Dermatologic Manifestations of Nocardiosis Follow-up

  • Author: Brent A Shook, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 11, 2012
 

Further Outpatient Care

  • Close outpatient follow-up care is vital to the success of therapy for cutaneous nocardiosis. Because of the long duration of therapy, relapse is possible. Although the optimal duration of therapy is uncertain, suggestions range from 6 weeks (in minor infections) to 1 year (severe systemic disease).
  • Frequent outpatient visits for the first 6 weeks are recommended, followed by less frequent visits if the patient does well clinically.
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Inpatient & Outpatient Medications

  • Antibiotic therapy and appropriate surgical drainage are treatments of choice (see Medication).
  • If parenteral therapy is necessary, it need not be continued beyond a period of 3-6 weeks, even in patients with life-threatening systemic disease. With improving clinical status, most patients can be switched safely to oral medications, especially trimethoprim and sulfamethoxazole (TMP-SMZ).
  • Outpatient antibiotics are much more easily administered in oral form, and oral antibiotics have been shown to be just as effective as intravenous forms in patients with cutaneous disease.
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Complications

  • Recurrence of disease is the most frequent complication. A full course of appropriate antibiotics is essential for preventing recurrence.
  • At least 3 cases of dissemination of primary cutaneous nocardiosis have been reported. Despite the rarity of this occurrence, dissemination is associated with a much higher mortality rate.
  • If a patient remains ill or febrile despite seemingly adequate therapy, treatment failure may be a result of a sequestered abscess that requires drainage. Often, localization and drainage subsequently result in efficacious results.
  • Mycetoma, although rare in developed countries, is much more invasive and destructive than other forms of cutaneous nocardiosis. Because fascia, bone, and muscle are frequently involved in severe untreated mycetoma, wide debridement and amputation are known complications.
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Prognosis

  • With proper antibiotic selection and course of treatment, the prognosis for patients with primary cutaneous nocardiosis is excellent.
  • In disseminated disease in immunocompromised patients, the cure or improvement rate can be as high as 90% with appropriate antibiotic therapy.
  • In a review of 137 cases of nocardiosis treated with TMP-SMZ, the cure or improvement rate was as high as 97% for soft tissue infections and as low as 50% with serious CNS infections. Immune suppression significantly affected the cure rate.
  • In an immunocompetent host, primary cutaneous nocardiosis is rarely fatal; full recovery can be expected with appropriate therapy.
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Patient Education

  • Patient education regarding proper wound care is important.
  • Patients must be educated about the importance of an extended course of antibiotics, which may be difficult to maintain if the apparent infection has resolved and the patient no longer feels ill.
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Contributor Information and Disclosures
Author

Brent A Shook, MD  Director, The Woodlands Skin Surgery Center, The Woodlands, Texas

Brent A Shook, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society for MOHS Surgery, Christian Medical & Dental Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD  Josey Professor and Chair, Department of Dermatology, Professor of Pathology, University of Texas Medical School at Houston and MD Anderson Cancer Center

Ronald P Rapini, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Society for Investigative Dermatology, and Texas Medical Association

Disclosure: Elsevier publishers Royalty Independent contractor

Specialty Editor Board

Daniel Mark Siegel, MD, MS  Director, Procedural Dermatology Fellowship Program, Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Micrographic Surgery and Cutaneous Oncology, American College of Physician Executives, American Society for Dermatologic Surgery, American Society for MOHS Surgery, and International Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Richard P Vinson, MD  Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

  1. Minero MV, Marin M, Cercenado E, Rabadan PM, Bouza E, Munoz P. Nocardiosis at the turn of the century. Medicine (Baltimore). Jul 2009;88(4):250-61. [Medline].

  2. Vijay Kumar GS, Mahale RP, Rajeshwari KG, Rajani R, Shankaregowda R. Primary facial cutaneous nocardiosis in a HIV patient and review of cutaneous nocardiosis in India. Indian J Sex Transm Dis. Jan 2011;32(1):40-3. [Medline]. [Full Text].

  3. Outhred AC, Watts MR, Chen SC, Sorrell TC. Nocardia infections of the face and neck. Curr Infect Dis Rep. Apr 2011;13(2):132-40. [Medline].

  4. Antonovich DD, Berke A, Grant-Kels JM, Fung M. Infectious eccrine hidradenitis caused by Nocardia. J Am Acad Dermatol. Feb 2004;50(2):315-8. [Medline].

  5. Beaman BL, Burnside J, Edwards B, Causey W. Nocardial infections in the United States, 1972-1974. J Infect Dis. Sep 1976;134(3):286-9. [Medline].

  6. Berd D. Nocardia brasiliensis infection in the United States: a report of nine cases and a review of the literature. Am J Clin Pathol. Aug 1973;60(2):254-8. [Medline].

  7. Law BJ, Marks MI. Pediatric nocardiosis. Pediatrics. Oct 1982;70(4):560-5. [Medline].

  8. Gyotoku T, Kayashima K, Nishimoto K, Ono T. Cutaneous nocardiosis developing around gravel inserted during a traffic injury. J Dermatol. Dec 2002;29(12):803-9. [Medline].

  9. Singh SM, Rau NV, Cohen LB, Harris H. Cutaneous nocardiosis complicating management of Crohn's disease with infliximab and prednisone. CMAJ. Oct 26 2004;171(9):1063-4. [Medline].

  10. Bernoux D, Mialou V, Rodríguez-Nava V, et al. [Disseminated nocardiosis in a child with acute lymphoblastic leukemia]. Arch Pediatr. Mar 2008;15(3):275-8. [Medline].

  11. Satterwhite TK, Wallace RJ Jr. Primary cutaneous nocardiosis. JAMA. Jul 27 1979;242(4):333-6. [Medline].

  12. Kostman JR, DiNubile MJ. Nodular lymphangitis: a distinctive but often unrecognized syndrome. Ann Intern Med. Jun 1 1993;118(11):883-8. [Medline].

  13. Garg P, Sharma S, Vemuganti GK, Ramamurthy B. A cluster of Nocardia keratitis after LASIK. J Refract Surg. Mar 2007;23(3):309-12. [Medline].

  14. Clark NM, Braun DK, Pasternak A, Chenoweth CE. Primary cutaneous Nocardia otitidiscaviarum infection: case report and review. Clin Infect Dis. May 1995;20(5):1266-70. [Medline].

  15. Gray TJ, Serisier DJ, Gilpin CM, Coulter C, Bowler SJ, McCormack JG. Nocardia paucivorans--a cause of disseminated nocardiosis. J Infect. Feb 2007;54(2):e95-8. [Medline].

  16. Smego RA Jr, Castiglia M, Asperilla MO. Lymphocutaneous syndrome. A review of non-sporothrix causes. Medicine (Baltimore). Jan 1999;78(1):38-63. [Medline].

  17. Lewis KE, Ebden P, Wooster SL, Rees J, Harrison GA. Multi-system Infection with Nocardia farcinica-therapy with linezolid and minocycline. J Infect. Apr 2003;46(3):199-202. [Medline].

  18. Brown-Elliott BA, Ward SC, Crist CJ, Mann LB, Wilson RW, Wallace RJ Jr. In vitro activities of linezolid against multiple Nocardia species. Antimicrob Agents Chemother. Apr 2001;45(4):1295-7. [Medline].

  19. Fukuda H, Saotome A, Usami N, Urushibata O, Mukai H. Lymphocutaneous type of nocardiosis caused by Nocardia brasiliensis: a case report and review of primary cutaneous nocardiosis caused by N. brasiliensis reported in Japan. J Dermatol. Jun 2008;35(6):346-53. [Medline].

  20. Curry WA. Human nocardiosis. A clinical review with selected case reports. Arch Intern Med. Jun 1980;140(6):818-26. [Medline].

  21. Hay RJ. Nocardial infection of the skin. J Hyg (Lond). Dec 1983;91(3):385-91. [Medline].

  22. Kalb RE, Kaplan MH, Grossman ME. Cutaneous nocardiosis. Case reports and review. J Am Acad Dermatol. Jul 1985;13(1):125-33. [Medline].

  23. Lerner PI. Nocardiosis. Clin Infect Dis. Jun 1996;22(6):891-903; quiz 904-5. [Medline].

  24. Mahgoub ES. Agents of mycetoma. In: Mandell et al, eds. Principles and Practice of Infectious Diseases. 4th ed. New York, NY: Churchill Livingstone; 1995:2327.

  25. Maraki S, Chochlidakis S, Nioti E, Tselentis Y. Primary lymphocutaneous nocardiosis in an immunocompetent patient. Ann Clin Microbiol Antimicrob. Nov 15 2004;3:24. [Medline].

  26. McNeil MM, Brown JM. The medically important aerobic actinomycetes: epidemiology and microbiology. Clin Microbiol Rev. Jul 1994;7(3):357-417. [Medline].

  27. Moeller CA, Burton CS 3rd. Primary lymphocutaneous Nocardia brasiliensis infection. Arch Dermatol. Oct 1986;122(10):1180-2. [Medline].

  28. Naka W, Miyakawa S, Niizeki H, Fukuda T, Mikami Y, Nishikawa T. Unusually located lymphocutaneous nocardiosis caused by Nocardia brasiliensis. Br J Dermatol. Apr 1995;132(4):609-13. [Medline].

  29. Nishimoto K, Ohno M. Subcutaneous abscesses caused by Nocardia brasiliensis complicated by malignant lymphoma. A survey of cutaneous nocardiosis reported in Japan. Int J Dermatol. Sep 1985;24(7):437-40. [Medline].

  30. Palmer DL, Harvey RL, Wheeler JK. Diagnostic and therapeutic considerations in Nocardia asteroides infection. Medicine (Baltimore). Sep 1974;53(5):391-401. [Medline].

  31. Robboy SJ, Vickery AL Jr. Tinctorial and morphologic properties distinguishing actinomycosis and nocardiosis. N Engl J Med. Mar 12 1970;282(11):593-6. [Medline].

  32. Schiff TA, McNeil MM, Brown JM. Cutaneous Nocardia farcinica infection in a nonimmunocompromised patient: case report and review. Clin Infect Dis. Jun 1993;16(6):756-60. [Medline].

  33. Tsuboi R, Takamori K, Ogawa H, Mikami Y, Arai T. Lymphocutaneous nocardiosis caused by Nocardia asteroides. Case report and literature review. Arch Dermatol. Oct 1986;122(10):1183-5. [Medline].

  34. Wallace RJ Jr, Tsukamura M, Brown BA, et al. Cefotaxime-resistant Nocardia asteroides strains are isolates of the controversial species Nocardia farcinica. J Clin Microbiol. Dec 1990;28(12):2726-32. [Medline].

  35. Ye Z, Shimomura H, Kudo S, Arao T, Sato Y, Ono T. A case of lymphocutaneous nocardiosis with a review of lymphocutaneous nocardiosis reported in Japan. J Dermatol. Feb 1996;23(2):120-4. [Medline].

  36. Zecler E, Gilboa Y, Elkina L, Atlan G, Sompolinsky D. Lymphocutaneous nocardiosis due to nocardia brasiliensis. Arch Dermatol. May 1977;113(5):642-3. [Medline].

 
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Red nodules on a patient with disseminated nocardiosis.
Ulcer on the arm of a patient with primary cutaneous nocardiosis.
Gomori methenamine silver stain demonstrating black filamentous Nocardia species.
 
 
 
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