Nocardiosis history and symptoms

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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## History and Symptoms

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Overall, 80% of nocardiosis cases present as invasive pulmonary infection, disseminated infection, or brain abscess; 20% present as cellulitis. Pulmonary infection commonly presents with fever, cough, or chest pain. Central nervous system (CNS) symptoms include headache, lethargy, confusion, seizures, or sudden onset of neurologic deficit.

### Pulmonary Infection

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* night sweats, fever, cough, chest pain
* Pulmonary nocardiosis is subacute in onset and refractory to standard antibiotherapy
* symptoms are more severe in immunocompromised individuals
* radiologic studies show multiple pulmonary infiltrates with tendency to central necrosis

### Neurological Infection

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* Headache, lethargy, confusion, seizures, sudden onset of neurological deficit
* CT scan shows cerebral abscess
* Nocardial meningitis is very rare and difficult to diagnose

### Lymphocutaneous Disease

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* Nocardial cellulitis is akin of erysipela but is more subacute
* Nodular lymphangeitis mimics sporotrichosis with multiple nodules alongside a lymphatic pathway
* Mycetoma is a rare complication and osteitis may ensue .

### Ocular Disease

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* Very rarely nocardiae cause keratitis
* Gennerally there is a history of ocular trauma

### Disseminated Nocardiosis

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* Disseminated infection can occur in very immunocompromised patients
* It generally involves both lungs and brain
* Fever, moderate or very high can be seen
* Multiple cavitating pulmonary infiltrates develop
* Cerebral abscesses arise later
* Cutaneous lesions are very rarely seen
* If untreated, the prognosis is grim for this form of disease

## References

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