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
