviewed. Microbiological data inc luded morphology, biochemical characteristics, serology and in vitro s usceptibility testing. The 29 isolates (1 case was diagnosed on the ba sis of serological results) were Nocardia asteroides (n = 25) and Noca rdia farcinica (n = 4). Predisposing factors included immunosuppressio n for organ transplant rejection prophylaxis, lung disease (silicotube rculosis and pulmonary fibrosis), solid tumours and hematological mali gnancies, and AIDS. Three patients had no identified risk factors. 20 cases of pulmonary nocardiosis were observed. Sites of infection in pa tients without previous pulmonary involvement were: brain abscesses, s oft tissues, pericardium, blood, and cerebrospinal fluid. Most strains tested were susceptible to amikacin and imipenem. Resistance to sever al antimicrobial agents was found, particularly erythromycin, fosfomyc in, pefloxacin, sulphonamides and trimethoprim. Antimicrobial chemothe rapy included sulphonamides, amikacin, ceftriaxone, imipenem and minoc ycline. 21 patients survived, although 2 relapsed transiently. Nocardi osis appears to be more common than generally realised by physicians i n northern Italy. The local species distribution and disease spectrum are similar to those described elsewhere. Nocardiosis should be part o f the differential diagnosis in patients with pulmonary infiltrates or brain abscess, particularly those with predisposing factors.