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Dermatologic Manifestations of Nocardiosis Treatment & Management

  • Author: Brent A Shook, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Jul 23, 2014
 

Medical Care

For primary cutaneous nocardiosis, antibiotic therapy is usually recommended, although spontaneous resolution occurs in some cases without treatment. Recommendations regarding the duration of therapy range from 2-3 months for most cutaneous infections to 1 year for chronic cutaneous and systemic infections. Trimethoprim-sulfamethoxazole (TMP-SMZ) is used most frequently for nocardiosis.

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Surgical Care

Surgical debridement or excision often is vital in the treatment of nocardiosis. Surgery is most helpful in abscesses and mycetomas, but it can also help resolve lymphocutaneous infection. In a review of nocardial lymphocutaneous syndrome published in 1999,[16] of 50 patients, 11 required surgery as a primary or secondary treatment.

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Consultations

See the list below:

  • Consult a dermatologist regarding the diagnostic workup and optimization of therapy.
  • Consult an infectious disease specialist regarding the diagnostic workup and optimization of therapy.
  • Consultation with a general surgeon or orthopedic surgeon may be required if extensive surgical debridement is necessary.
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Activity

Activity depends on the severity of illness and the location of the infection.

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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 Surgery, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society for MOHS Surgery, American Medical Association, Christian Medical and Dental Associations, Texas Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Ronald P Rapini, MD Professor and Chair, Department of Dermatology, The University of Texas MD Anderson Cancer Center; Distinguished Chernosky Professor and Chair of Dermatology, Professor of Pathology, University of Texas McGovern Medical School at Houston

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

Disclosure: Received royalty from Elsevier publishers for independent contractor; May receive consulting fee from FDA panel for consulting in future, since I am on one of their committees, but at this time so far have received zero from FDA.

Specialty Editor Board

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, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

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, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

Daniel Mark Siegel, MD, MS Clinical Professor of Dermatology, Department of Dermatology, State University of New York Downstate Medical Center

Daniel Mark Siegel, MD, MS is a member of the following medical societies: American Academy of Dermatology, American College of Mohs Surgery, American Association for Physician Leadership, American Society for Dermatologic Surgery, American Society for MOHS Surgery, International Society for Dermatologic Surgery

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). 2009 Jul. 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. 2011 Jan. 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. 2011 Apr. 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. 2004 Feb. 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. 1976 Sep. 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. 1973 Aug. 60(2):254-8. [Medline].

  7. Law BJ, Marks MI. Pediatric nocardiosis. Pediatrics. 1982 Oct. 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. 2002 Dec. 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. 2004 Oct 26. 171(9):1063-4. [Medline]. [Full Text].

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

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

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

  13. Garg P, Sharma S, Vemuganti GK, Ramamurthy B. A cluster of Nocardia keratitis after LASIK. J Refract Surg. 2007 Mar. 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. 1995 May. 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. 2007 Feb. 54(2):e95-8. [Medline].

  16. Smego RA Jr, Castiglia M, Asperilla MO. Lymphocutaneous syndrome. A review of non-sporothrix causes. Medicine (Baltimore). 1999 Jan. 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. 2003 Apr. 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. 2001 Apr. 45(4):1295-7. [Medline]. [Full Text].

  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. 2008 Jun. 35(6):346-53. [Medline].

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

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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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