PULMONARY INFECTION WITH NOCARDIA SPECIES - A REPORT OF 10 CASES AND REVIEW

Pulmonary nocardiosis (PN) is an infrequent and severe infection due t o Nocardia spp., microorganisms that may behave both as opportunists a nd as primary pathogens, The aim of this study and review was to evalu ate the clinical features, evolution and prognostic factors of PN. The study group comprised 10 consecutive patients with pulmonary nocardio sis acquired in a community setting, diagnosed and followed in a terti ary teaching hospital. Chronic obstructive pulmonary disease (COPD), n eoplastic disease and human immunodeficiency virus (HIV) infection wer e the most frequent predisposing factors, Four patients were receiving corticosteroid treatment. Clinical course was chronic and diagnosis w as delayed 3 weeks or more in seven of the patients, Lobar or multilob ar condensation was the most frequent radiographic pattern, Antimicrob ial susceptibility testing showed: 100% sensitivity for amikacin; 83% for imipenem; 71% for cefotaxime; and 71% for trimethoprim-sulphametho xazole. The disease remained localized in the lung in five cases, with a trend toward chronicity in one with bronchiectasis. In the other fi ve, the disease disseminated, affecting subcutaneous tissue, the centr al nervous system and the kidney, Three patients died, one with dissem inated disease and two who were receiving corticosteroid therapy. The following conclusions were reached: 1) pulmonary nocardiosis is diffic ult to diagnose, diagnosis is frequently delayed and a high level of s uspicion is, thus, required in patients with underlying diseases or ch ronic corticosteroid therapy; 2) there is frequent dissemination and h igh mortality; and 3) antimicrobial combinations with proven synergy, such as imipenem and amikacin, are recommended for initial therapy.