Pediatric Nocardiosis Clinical Presentation

  • Author: Nicholas John Bennett, MB, BCh, PhD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Feb 11, 2011
 

History

  • Generalized nocardiosis
    • In patients with cutaneous disease, elicit history of trauma at the site of mycetoma (eg, scrape from thorn), firm subcutaneous abscesses (eg, cat scratch, insect bite, open cut), and/or cervical adenitis (eg, dental injury). Signs of infection tracking along lymph node chains or a draining sinus may be present.
    • Slowly progressive joint swelling and pain, with or without fever, may occur, resulting in Nocardia septic arthritis if the trauma was deep (eg, puncture from rooster's claw).
    • The pulmonary course begins with nonspecific complaints, including fever (night sweats), malaise, chest or abdominal pain (may be sudden onset), persistent cough (rarely hemoptysis), and anorexia.
  • Disseminated nocardiosis
    • If dissemination occurs from a pulmonary infection, a constellation of acute and chronic symptoms develops, ranging from headache to obtundation (CNS), pyuria (kidneys), and right upper abdominal pain (liver). CNS infection may have no signs or symptoms or may present with focal neurological deficits, seizures, and coma.
    • Children at risk for nocardiosis as an opportunistic infection include patients with the following:
      • Lymphoreticular neoplasms
      • Chronic pulmonary disorders (most notably alveolar proteinosis)
      • Prolonged corticosteroid usage
      • Systemic lupus erythematosus
      • Severe asthma
      • Chronic granulomatous disease
      • Children with acquired immune deficiency syndrome (AIDS)
    • Patients undergoing transplant for the following are at risk:
      • Renal
      • Cardiac
      • Liver
      • Bone marrow
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Physical

  • Subcutaneous abscesses are palpable at the site of trauma and generally feel firmer than fluctuant. Contiguous lymph nodes may indicate infection tracking along lymphatics.
  • A lung examination may reveal diffuse or localized abnormal breath sounds.
  • Mild-to-severe respiratory distress that progresses to respiratory failure may occur.
  • Disseminated miliary appearance can occur with diffuse organ abscesses that mimic miliary tuberculosis.
  • Clinical manifestations may include the following:
    • Bronchopneumonia
    • Lobar pneumonia
    • Necrotizing pneumonia
    • Persistent meningitis
    • Cerebral abscesses
    • Peritonitis
    • Intra-abdominal abscesses
    • Hematogenous endophthalmitis
    • Sinusitis
    • Endocarditis
    • Aortitis
    • Mediastinitis
    • Pyelonephritic abscesses
    • Septic arthritis
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Causes

  • Nocardia are usually found in soil and dust, and infection results from inoculation of a wound or inhalation. Person-to-person transmission has not been reported, and Nocardia are not commensal in humans or animals.
  • Nosocomial cases have been reported. In some cases, N asteroides were detected in the dust and air of the hospital unit.
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Contributor Information and Disclosures
Author

Nicholas John Bennett, MB, BCh, PhD  Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University

Nicholas John Bennett, MB, BCh, PhD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Rosemary Johann-Liang, MD  Medical Officer, Infectious Diseases and Pediatrics, Division of Special Pathogens and Immunological Drug Products, Center for Drug Evaluation and Research, Food and Drug Administration

Rosemary Johann-Liang, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Gary J Noel, MD  Department of Pediatrics, Clinical Associate Professor, Weill Medical College of Cornell University

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

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