Nocardiosis Follow-up

  • Author: Ronald A Greenfield, MD; Chief Editor: Burke A Cunha, MD   more...
 
Updated: May 4, 2011
 

Inpatient & Outpatient Medications

  • Antimicrobial therapy for pulmonary or disseminated nocardiosis should be continued for 6-12 months and at least 1 month following resolution of all evidence of infection.
  • Follow-up radiographic studies should be obtained to monitor treatment.
  • Follow-up laboratory studies are required to monitor for adverse effects of prolonged antimicrobial therapy.
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Deterrence/Prevention

Although not clearly established, prophylactic therapy for Pneumocystis jiroveci pneumonia (PCP) with TMP-SMX in patients with AIDS whose CD4 count is less than 200 cells/µL probably decreases the likelihood of nocardiosis. (For an excellent discussion of PCP prophylaxis, see the eMedicine article Prevention of Opportunistic Infections in Patients Infected With HIV.) Similarly, TMP-SMX prophylaxis in solid-organ transplant or hematopoietic stem cell transplant recipients may decrease the likelihood of nocardiosis. However, prophylaxis is not fully effective in either circumstance.

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Patient Education

  • Patients with nocardiosis must be educated about the need for protracted antimicrobial therapy.
  • Patients with nocardiosis should be informed of the potential adverse effects of protracted antimicrobial therapy and which circumstances require reporting to their physician promptly.
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Contributor Information and Disclosures
Author

Ronald A Greenfield, MD  Professor, Department of Internal Medicine, University of Oklahoma College of Medicine

Ronald A Greenfield, MD is a member of the following medical societies: American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Central Society for Clinical Research, Infectious Diseases Society of America, Medical Mycology Society of the Americas, Phi Beta Kappa, Southern Society for Clinical Investigation, and Southwestern Association of Clinical Microbiology

Disclosure: Pfizer Honoraria Speaking and teaching; Gilead Honoraria Speaking and teaching; Ortho McNeil Honoraria Speaking and teaching; Abbott Honoraria Speaking and teaching; Astellas Honoraria Speaking and teaching; Cubist Honoraria Speaking and teaching; Forest Pharmaceuticals Speaking and teaching

Specialty Editor Board

Thomas J Marrie, MD  Dean of Faculty of Medicine, Dalhousie University Faculty of Medicine, Canada

Thomas J Marrie, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society for Microbiology, Canadian Infectious Disease Society, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

John W King, MD  Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University Health Sciences Center; Consultant in Infectious Diseases, Overton Brooks Veterans Affairs Medical Center

John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi

Disclosure: emedicine $50.00 Author of chapter; MERCK None Other

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

References

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  2. Beaman BL, Beaman L. Nocardia species: host-parasite relationships. Clin Microbiol Rev. Apr 1994;7(2):213-64. [Medline].

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  13. Pintado V, Gomez-Mampaso E, Cobo J, et al. Nocardial infection in patients infected with the human immunodeficiency virus. Clin Microbiol Infect. Jul 2003;9(7):716-20. [Medline].

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  15. Pilsczek FH, Augenbraun M. Mycetoma fungal infection: multiple organisms as colonizers or pathogens?. Rev Soc Bras Med Trop. Jul-Aug 2007;40(4):463-5. [Medline].

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  17. Peleg AY, Husain S, Qureshi ZA, et al. Risk factors, clinical characteristics, and outcome of Nocardia infection in organ transplant recipients: a matched case-control study. Clin Infect Dis. May 15 2007;44(10):1307-14. [Medline].

  18. Uhde KB, Pathak S, McCullum I Jr, Jannat-Khah DP, Shadomy SV, Dykewicz CA, et al. Antimicrobial-resistant nocardia isolates, United States, 1995-2004. Clin Infect Dis. Dec 15 2010;51(12):1445-8. [Medline].

  19. Jodlowski TZ, Melnychuk I, Conry J. Linezolid for the treatment of Nocardia spp. infections. Ann Pharmacother. Oct 2007;41(10):1694-9. [Medline].

  20. Sridhar MS, Gopinathan U, Garg P, et al. Ocular nocardia infections with special emphasis on the cornea. Surv Ophthalmol. Mar-Apr 2001;45(5):361-78. [Medline].

 
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High-power microscopic appearance of Nocardia. Image courtesy of CDC.
Photomicrograph of tissue biopsy stained with Gomori methenamine silver demonstrating acute inflammatory response and organisms compatible with Nocardia.
Plain chest radiograph in a patient with nocardiosis. Image courtesy of Applied Radiology, Anderson Publishing, LTD.
Chest CT scan in a patient with pleuropulmonary nocardiosis. Image courtesy of Applied Radiology, Anderson Publishing, LTD.
Brain CT scan in a patient with nocardial brain abscess. Image courtesy of Applied Radiology, Anderson Publishing, LTD.
Table. In Vitro Susceptibility Data[1]
N asteroides N farcinica N nova N brasiliensis N transvalensis N otitidiscaviarum
Sulfamethoxazole96-9989-10089-9799-10090Variable
TMP-SMX100------10088Variable
Amoxicillin-clavulanate53-6747-713-665-9730Resistant
Ceftriaxone94-1000-7310088-10050---
Imipenem77-9864-8710020-3090Resistant
Amikacin10010010010082Susceptible
Minocycline78-9420-9689-10075-9054Susceptible
Linezolid100100100100100100
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