Nocardiosis in Sudan: Current Situation and Future Perspective

Abstract

Infections caused by Nocardia are rare, but misguided to clinicians, especially if there is a delay in the diagnosis and/or low response to chemotherapy. The incidence of nocardiosis is increasing constantly worldwide, and the situation is getting worse if we consider immunocompromised individuals, such as human immune virus (HIV) positive patients since they are at higher risk. Surgical amputation, although not common, but should be considered as a result in some cases that cause partial disability. To throw light on the situation of nocardiosis in Sudan, the possible reasons for the increased prevalence are investigated and discussed the possible strategies for prevention and control. Data Review: PubMed investigations were adopted using terms that included nocardiosis in Sudan as well as in other parts of the world. Part of the review has been retrieved from the main library of the postgraduate college, University of Khartoum and University of Newcastle upon Tyne. In Sudan, nocardiosis revealed wide geographical distribution; different cases were reported from western, middle as well as the northern parts of the country. Moreover, several clinical presentations were seen. While pulmonary, coetaneous and subcutaneous infections represent the primary types caused by Nocardia, disseminated infection in two or more organs had also been reported. As in all other infectious diseases, opportunistic nocardiosis is more prevalent among HIV patients. Zoonotic transmission of the disease was also proved; several cases of bovine and caprine mastitis were due to one or another species of Nocardia. The effect of ecology on the prevalence and pathogenicity of Nocardia is proved by the isolation of Nocardia and other actinomycetes from Sudanese soil, which represents the most probable source of infection. Regarding treatment, effective results are usually obtained by the use of sulfonamides and thirdgeneration cephalosporins. However, surgical interference is also used when necessary, such as in cases of drainage of abscesses. Since the description of Nocardia by Edmond Nocard in 1888, it started to be well known worldwide. In Sudan, however, the awareness regarding this bacterium is still below the level and is only due to the end of the fifties of the twentieth century, which is relatively late. Hence, attention towards this neglected pathogen may lead to early recognition and prompt treatment, resulting in complete cure.