Pediatric Nocardiosis Workup

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

Laboratory Studies

  • Gram staining is indicated in nocardiosis.
    • Directly examine clinical materials (eg, sputum, bronchoalveolar lavage, cerebral spinal fluid, pus) by Gram stains and acid-fast stains (modified Ziehl-Neelsen stains). Delicately branched, weakly gram-positive, variably acid-fast bacilli with tendency to fragment are indicative of Nocardia.
    • Use methenamine-silver stains for demonstrating the organisms in tissue specimens.
    • Inoculate clinical material, including blood specimens, on brain-heart infusion media or Sabouraud agar without antibiotics. N asteroides and N braziliensis are obligate aerobes, thermophilic, and slow growing. Colonies take 1-2 weeks to develop and are usually waxy then chalky in appearance.
  • Serological diagnosis is not readily available.
  • Cultures typically grow within 3-5 days on blood or chocolate agar, but cultures from normally sterile sites should be maintained for 3 weeks in a liquid medium.
Next

Imaging Studies

  • Generalized infections
    • Chest radiographic findings vary and include fluffy infiltrates, scattered nodules, and confluent lobar infiltrates progressing to complete consolidation and cavitation.
    • Chest CT scanning may be necessary to visualize the extent of disease and to rule out empyema.
    • CT scanning with contrast or MRI may be necessary to visualize cerebral abscesses.
  • Disseminated nocardiosis
    • Perform CT scanning with contrast or MRI to rule out cerebral abscesses. Because of the high incidence of spread to the brain, all patients with pulmonary nocardiosis should have a neuroimaging study, even in the absence of CNS symptoms. Lesions should show ring-enhancement with contrast and fluid-attenuated inversion recovery (FLAIR). Early lesions, or those present during treatment with steroids, may not enhance and may mimic infarction.
    • Use 2-dimensional echocardiography to rule out vegetations.
    • Perform abdominal and/or pelvic sonography and CT scanning to rule out intra-abdominal, hepatic, splenic, or renal abscesses.
Previous
Next

Procedures

  • A bronchoalveolar lavage is recommended in immunocompromised individuals in whom nocardiosis is suspected because mortality can exceed 50% without rapid diagnosis and treatment.
Previous
Proceed to Treatment & Management
 
 
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

  1. Watanabe K, Shinagawa M, Amishima M, et al. First clinical isolates of Nocardia carnea, Nocardia elegans, Nocardia paucivorans, Nocardia puris and Nocardia takedensis in Japan. Nippon Ishinkin Gakkai Zasshi. 2006;47(2):85-9. [Medline]. [Full Text].

  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].

  3. Hamid ME, Maldonado L, Sharaf Eldin GS, et al. Nocardia africana sp. nov., a new pathogen isolated from patients with pulmonary infections. J Clin Microbiol. Feb 2001;39(2):625-30. [Medline].

  4. Rodriguez-Nava V, Couble A, Khan ZU, et al. Nocardia ignorata, a new agent of human nocardiosis isolated from respiratory specimens in Europe and soil samples from Kuwait. J Clin Microbiol. Dec 2005;43(12):6167-70. [Medline]. [Full Text].

  5. Conville PS, Witebsky FG. Organisms designated as Nocardia asteroides drug pattern type VI are members of the species Nocardia cyriacigeorgica. J Clin Microbiol. Jul 2007;45(7):2257-9. [Medline]. [Full Text].

  6. Sohng JK, Yamaguchi T, Seong CN, Baik KS, Park SC, Lee HJ, et al. Production, isolation and biological activity of nargenicin from Nocardia sp. CS682. Arch Pharm Res. Oct 2008;31(10):1339-45. [Medline].

  7. Kagliwal LD, Survase SA, Singhal RS. A novel medium for the production of cephamycin C by Nocardia lactamdurans using solid-state fermentation. Bioresour Technol. May 2009;100(9):2600-6. [Medline].

  8. [Guideline] Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis. Nov 15 2005;41(10):1373-406. [Medline].

  9. Brown-Elliott BA, Ward SC, Crist CJ, et al. In vitro activities of linezolid against multiple Nocardia species. Antimicrob Agents Chemother. Apr 2001;45(4):1295-7. [Medline]. [Full Text].

  10. American Academy of Pediatrics. Nocardiosis. In: Red Book: Report of the Committee on Infectious Diseases. 27th ed. 2007:470-1.

  11. Barone MA. Formulary. In: The Harriet Lane Handbook. 14th ed. 1996:474-667.

  12. Blackwell Synergy. Nocardia infections. American Journal of Transplantation. 2004;Vol 4 Issue S10:47. [Full Text].

  13. Brown-Elliott et al. Clinical and Laboratory Features of the Nocardia spp. Based on Current Molecular Taxonomy. Clin Microbiol Rev. April 2006;19(2):259-282. [Medline]. [Full Text].

  14. Bruckner DA, Colonna P, Bearson BL. Nomenclature for aerobic and facultative bacteria. Clin Infect Dis. Oct 1999;29(4):713-23. [Medline].

  15. Dinulos JG, Darmstadt GL, Wilson CB, et al. Nocardia asteroides septic arthritis in a healthy child. Pediatr Infect Dis J. Mar 1999;18(3):308-10. [Medline].

  16. Dorman SE, Guide SV, Conville PS, et al. Nocardia infection in chronic granulomatous disease. Clin Infect Dis. 2002;35 (4):390-4. [Medline].

  17. Fabre S, Gilbert C, Lechiche C, et al. Primary cutaneous Nocardia otitiscaviarum infection in a patient with rheumatoid arthritis treated with infliximab. J Rheumatol. 2005;32 (12):2432-3. [Medline].

  18. Feigin RD, Cherry JD. Actinomycosis and nocardiosis. In: Textbook of Pediatric Infectious Diseases. Vol 1. 1992:1042-44.

  19. Hitti W, Wolff M. Two cases of multidrug-resistant Nocardia farcinica infection in immunosuppressed patients and implications for empiric therapy. Eur J Clin Microbiol Infect Dis. Feb 2005;24(2):142-4. [Medline].

  20. Kontoyiannis DP, Ruoff K, Hooper DC. Nocardia bacteremia. Report of 4 cases and review of the literature. Medicine (Baltimore). Jul 1998;77(4):255-67. [Medline].

  21. Leitersdorf I, Silver J, Naparstek E, Raveh D. Tetracycline derivatives, alternative treatment for nocardiosis in transplanted patients. Clin Nephrol. Jul 1997;48(1):48-51. [Medline].

  22. Mok CC, Yuen KY, Lau CS. Nocardiosis in systemic lupus erythematosus. Semin Arthritis Rheum. Feb 1997;26(4):675-83. [Medline].

  23. Paredes BE, Hunger RE, Braathen LR, Brand CU. Cutaneous nocardiosis caused by Nocardia brasiliensis after an insect bite. Dermatology. 1999;198(2):159-61. [Medline].

  24. Schlaberg R, Huard RC, Della-Latta P. Nocardia cyriacigeorgica is an emerging pathogen in the United States. J Clin Microbiol. Nov 14 2007;Epub ahead of print:[Medline].

  25. Singh NP, Goyal R, Manchanda V, Gupta P. Disseminated nocardiosis in an immunocompetent child. Ann Trop Paediatr. Mar 2003;23(1):75-8. [Medline].

  26. van Burik JA, Hackman RC, Nadeem SQ, et al. Nocardiosis after bone marrow transplantation: a retrospective study. Clin Infect Dis. Jun 1997;24(6):1154-60. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.