eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Nocardiosis: Follow-up

Author: Nicholas John Bennett, MB, BCh, PhD, Fellow in Pediatric Infectious Disease, Department of Pediatrics, State University of New York Upstate Medical University
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; 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
Contributor Information and Disclosures

Updated: Aug 28, 2009

Follow-up

Further Inpatient Care

  • Fulminant or disseminated nocardiosis requires multidisciplinary intensive-care management.
  • Provide ongoing assessment for surgical debridement of nocardial abscesses.
  • Initiate intravenous antibiotic therapy immediately, during inpatient admission.

Further Outpatient Care

  • Once patient is stable, continue prolonged antibiotic therapy on an outpatient basis.
  • An infectious diseases specialist should continue to monitor the patient to determine treatment progress and duration.

Transfer

  • In cases of fulminant disseminated nocardiosis, transfer patient to a facility with pediatric intensive care and subspecialty care.

Deterrence/Prevention

  • No specific recommendations for prophylaxis against Nocardia as an opportunistic pathogen in patients with immunocompromising conditions are known.
  • Bactrim prophylaxis is recommended for patients with AIDS, chronic granulomatous disease, and various malignancies but is usually used in the context of preventing Pneumocystis pneumonia.
  • The use of prophylaxis should not preclude testing, if the situation warrants, attenuate the symptoms and signs of infection. Case reports of drug-resistant Nocardia presenting in Bactrim-prophylaxed immunosuppressed patients have been presented.

Prognosis

  • Morbidity and mortality are high from fulminant nocardiosis. A high index of suspicion, followed by a rapid diagnosis and treatment, is warranted.
  • Intensive medical management (surgery, if necessary) and prolonged treatment leads to a cure.

Miscellaneous

Medicolegal Pitfalls

  • Failure to rapidly diagnose and treat fulminant pulmonary or systemic nocardiosis, which is curable but has a high mortality rate, is a pitfall.
  • Nocardia should be suspected in immunosuppressed patients who present with pulmonary symptoms (primary site of infection) or CNS findings (primary site of systemic spread), especially in the context of compatible radiographic imaging findings.
 


More on Nocardiosis

Overview: Nocardiosis
Differential Diagnoses & Workup: Nocardiosis
Treatment & Medication: Nocardiosis
Follow-up: Nocardiosis
Multimedia: Nocardiosis
References
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References

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  2. Marchandin H, Eden A, Jean-Pierre H, et al. Molecular diagnosis of culture-negative cerebral nocardiosis due to Nocardia abscessus. Diagn Microbiol Infect Dis. Jul 2006;55(3):237-40. [Medline].

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Further Reading

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Keywords

nocardiosis, Nocardia, Nocardiaceae, Nocardia asteroides, Nocardia brasiliensis, Nocardia pseudobrasiliensis, Nocardia otitidis-caviarum, Nocardia caviae, Nocardia farcinica, Nocardia nova, Nocardia transvalensis, Nocardia carnea, Nocardia elegans, Nocardia paucivorans, Nocardia puris, Nocardia takedensis, chronic mycetoma, Nocardia abscessus, Nocardia africana, pneumonia, Nocardia ignorata, Nocardia cyriacigeorgica, cutaneous abscess, lymphocutaneous abscess, chronic granulomatous disease, human immunodeficiency virus, HIV, pulmonary alveolar proteinosis, tuberculosis, interleukin 12 deficiency, systemic lupus erythematosus, sepsis, subcutaneous abscesses, cervical adenitis, mycetoma, septic arthritis, anorexia, lymphoreticular neoplasms, respiratory distress, respiratory failure, bronchopneumonia, lobar pneumonia, necrotizing pneumonia, cerebral abscess, peritonitis, hematogenous endophthalmitis, sinusitis, aortitis, endocarditis, mediastinitis, treatment, diagnosis

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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.

Medical Editor

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.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

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.

CME Editor

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

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: None None None

 
 
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