Nocardiosis

Abstract

Nocardiosis is a rare infectious disease caused by the bacterium Nocardia, of the Actinomycetales order. It causes granulomatous inflammation in different organs and has a subacute or chronic course. Lung involvement is most common in our setting. There are also cutaneous and disseminated forms with a special predilection for the central nervous system, which entail a high mortality rate. It is more common in immunosuppressed patients, although it can also occur in immunocompetent subjects, especially its cutaneous form. The main risk factors are situations which entail deficient cellular immunity. Molecular biology and MALDI-TOF mass spectrophotometry techniques have improved diagnosis in regard to time and reliability. Co-trimoxazole is the first-line drug. However, treatment will depend on the clinical form, degree of immunosuppression, and initial severity. In severe cases and in cases of disseminated disease, the combination of at least two antimicrobial agents with activity against Nocardia is recommended. Treatment must be prolonged in order to avoid relapse.