Pulmonary nocardiosis (PN) is a rare but severe disease caused by Nocardia spp. Despite the traditional description as opportunistic infection, case reports and case series of pulmonary nocardiosis have recently been reported in immunocompetent patients too, in particular among people with chronic pulmonary diseases such as advanced Chronic Obstructive Pulmonary Disease (COPD).

PN is characterized by non-specific symptoms and radiological findings; bacteriological culture can be difficult. For the reasons above, diagnosis of PN is challenging, sometimes resulting in a misdiagnosis of tuberculosis.

We report an interesting case of PN in a 75-year-old male with COPD. He complained a 3-months history of fatigue, evening rise in body temperature, night sweats, unexplained weight loss of 5 kg, worsening dyspnea, cough and mucopurulent sputum. The chest X-ray showed multiple nodules with cavitations bilaterally in the apical and subclavian regions. Nocardia cyriacigeorgica with 100% identity was identified in three sputum samples.

Since the patient has never undergone a systemic and/or inhaled steroid therapy, and has no respiratory failure and comorbidities entailing immunodepression, it is conceivable that, in this immunocompetent patient, the COPD could represent an isolated risk factor for PN.

Risk factors, clinical presentations, radiographic findings, differential diagnosis and review of the literature of PN cases in COPD, pointing out the similarities and differences, are also described.

Pulmonary nocardiosis in Chronic Obstructive Pulmonary Disease: A new clinical challenge.

Nocardia Arthritis: 3 Cases and Literature Review

Nocardia spp. are a group of aerobic actinomycetes widely distributed in soil, and associated with severe opportunistic infections, essentially pulmonary infections. We report the first case of disseminated infection associated with urinary tract infection caused by Nocardia veterana. The diagnosis was difficult; despite the presence of pulmonary nodules, the lung biopsies remained negative while only one aerobic blood culture and the urine culture were positive for N. veterana, identified after a 16S rDNA gene sequence analysis. Few cases of clinical importance due to N. veterana have been published since its characterization. The bacteriological diagnosis of nocardiosis can be difficult to establish because of the delayed growth and the specific techniques that are required. This case illustrates the necessity of performing specific investigations in immunocompromised patients who present with infectious disease because the severity of this infection requires early diagnosis and quick initiation of appropriate antibiotic therapy.

/pdf/nocardia-veterana-disseminated-infection-with-urinary-tract-4btccoxkxo.pdf

Nocardia veterana: disseminated infection with urinary tract infection

Pulmonary nocardiosis is commonly recognized as an opportunistic infection in patients with predisposing immunosuppressive conditions. However, reports of pulmonary nocardiosis in the immunocompetent host are rare. Here, we report a case series of four patients with pulmonary nocardiosis without a predisposing condition.

/pdf/pulmonary-nocardiosis-in-the-immunocompetent-host-case-10uhv8nw9h.pdf

Pulmonary Nocardiosis in the Immunocompetent Host: Case Series.

Nocardia is an opportunistic pathogen and Pulmonary Nocardiosis (PN) occurred in more than half of the cases in subjects with immuno-suppressed status. COPD is one of the most common comorbidity observed in immuno-competent patients with PN. In this perspective study, we report the clinical patterns, the outcomes and the comorbidities of all cases of PN admitted in our Unit in the years 1999–2012. Among 6545 patients admitted in our Unit during the study time, we identified PN in 4 patients. COPD was coexistent in 3 out of 4 cases. A delayed time for the diagnosis was observed. Clinical-radiological improvement was detected in all cases after one month of specific anti-PN therapy.According to our experience, PN is a rare disease that should be suspected also in immuno-competent patients. COPD is confirmed to be a risk factor for the development of PN, probably due to reduced respiratory defenses and prolonged steroid therapy.

Nocardia and Lungs in COPD: Beyond Immuno-deficiencies.

Nocardiosis is an infrequent but potentially serious pulmonary infection that typically affects patients with immune suppression
or structural lung disease. We report a case of a 70-year-old patient with chronic obstructive pulmonary disease (COPD)
treated with inhaled steroids, theophylline, short-acting beta-agonists and anticholinergics, and long-term oxygen therapy,
who presented with non-resolving pneumonia. Following a diagnosis of nocardiosis, made based on sputum culture, the
patient was treated with trimethoprim/sulphamethoxazole and then, due to treatment side effects, with minocycline. We
review the literature data on nocardiosis in COPD patients.

/pdf/pulmonary-nocardiosis-in-a-patient-with-chronic-obstructive-1xlle45j4h.pdf

Pulmonary nocardiosis in a patient with chronic obstructive pulmonary disease--case report and literature review.

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Pulmonary nocardiosis in a patient with chronic obstructive pulmonary disease--case report and literature review.