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CC BY-NC-ND 4.0 · J Lab Physicians 2017; 9(04): 288-295
DOI: 10.4103/JLP.JLP_111_16
Original Article

Clinical manifestations of nocardiosis: Study of risk factors and outcomes in a tertiary care hospital

Teena Wadhwa
Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
,
Usha Baveja
Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
,
Navin Kumar
Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
,
Deepak Govil
Department of Critical Care, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
,
Sharmila Sengupta
Department of Microbiology, Medanta-The Medicity, Sector-38, Gurgaon, Haryana, India
› Author Affiliations Financial support and sponsorship: Nil.
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Abstract

PURPOSE: The aim of this study is to evaluate the predisposing risk factors, clinical presentations, laboratory parameters, and treatments taken and outcomes in patients of nocardiosis in the span of 5 years in a tertiary care hospital.

MATERIALS AND METHODS: The patients whose specimens showed Nocardia like organism in Gram-staining, Kinyoun staining and characteristic colonies in culture were included in the retrospective analysis study. Retrospective analysis of associated risk factors, clinical presentations, and radiological findings was performed.

RESULTS: Of the thirteen patients, 11 (76.9%) had immunosuppressive pathologies including solid organ transplantation, autoimmune disease, use of steroids, and immunosuppressive drugs as important risk factors. Four types of clinical manifestations were observed, pulmonary (46.1%), cutaneous (23.07%), cerebral (15.3%), and bacteremia (15.3%). The most common presentation was pulmonary with steroid therapy as a significant risk factor. Consolidation and pleural effusion were the common radiological findings in these cases. In eight of the nine patients anti-nocrdial drugs were given. Cotrimoxazole as monotherapy was given in four cases (44.44%), cotrimoxazole in combination with meropenem in two cases (22.22%); minocycline and linezolid were given in one case each. The overall mortality was 36.36% and was seen in patients with pulmonary nocardiosis.

CONCLUSIONS: The study indicates that Nocardial infections are re-emerging on account of an increase in numbers of immunocompromised patients due to increased organ transplants, autoimmune diseases, malignancies, and use of immunosuppressive drugs and steroids. The diagnosis is often missed/not suspected and delayed because of the clinical resemblance to many other infections. Nocardial infection should be suspected and assessed particularly in immunocompromised patients not responding to treatment/improving clinically.

Key words

Immunosuppressant drugs - nocardiosis - solid organ transplant - steroids


Publication History

Received: 19 August 2016

Accepted: 21 March 2017

Article published online:
19 February 2020

© 2017.

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

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