Case Of Nocardiosis Research Articles

Mycetoma by Nocardia blacklockiae: The first case

The present report describes a first case of N. blacklockiae as a causative agent of mycetoma of foot. It is an unusual Nocardia species and a member of the Nocardia transvalensis complex. N. blacklockiae has been isolated from cases of pulmonary nocardiosis earlier but this is a first case of mycetoma caused by this bacteria. The organism was isolated from the lesion. This case is reported to emphasise the importance of the species identification and its association with this rare disease.

Lung and Cerebral Nocardiosis Caused by Nocardia elegans in a Lung Transplant Recipient: A Case Report and Literature Review.

Patients after lung transplantation are at risk for Nocardia infections. We herein report a case of lung and cerebral nocardiosis caused by Nocardia elegans, a rare species of Nocardia, in a lung transplant recipient. Antibiotic therapy, including sulfamethoxazole-trimethoprim (ST), and brain abscess drainage improved symptoms and imaging findings. A literature review of N. elegans infections showed that 12 of 14 cases (85.7%) were reported from East Asia, particularly Japan (9 cases, 64.2%). The lungs were the predominant site (12/14 cases, 85.7%), and most of the cases were susceptible to ST (9/10 cases, 90%).

The Clinical Characteristic and Management of Patients with Nocardiosis in a Tertiary Hospital in China.

Nocardiosis is an uncommon opportunistic bacterial infection which becomes a significant health problem due to its increasing incidence and high mortality rate. However, many nocardiosis patients are underdiagnosed by physicians. To summarize the clinical characteristics and management of nocardiosis would help with better diagnosis and prognosis of nocardiosis. This retrospective study was conducted based on the medical records of nocardiosis patients between January 2015 and December 2021 in a tertiary hospital in China. Overall, 44 nocardiosis patients with 54 specimens were included. The patients consisted of 26 males and 18 females with a mean age of 50.4 ± 13.2 years. Among 44 patients, 26 (59.1%) were previously given immunosuppressive therapy. Connective tissue diseases (CTDs) were the most common underlying disease (16/44). The most frequent infection sites were the lungs (17/44) and skin or soft tissues (8/44). Common symptoms included cough (23/44), expectoration (18/44), fever (15/44), and subcutaneous abscesses (15/44). Forty-five out of 54 specimens (83.3%) required over 48 hours of culture time for nocardiosis detection. Thirty-six patients were cured or improved, 5 patients were discharged from the hospital due to poor prognosis, and 1 patient died. The average diagnosis time of poor prognosis cases was 19.7 days, which was significantly longer than those of improved or cured patients (7.3 days). Immunosuppressed patients comprise a large part of nocardiosis cases, which is worth attention in clinical practice. Early diagnosis, specifically through prolonged cultivation time of specimen, could help achieve better prognosis of nocardiosis patients.

Clinical characteristics and treatment strategy of nocardiosis in lung transplant recipients: A single-center experience

Nocardia are infrequent pathogens that disproportionately afflict organ transplant recipients. The present study aimed to summarize the clinical manifestations, diagnostic approaches, and treatment strategies of nocardiosis in lung transplant recipients. This retrospective study reviewed the clinical data of adult lung transplant recipients who were complicated with nocardiosis between January 2018 and December 2021 at the largest lung transplant center in South China. The incidence of nocardiosis was 4.2% (13/316), including 9 cases of pulmonary nocardiosis and 4 disseminated nocardiosis (blood, pulmonary and intracranial). The accuracy in diagnosing nocardiosis was 77.8% by culture and 100% by metagenomic next-generation sequencing (mNGS). Nocardia farcinica was the most common causative pathogen. Trimethoprim-sulfamethoxazole-based combination therapy was administered initially, followed by a single antibiotic as the maintained therapy, lasting for 4-8 months. mNGS is more accurate than culture in diagnosing nocardiosis. Most patients responded well to the antibiotic therapy with combined antibiotics at the initial stage followed by a single antibiotic treatment.

Nocardiosis: A two-center analysis of clinical characteristics.

The objective of the present study was to describe and analyze the clinical characteristics of nocardiosis. We described and analyzed the clinical characteristics of nocardiosis cases from two centers over the past 5 years from the following aspects: age and sex, Nocardia species, sites of Nocardia infection, test specimens, detection methods, concurrent pathogens, symptoms, imaging features, co-conditions, drug susceptibility tests, antibiotic therapy/duration, outcomes, and follow-up. The median age of the 19 cases was 64 years, with an interquartile range (IQR) of 56-68 years. Eight cases (42.1%) were immunocompromised [those who had been on corticosteroid use (62.5%), those who had used immunosuppressants (50.0%), or those who had suffered from chronic nephrosis (37.5%) or diabetes mellitus (DM) (25.0%)]. The plethora of comorbidities of these cases included diabetes (10.5%), chronic kidney disease (CDK) (15.8%), chronic lung disease (36.8%), and rheumatic diseases (10.5%). Cough and expectoration (73.7%) was the most common symptom of nocardiosis. The respiratory tract (89.5%) was the most common site of the clinical disease. Nearly half (9 cases, 47.3%) of these patients had concurrent infections. The most common Nocardia isolation site was the respiratory tract (73.7%). All patients were given antibiotic therapies, out of whom as many as 63.6% of patients were treated with two concurrent antimicrobial agents, 15.8% of patients were treated under monotherapy and 21.1% of patients were treated with three or more concurrent antimicrobial agents. An uncommon life-threatening infection, nocardiosis, affects those patients with structural lung disease or immunosuppression. Although nocardiosis is capable of progressing into a serious and metastatic disease, early recognition and prompt treatment usually result in successful outcomes benefitting the patient.

Pulmonary nocardiosis: Risk factors and species distribution from a high burden centre

Nocardiosis is a clinical and diagnostic challenge. This was a retrospective study carried out on cases of pulmonary nocardiosis presenting over 15 years.Clinical data was retrieved using the electronic patient records. Vitek MS 3.2 (MALDI TOF MS) was carried out on 22 isolates and sequencing on another 9 isolates.Of 71 patients presenting with pulmonary nocardiosis, 58 (81.6%) were on immunosuppressant therapy, 26 (46%) had a previous lung pathology, 11 (8%) were HIV associated. Disseminated disease was seen in 6 (8.4%). There were 8 (11.26%) deaths in this cohort of patients. Of 31/71 identified to species, the most common were Nocardia cyriacigeorgica (n ​= ​11) followed by Nocardia farcinica (n ​= ​9).

Pulmonary Nocardiosis as an Opportunistic Infection in COVID-19.

Secondary bacterial pneumonia infection is frequent in COVID-19 patients. Nocardia are responsible for opportunistic pulmonary infections especially after steroid treatment. We describe a case of pulmonary nocardiosis following critical COVID-19 pneumonia in an 83-year-old male. Two weeks after initiation of dexamethasone 6 mg/L, the patient developed a new episode of acute dyspnea. The sputum cultures identified Nocardia cyriacigeorgica. In spite of intravenous imipenem and cotrimoxazole treatment the patient died. Physicians should be aware of the possibility of nocardiosis in case of deterioration of respiratory status of severe COVID-19 inpatients and perform Nocardia evaluation. This evaluation requires prolonged culture.LEARNING POINTSNocardia are responsible for opportunistic pulmonary infections after steroid treatment.We describe a case of pulmonary nocardiosis following critical COVID-19 pneumonia.Physicians should be aware of the possibility of secondary nocardiosis in COVID-19 inpatients.

Clinico-pathological analysis of a rare case of pulmonary nocardiosis under the mask of disseminated tuberculosis

Nocardiosis is a rare infectious disease caused by bacteria of the genus Nocardia and characterized by the development of foci of purulent-necrotic inflammation of the lungs, brain, and internal organs. Clinical diagnosis of nocardiosis has objective difficulties. The aim of the study is to highlight a rare clinical case of pulmonary nocardiosis, to analyze mistakes in the clinical diagnostics of the main disease, to discuss the differential diagnosis of nocardiosis. Materials and methods. A clinico-pathological analysis of an inpatient and outpatient medical record card, and the results of an autopsy of a 58-year-old patient who died in an anti-tuberculosis institution from pulmonary nocardiosis has been carried out. Results. According to the anamnesis, the patient suffered from COPD and chronic polyposis rhinitis with hypertrophy of the nasal turbinates for many years. Polypectomy and submucosal resection of the nasal septum were performed in the otolaryngology department. Wegener's granulomatosis was suspected during the intravital pathomorphological examination of nasal polyps, and glucocorticoids were prescribed in the hospital. Histological preparations and biological material of the patient were examined in clinics in Berlin, the diagnosis of “Wegener's granulomatosis” was not confirmed, however, domestic doctors recommended Medrol, which the patient received continuously for 5 years at a dose of 12 mg/day. After 5 years, the patient was admitted to the hospital of a specialized anti-tuberculosis institution in serious condition with a clinical diagnosis: newly diagnosed disseminated tuberculosis of both lungs with disintegration, right-sided spontaneous tension pneumothorax, respiratory insufficiency of the III degree. According to urgent indications, thoracentesis and drainage of both pleural cavities were performed. Despite intensive therapy, the condition worsened, and biological death occurred 11 days after hospitalization. During the post-mortem pathological examination, signs of tuberculosis of both lungs were not detected, nocardiosis of both lungs was diagnosed, which pathomorphologically manifested as multiple foci of purulent-necrotic bronchopneumonia with disintegration. Pathological diagnosis was confirmed by bacteriological and PCR examination of the post-mortem material. The disease developed on the background of wrongly prescribed long-term glucocorticosteroid therapy, which was carried out for the misdiagnosis “Wegener's granulomatosis”. No signs of Wegener's granulomatosis were found at autopsy. The direct cause of death was acute respiratory failure. Conclusion. Thus, pulmonary nocardiosis was not diagnosed in the hospital, the reason for the misdiagnosis was the rarity of the disease and the objective difficulties of diagnostics. A decisive role in the development of nocardiosis was played by erroneously prescribed long-term glucocorticosteroid therapy, which should be considered as a pathology of the therapy

A case of pulmonary nocardiosis with brain and extrapleural abscesses mimicking malignant disease

A case of pulmonary nocardiosis with brain and extrapleural abscesses mimicking malignant disease

Nocardiose em um Felino : Relato de caso

Nocardiosis is an infectious disease which can befall acutely or chronically with pyogranulomatous characteristics, and may affect the animal in a systemic way, being considered rare in felines. Infection occurs through wound contact with the agent Nocardia spp. which is found in soil, water, wood and other places favorable to its growth and contamination. The disease can generate fistula formation, localized or disseminated abscesses, and present serosanguineous secretion. Hence, the aim of this article is to report a case of feline nocardiosis. The animal was treated at a private veterinary clinic in Lagarto/SE, it was 3 years old, of no defined breed (RDS), with abscesses in the rostral region, abdomen, thoracic and pelvic limbs. Histopathological examination diagnosed nocardiosis and the animal underwent pharmacological treatment along with reconstructive surgery. However, the patient died with ascites, anorexia and low nutritional status when he returned to the clinic. The tutor did not authorize the autopsy to elucidate the cause of death.

Epidemiology and Antimicrobial Resistance Profiles of the Nocardia Species in China, 2009 to 2021.

ABSTRACTThe genus Nocardia includes ubiquitous environmental saprophytes and the most frequently isolated aerobic actinomycete human pathogen responsible for localized or disseminated infection. Herein, the species distribution and antimicrobial susceptibility profiles of 441 nonrepetitive Nocardia strains are reported, collected from 21 provinces/cities in China over 13 years (from 2009 to 2021). These isolates were identified to species level by mass spectrometry or targeted DNA sequencing. The susceptibility profiles of Nocardia species for 15 antibiotics were determined by the broth microdilution method. Among these Nocardia isolates, Nocardia farcinica was the most commonly isolated species (39.9%, 176 of 441), followed by Nocardia cyriacigeorgica (28.6%, 126), Nocardia abscessus (6.6%, 29), and Nocardia otitidiscaviarum (5.9%, 26). Furthermore, 361 Nocardia strains (81.9%) were collected from lower respiratory tract (sputum, lung tissue, and bronchoalveolar lavage fluid), 50 (11.3%) were collected from skin and soft tissues, 9 were collected from blood, 9 were collected from eye, 4 were collected from cerebrospinal fluid and brain abscesses, and 2 were collected from pleural effusion. All of the Nocardia strains were susceptible to linezolid, followed by amikacin (99.3%) and trimethoprim-sulfamethoxazole (TMP-SMX) (99.1%). The antibiotic resistance profiles of other antibiotics varied tremendously among different Nocardia species. This demonstrated that accurate species identification and/or antibiotic susceptibility testing should be performed before the usage of these antibiotics. In summary, this is the largest study on the species and antibiotic resistance profiles of the genus Nocardia circulating in China, and our data will contribute to a better understanding of clinical nocardiosis.IMPORTANCE The genus Nocardia has the potential to cause nocardiosis, which might be underrecognized and underdiagnosed. Herein, the demographical features of 441 nonrepetitive nocardiosis cases and species distribution of their Nocardia strains in China, 2009 to 2021, are summarized. The susceptibility profiles for 15 antibiotics against all of the above Nocardia strains were also determined by the broth microdilution method. To date, this is the largest study on the genus Nocardia contributing to nocardiosis in China. Our study will be helpful for understanding the species diversity of Nocardia isolates distributed in China and for decision-making in the context of nocardiosis diagnosis and treatment.

A Case of Nocardiosis with an Unusual Presentation

Nocardiosis is a neglected, unusual disease caused by aerobic, gram positive, actinomycete in the genus Nocardia. Nocardial infection most often occurs in immunocompromised patients. It has varied geographical distribution and a range of clinical presentations. Lungs are the primary sites of nocardial infection in more than two-third of cases. We report a case from a tertiary care setup in Karachi where nocardiosis occurred in an immunocompetent patient with an isolated CNS involvement.

Isolation and Characterization of Nocardia Species from Pulmonary Nocardiosis in a Tertiary Hospital in China.

This study aimed to investigate the clinical features, distribution, and antimicrobial susceptibility of Nocardia species isolated from pulmonary nocardiosis cases in a tertiary hospital in China. The species were collected from January 1, 2018, to May 31, 2019, and identified using Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry or polymerase chain reaction. Antimicrobial susceptibility testing was performed using the broth microdilution method. Within the 44 Nocardia species, N. farcinica was the most frequently identified species (n = 36), followed by N. nova (n = 5), N. otitidiscaviarum (n = 1), N. cyriacigeorgica (n = 1), and N. transvalensis (n = 1). The top 3 predisposing factors of pulmonary nocardiosis were chronic obstructive pulmonary disease (45.5%), hypertension (34.1%), and tuberculosis (31.8%). All 44 Nocardia species were susceptible to amikacin, trimethoprim/sulfamethoxazole, and linezolid. The resistance rates of Nocardia to amoxicillin-clavulanic acid, ciprofloxacin, clarithromycin, ceftriaxone, tobramycin, and imipenem were 4.5%, 9.1%, 79.5%, 72.7%, 63.6%, and 38.6%, respectively. Two Nocardia strains had decreased sensitivity to trimethoprim/sulfamethoxazole. In conclusion, N. farcinica was the most frequently isolated Nocardia species in the First Hospital of Changsha. All the isolated clinical Nocardia species showed susceptibility to amikacin, trimethoprim/sulfamethoxazole, and linezolid, suggesting that these drugs can be primary therapeutic choices for treating Nocardia infections.

Atypical presentation of an uncommon pathogen

Establishing a definitive diagnosis of Nocardia infection can be challenging due to its rarity, its diverse clinical presentation and the limitations in cultivating this microorganism. Only two cases of laryngeal nocardiosis have previously been reported, both in immunocompromised patients. We describe the case of a 67-year-old seemingly immunocompetent wildlife photographer, with an extensive travel history to Asia and Central America, who presented with an 8 month history of hoarse voice and odynophagia. An initial CT had revealed the presence of a laryngeal “mass” suggestive of malignancy, but several biopsies showed granulomatous inflammation. These were not sent for microbiological investigation. Empirical high dose steroids -started due to concerns of airway compromise- did not significantly improve his symptoms. Further laryngeal biopsies led to the isolation of a fungal mold (Chaetomium spp) of uncertain relevance. Voriconazole was initiated but not tolerated. A repeat biopsy was arranged: Fungal cultures were negative, however histological examination revealed branching gram positive bacteria. Nocardia spp was isolated on mycobacterial culture media and confirmed by PCR. Speciation was inconclusive. Co-trimoxazole was continued for 6 months with good clinical and radiological response. Treatment was discontinued at the patient's request, but within two months he relapsed with worsening dysphagia and odynophagia accompanied by weight loss. He was found to have developed a further post-cricoid collection with associated necrosis. Co-trimoxazole was restarted for 12 months followed by life-long secondary prophylaxis. He remains well with no further recrudescence. This case illustrates the many challenges in the diagnosis and treatment of nocardiosis. Abstract without diagnosis Establishing a definitive diagnosis of infection with this microorganism can be challenging due to its rarity, its diverse clinical presentation and the limitations in cultivating it. Only two cases of laryngeal infection have previously been reported, both in immunocompromised patients. We describe the case of a 67-year-old seemingly immunocompetent wildlife photographer, with an extensive travel history to Asia and Central America, who presented with an 8 month history of hoarse voice and odynophagia. An initial CT had revealed the presence of a laryngeal “mass” suggestive of malignancy, but several biopsies showed granulomatous inflammation. These were not sent for microbiological investigation. Empirical high dose steroids -started due to concerns of airway compromise- did not significantly improve his symptoms. Further laryngeal biopsies led to the isolation of a fungal mold (Chaetomium spp) of uncertain relevance. Voriconazole was initiated but not tolerated. A repeat biopsy was arranged: Fungal cultures were negative, however histological examination revealed a pathogen through Gram stain. This microorganism was further isolated on mycobacterial culture media and confirmed by PCR. Speciation was inconclusive. Tailored treatment was continued for 6 months with good clinical and radiological response. Treatment was discontinued at the patient's request, but within two months he relapsed with worsening dysphagia and odynophagia accompanied by weight loss. He was found to have developed a further post-cricoid collection with associated necrosis. Once he completed 12 months of treatment, life-long secondary prophylaxis ensued. He remains well with no further recrudescence.

Nocardiosis diagnosed on bronchoalveolar lavage: Role of cytopathology.

Nocardia are gram-positive, filamentous bacteria that have the potential to cause serious disease, particularly in immunocompromised patients. Nocardia may cause a complex clinical picture, with radiologic features that can mimic other infectious organisms or malignancy. The organisms are not easily identified on cytologic examination given their weak staining with routine preparations and because they may be obscured by the associated inflammatory exudate. However, recognition of subtle features and a high index of suspicion in the appropriate clinical setting can lead to the appropriate triaging of material for ancillary stains and confirmatory microbiology tests. We herein present three cases of nocardiosis diagnosed on bronchoalveolar lavage in order to discuss the clinical presentation and cytomorphologic features with emphasis on the role of cytopathologists in facilitating timely diagnosis and helping direct appropriate management.

A ten-year retrospective analysis of nocardiosis in a tertiary care center of South-coastal India.

Nocardiosis is an uncommon life-threatening infection caused by Nocardia spp. This study aimed to review the distribution of risk factors, clinical characteristics, microbiological findings, treatment and outcome of patients diagnosed with nocardiosis. This study was a retrospective case record review of all nocardiosis cases that were diagnosed at our tertiary care hospital from January 2008 to December 2019. A total of 48 patients with a mean age of 52.2±16.28 years were included. Out of which forty one (85%) were diagnosed as pulmonary nocardiosis and seven (14.6%) as disseminated disease. Chronic lung disease 25 (52.1%), long term steroid use 22 (45.8%) followed by diabetes mellitus 11 (22.9%) were common predisposing factors. The common symptoms were fever (87.5%), cough (79.2%) and breathlessness (52.1%). The most frequent radiologic finding included consolidation in 38 (79.1%), cavitation with thickened wall in 2 (4.1%), reticulonodular shadows in 2 (4.1%), and unilateral pleural effusion in 5 (10.4%). Nocardia otitidiscaviarum (22.9%) was frequently isolated from cultures. Resistance to trimethoprim-sulfamethoxazole (TMP-SMX) was observed in 21% cases. Mortality was noted in 6 (12.5%) patients and all were with pulmonary involvement. The percentage of death among those with and without pulmonary tuberculosis was 33.3% and 5% respectively. Patients affected by pulmonary nocardiosis with previous history of pulmonary tuberculosis showed significant association with poor outcome (p-value=0.05). In conclusion, nocardiosis mainly affects patients with structural lung disease or immunocompromised hosts with adverse outcome. Awareness of this infection is crucial for a clinician, and any suspicion should lead to make an early diagnosis and choose an appropriate empirical treatment to improve the outcome in this population.

M165 RECURRENT NOCARDIOSIS IN A PATIENT WITH HYPOGAMMAGLOBULINEMIA SECONDARY TO MEMBRANOUS NEPHROPATHY

Nephrotic syndrome is a known cause of secondary hypogammaglobulinemia. The risk of infections occurs when serum IgG levels fall below 600 mg/dL. Patients present with recurrent sinopulmonary disease, typically with encapsulated organisms. I present an interesting case of recurrent nocardiosis in a patient with hypogammaglobulinemia from asymptomatic membranous glomerulopathy (MGN).

Clinical Features, Radiological Findings, and Treatment Outcomes in Patients with Pulmonary Nocardiosis: A Retrospective Analysis.

IntroductionLack of specific clinical features makes the diagnosis of pulmonary nocardiosis difficult. A high index of suspicion is required for diagnosis especially in cohorts with pre-existing risk factors. This study aimed to study the clinical and radiological characteristics and outcomes in patients with pulmonary nocardiosis.MethodsThis was a retrospective observational study. Data of confirmed cases with pulmonary nocardiosis were collected from a digital patient management system.ResultsA total of eight cases of pulmonary nocardiosis were included. The mean age of patients was 50 ± 14.3 years with a female preponderance (62.5%). The most common co-morbidity was chronic lung disease (37.5%). The common clinical feature of pulmonary nocardiosis was cough with expectoration (50%) and the mean duration of symptoms was 18 days. The common radiological (CT thorax) findings were consolidation, bronchiectasis, mediastinal lymphadenopathy, and nodularity (50% each). One patient had an extension of pulmonary disease in the chest wall. Microbiological detection of Nocardia spp. was done in sputum samples (50%) and in bronchoalveolar lavage (BAL) samples (50%). Culture was positive in two BAL samples. Intravenous empirical antibiotics in combination with oral trimethoprim-sulfamethoxazole double standard (15 mg/kg trimethoprim) were started at the time of diagnosis. Ceftriaxone and amikacin were commonly used antimicrobials.ConclusionNocardia spp. commonly causes disease in patients with pre-existing chronic disease. A high index of suspicion is required in patients with subacute to chronic respiratory symptoms, raised inflammatory markers, and the absence of common respiratory pathogens in evaluation.

Case report: pulmonary nocardiosis caused by Nocardia exalbida in an immunocompetent patient

BackgroundNocardiosis is known as an opportunistic infection in immunocompromised hosts, but it occasionally has been reported in immunocompetent patient. The Nocardia exalbida is first-reported in 2006 from Japan, and a few cases of have been reported in only immunocompromised host, and the characteristic is still unclear. We herein describe the first case of pulmonary nocardiosis caused by N. exalbida in an immunocompetent patient.Case presentationA77 -year-old Japanese man was admitted to our hospital on November 2, 2018. He was a lifelong non-smoker with no childhood history of respiratory disease. He had a medical history of dyslipidemia. One month before this admission fevers, sputum, mild cough were developed and he was evaluated in a clinic near our hospital. His diagnosis was community acquired pneumonia within his right middle lobe. He was treated with ceftriaxone 1 g/day intravenously for a week, however his symptoms relapsed a few days later. So, the physician retried ceftriaxone for another 3 days, but his symptoms did not improve. He was referred to our hospital. He was treated with sitafloxacin as an outpatient for a week, however his symptoms got worse. The chest CT showed consolidation and atelectasis in his right middle lobe. Low density area was scattered in consolidation, and right pleural effusion was observed.The patient was diagnosed with pulmonary abscess and he was admitted. Administration of piperacillin/tazobactam improved his condition. We switched antibiotics to amoxicillin/clavulanate, and he was discharged. After 2 weeks, he relapsed and was admitted again. After administration of piperacillin/tazobactam for 3 weeks, we perform bronchoscopy and Nocardia species were cultured from samples of the bronchial wash. The isolates were identified as N. exalbida using 16S rRNA gene sequencing. We prescribed Trimethoprim / Sulfamethoxazole (TMP/SMX) for 4 months. Then we switched to minocycline for renal dysfunction caused from TMP-SMX for 1 more month. After 5 months therapy, Consolidation on CT disappeared, and Nocardiosis was cured.Conclusionwe reported the first case of pulmonary nocardiosis caused by N. exalbida in an immunocompetent patient. N. exalbida infection might be associated with a good response to treatment.

Nocardiosis Cases and Risk Factors for Infection in a Tertiary Care Hospital

Nocardiosis Cases and Risk Factors for Infection in a Tertiary Care Hospital